Search PubMed⌕ Search

Biomedical subjects

E Kalso

Publications and source records attributed to E Kalso.

83 records · Page 5Linked to original sources
PubMed1988

Efficacy of 0.3 mg morphine intrathecally in preventing tourniquet pain during spinal anaesthesia with hyperbaric bupivacaine.

Tourniquet-induced pain is probably mediated by C-fibres. The ability of morphine to interrupt this nociceptive conduction was studied in a double-blind fashion by administering either morphine 0.3 mg or saline intrathecally along with hyperbaric bupivacaine 15 mg for spinal anaesthesia in 40 patients undergoing orthopaedic surgery on the lower extremity. The block characteristics were similar in both groups. During surgery, no patient in the morphine group complained of pain, whereas in the saline group one patient complained of pain caused by the tourniquet and two other patients experienced surgical pain. A 60-min experimental thigh tourniquet pressure provocation (53 kPa for 20 min; 0 kPa for 20 min; 53 kPa for 20 min) on the contralateral unoperated extremity was then performed following surgery, when the spread cephalad of the sensory block had decreased below the T10 dermatomal level. Eight patients in the morphine group experienced no pain in this test, compared with two patients in the saline group (P less than 0.05). The remaining 12 patients in the morphine group had pain responses similar to those patients not given morphine. Intrathecal morphine provides a level of prophylaxis against tourniquet pain. However, the dosage employed here was associated with urinary and emetic side-effects.

Adult↗
PubMed1984

Bupivacaine and intravenous regional anaesthesia--a matter of controversy.

The role of bupivacaine in IVRA is controversial. It produces a reliable sensory and motor block and when used in larger doses prolonged residual analgesia is also achieved. Large series of its use without toxic complications have been presented. Yet, there are sporadic reports of severe, even fatal complications, usually as the result of a technical failure. In this article bupivacaine is compared to two other local anaesthetics commonly used in IVRA, i.e. lignocaine and prilocaine. Acidosis and hyperkaliemia are likely to increase the risk of bupivacaine toxicity. Other contributing factors include leakage under the tourniquet cuff and preexisting cardiac disease. We conclude that bupivacaine is a useful agent for IVRA assuming that the patients are carefully selected and the anaesthetist is aware of the possible risks and their prevention.

Anesthesia, Conduction↗
PubMed1983

Effects of intrathecal morphine, injected with bupivacaine, on pain after orthopaedic surgery.

Morphine hydrochloride 0.4 mg was administered with isobaric 0.5% bupivacaine intrathecally for orthopaedic surgery and produced good analgesia for about 24 h after operation in both elderly (60-80 yr) and middle-aged patients (30-50 yr). Morphine 0.2 mg (older patients only) was not as effective in preventing pain after operation, but even this dose postponed the requirement for analgesia. Morphine did not change the quality of spinal anaesthesia. In the older groups the capillary PCO2 was increased in two patients receiving morphine 0.2 mg and in one patient receiving 0.4 mg. Severe delayed respiratory depression was not noted. Urinary retention and minor voiding difficulties were the most disturbing side-effects. This complication did not appear to be dose-dependent, and also occurred in patients not receiving morphine.

Adult↗
PubMed1983

Blood levels of bupivacaine after single dose, supplementary dose and during continuous infusion in axillary plexus block.

The material consisted of 25 patients undergoing orthopaedic or plastic surgery of the upper extremity, including seven cases of replantation surgery. The total doses of bupivacaine, 150-267 mg as a single dose, 280-440 mg as a supplementary dose and 247-629 mg as a continuous infusion, resulted in maximum venous concentrations of 0.68-3.33 micrograms/ml, 1.21-2.44 micrograms/ml and 0.51-1.89 micrograms/ml, respectively. These usually occurred 30-60 min after the injection of bupivacaine and always following the second injection when a supplementary dose was needed. The highest individual value noted occurred 15 min after single injection, possibly as a result of an exceptionally rapid absorption. Despite the high doses and the rather high venous peak concentration of bupivacaine in some of the patients, no toxic side-effects were observed during the block or during the recovery period.

