W Zuurmond | PubMed Health

PubMed1995

Safety of unilateral and bilateral percutaneous cervical cordotomy in 80 terminally ill cancer patients.

PURPOSE AND METHODS: The safety of percutaneous cervical cordotomy (PCC) and bilateral percutaneous cervical cordotomy (BPCC) was studied in 62 and 18 patients, respectively, with intractable malignant pain. Cordotomy was indicated for pain that did not respond to any other therapy. RESULTS: After PCC, 54 patients showed satisfactory, six partial, and two no pain relief. Concerning major permanent complications, urinary retention, hemiparesis, and mirror-image pain occurred in four (6.5%), five (8.1%), and four (6.5%) patients, respectively. After BPCC, nine patients showed satisfactory, six partial, and three no pain relief. The major permanent complications were the same as after PCC, and occurred in two (11.1%), two (11.1%), and one (5.6%) patient, respectively. Sleep-induced apnea was not observed in any patient. CONCLUSION: In the treatment of intractable malignant pain, localized unilaterally, if other symptomatic management fails, PCC is a recommendable procedure, particularly when pain due to movement dominates. However, due to the high incidence of complications combined with the high failure rate, BPCC is not recommended.

Adult↗

PubMed1989

[A sufentanil dosage study in general surgery].

Sufentanil is widely used for cardiac surgery in initial doses up to 15 micrograms/kg. It was expected that for general surgery much smaller doses would be appropriate. The aim of the study, therefore, was to find a dosage scheme for sufentanil that could be used in general surgery for operations lasting 1 h. METHODS. In 62 patients (Table 1), anesthesia was induced with 15 micrograms sufentanil and 0.2 mg/kg etomidate. According to a random group allocation, a bolus injection of sufentanil was administered 1 min before incision, so that the patients received 0.5, 1.0 or 1.5 micrograms/kg along with the initial dose. During maintenance anesthesia, repeat doses of 10 micrograms sufentanil were injected as required (rise in blood pressure and/or heart rate by more than 20%, or other stress signs i.e., sweating, movement). Intubation was facilitated by means of atracurium 0.5 mg/kg. Increments of 5-10 mg were given when needed. RESULTS. In the group of patients who had received 1.0 micrograms/kg, both the number requiring repeat doses, and the total number of repeat doses were significantly lower than in the 0.5 microgram/kg group. A further increase to 1.5 micrograms/kg did not prove to have any advantage and it led to a drop in blood pressure, that was more pronounced and of longer duration than in the other groups. CONCLUSION. A dose of 1.0 micrograms/kg, therefore, appeared to be the optimum initial dose in general surgery for operations lasting at least 1 h.

Abdomen↗