Adolescent↗
PubMed1982

Effect of posture and some c.s.f. characteristics on spinal anaesthesia with isobaric 0.5% bupivacaine.

The effect of the sitting position (0, 2.5, 5.0 or 7.5 min), during and after the injection of 3 ml of 0.5% isobaric bupivacaine-HCl, on the segmental spread of spinal analgesia was studied in 40 patients. Ten patients injected in the lateral horizontal position acted as controls. The spread of analgesia was significantly greater in those who sat for 2.5 min or more compared with those who were immediately put in the supine position. Prolongation of the sitting time did not produce a higher analgesic block. The motor block was complete in all patients; its duration was significantly longer in the horizontal group than in all the sitting groups. There was no significant correlation between the different c.s.f. indices (pressure, protein and chloride ion concentration pH, and specific gravity) and the spinal block.

Adult↗
PubMed1982

Effects of posture on the spread of spinal anaesthesia with isobaric 0.75% or 0.5% bupivacaine.

In a double-blind study the effects of posture on the spread of 3 ml of isobaric bupivacaine 5 and 7.5 mg ml-1 were compared after intrathecal injection in 40 patients undergoing orthopaedic surgery. Three millilitre of isobaric bupivacaine 7.5 mg mg-1 administered with the patient in a sitting position during and for 2.5 min after injection produced the highest spread of analgesia (T4). Horizontal posture, and the smaller dose in both positions, resulted in spread of analgesia to T7-8. Motor block in the legs was good in all cases. Horizontal posture at the time of injection resulted in the longest mean duration of analgesia and motor block, although there was no statistically significant difference in mean times between the groups. The longest mean duration of pin-prick analgesia (329 +/- 23 min) was in the patients injected in the horizontal posture with bupivacaine 7.5 mg ml-1. The course of anaesthesia and recovery were uneventful in all patients.

Aged↗
PubMed1982

How much do arm movements displace cubital central venous catheters?

The effect of abduction and adduction of the arm on the position of central venous catheters inserted via cubital veins was studied in 41 surgical patients. The location of the catheter tip and the abduction-adduction angle were measured from x-ray pictures. With adduction, the catheter always advanced inwards, the maximal movement being 9.5 cm. The average displacement varied from 2.0 cm to 3.3 cm and there was a statistically significant correlation (P less than 0.001; r = 0.831) between the advancement of the catheter tip and the abduction-adduction angle. There was no correlation between tip displacement and change in central venous pressure.

Arm↗
PubMed1982

Bupivacaine blood levels after intravenous regional anesthesia of the arm.

Toxic reactions have been reported in patients after immediate release of the tourniquet cuff following intravenous regional anesthesia (I.V.R.A.) with bupivacaine. In this study we induced I.V.R.A. with 0.25% bupivacaine, mean dose 1.8 mg/kg (range 1.4-2.6 mg/kg). The patients were divided into two groups according to the method used to release the cuff; these were immediate release (Group I), or release with an "on and off" technique (Group II). The highest venous bupivacaine concentrations (max. 2.72 micrograms/ml) were measured 10 min after the ischaemic period, but there were not statistically significant differences between the two groups (the highest mean concentration was 0.91 microgram/ml in Group I and 0.93 microgram/ml in Group II). There was a difference in the bupivacaine concentrations between the subgroups of short (less than 40 min) and long (greater than 90 min) periods of ischaemia, but it was not significant. The fact that the bupivacaine concentration peak appeared later and was higher in the latter group might be associated with the lower pH (long ischemia) and its effect on the bupivacaine binding in the tissues. No toxic symptoms were recorded in the 40 patients in our study. Additional analgesics were needed in 11 cases and in 8 of these the reason was an uncomfortable feeling under the cuff. It is concluded that bupivacaine in doses of 1.4 to 2.6 mg/kg is safe for I.V.R.A. The tourniquet cuff could be released without toxic reactions. However, after long periods of ischaemia, the possibility of delayed, potentially toxic blood bupivacaine concentrations is higher.

Adult↗