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Biomedical subjects

H Kehlet

Publications and source records attributed to H Kehlet.

At least 325 records · Page 18Linked to original sources
PubMed1985

Effects of the extradural administration of local anaesthetic agents and morphine on the urinary excretion of cortisol, catecholamines and nitrogen following abdominal surgery.

Twenty patients undergoing major abdominal surgery were allocated randomly to receive either general anaesthesia with low-dose fentanyl plus intermittent systemic morphine for postoperative pain or the same general anaesthetic plus extradural analgesia during and following surgery (local anaesthetics from before skin incision until 24 h after skin incision plus extradural morphine 4 mg every 12 h from 3 h to 72 h after skin incision). Postoperative pain scores were lower (P less than 0.05) in the group receiving extradural analgesia, but this regimen failed to prevent the increase in the urinary excretion of cortisol, adrenaline, noradrenaline and nitrogen both on separate days and on cumulative measurements over 4 days. Pain scores did not correlate to urinary excretion of the various endocrine-metabolic indices either on separate days or over the cumulative 4-day period. It is concluded that the relief of pain per se has no major influence on the catabolic response to abdominal surgery.

Abdomen↗
PubMed1985

Effect of alfentanil anaesthesia on the adrenocortical and hyperglycaemic response to abdominal surgery.

Plasma concentrations of cortisol and glucose were measured from before to 9 h after skin incision in 24 patients undergoing abdominal hysterectomy. The patients were randomly allocated to receive either high-dose alfentanil anaesthesia (150 micrograms kg-1 initially, followed by continuous infusion at a rate of 3 micrograms kg-1 min-1) or neurolept anaesthesia (droperidol 0.25 mg kg-1 plus fentanyl 5 micrograms kg-1 initially, followed by intermittent incremental doses of fentanyl 50 micrograms). The intraoperative and initial postoperative increases in plasma cortisol and glucose concentrations were inhibited (P less than 0.05) by alfentanil but, later in the postoperative period, both groups showed identical increases in cortisol and glucose concentrations. Mean arterial pressure and heart rate were more stable in the alfentanil group. The concept of "stress-free" anaesthesia during high-dose opiate administration seems to be valid during operation and for the initial 1-3 h into the postoperative period.

Abdomen↗
PubMed1985

Disruption of colonic anastomosis during continuous epidural analgesia. An early postoperative complication.

The clinical presentation is described of partial rupture of a colonic anastomosis two hours after surgery during epidural analgesia. The unusually early presentation of this complication is possibly due to removal of normal intestinal sympathetic activity by epidural analgesia resulting in normal or increased colonic motility. It is not known whether epidural analgesia may precipitate anastomotic breakdown due to increased contractions and strain on the anastomosis, or lead to an earlier presentation of a disruption caused by failure of surgical technique or other factors.

Anesthesia, Epidural↗
PubMed1985

A controlled study on the effect of epidural analgesia with local anaesthetics and morphine on morbidity after abdominal surgery.

A hundred patients scheduled for elective abdominal surgery were randomized to either general anaesthesia (low-dose fentanyl) and systemic morphine for postoperative pain or combined general anaesthesia and epidural analgesia with etidocaine 1.5% intraoperatively (T4-S5) and bupivacaine 0.5% 5 ml/4 h for 24 h and morphine 4 mg/12 h for 72 h. Postoperative pain was better controlled by the epidural regimen (P less than 0.0001). We found no significant reduction in postoperative mortality (6% to 2%), pneumonia (28% to 20%), cardiac dysrhythmia (10% to 5%) and wound complications (14% to 11%) by the epidural analgesic regimen. The incidence of deep venous thrombosis (125I-fibrinogen scan) was 32% after general anaesthesia and low-dose heparin and 34% after epidural analgesia with no prophylactic antithrombotic treatment (P greater than 0.9). Postoperative weight loss and decrease in serum-albumin and serum-transferrin, as well as the reduction in haemoglobin and the need for postoperative transfusions, were similar in the two groups. Convalescence, as assessed by postoperative fatigue, restoration of bowel function (flatus, bowel movement and food intake) and the time until the patients were self-aided at their preoperative level, was not reduced by epidural analgesia. Since 50% of the patients in each group suffered from one or more of the above-mentioned postoperative complications, this epidural regimen was not effective in reducing postoperative morbidity after major abdominal surgery despite the achievement of adequate pain relief.

Abdomen↗
PubMed1985

Morbidity after femoral neck fracture not increased in diabetics.

In a retrospective study the morbidity following surgery for femoral neck fracture was investigated in 81 patients with diabetes mellitus and in 81 non-diabetic matched control patients. Sixteen patients in each group had postoperative complications with no tendency to specific complications in the diabetic patients. Morbidity was equally distributed between patients treated with insulin, antidiabetic agents, and diet. Our results do not support the common belief that there is an increased postoperative risk in diabetic patients.

Aged↗
PubMed1985

Electrical activity and arm muscle force in postoperative fatigue.

Muscle force of elbow flexors and quantitative electromyographic analyses were assessed before and 10 and 20 days after uncomplicated elective abdominal surgery in 20 patients. The findings were compared with subjective fatigue. Fatigue increased significantly from a mean preoperative level of 3.4 +/- 0.4 arbitrary units to 7.0 +/- 0.5 and 6.1 +/- 0.5 on postoperative days 10 and 20. Muscle force decreased by about 10% postoperatively. The duration of sustained contraction (endurance) at a force adjusted to 30% of maximum fell from 426 +/- 64 sec preoperatively to 301 +/- 22 sec 20 days after surgery (all differences significant). Postoperative increase in fatigue correlated significantly to decrease in maximum force (r = 0.45) and to decrease in endurance (r = 0.5). The electromyographic findings at a force of 2 kg and at 30% of maximum suggested activation of fewer motor units during short contraction in the early postoperative period. During sustained contraction there was more pronounced increase in mean amplitude 20 days postoperatively than before surgery. This may suggest that the decreased muscle performance in the late postoperative period was secondary to muscle fatigue.

Abdomen↗
PubMed1985

Morbidity in diabetic and nondiabetic patients after abdominal surgery.

Morbidity after abdominal surgery was retrospectively investigated in 79 patients with diabetes mellitus and in 79 nondiabetic controls matched for type of surgery (biliary, gastric or colonic), sex, age, body weight and complicating cardiovascular disease. There were 20 complications (including 2 in each of 4 patients) in the diabetic group and 18 (2 patients with 2 complications) among the controls, with no tendency to specific complications in the diabetics. The difference in complication rate was not statistically significant. The mean blood glucose level preoperatively and in the first four postoperative days did not differ significantly between the diabetics with and those without postoperative complications. The risk of overlooking (type II error) a 25% heightened complication rate among the diabetic patients was calculated to be less than 30%, and the risk of overlooking a 50% increase was less than 8%. The authors conclude that elective abdominal surgery in diabetic patients is not burdened by clinically significant increase of postoperative morbidity.

Adult↗
PubMed1984

Postoperative fatigue and changes in nutritional status.

Subjective feeling of fatigue was quantified before and 10, 20 and 30 days after elective uncomplicated abdominal surgery in 36 otherwise healthy patients, using a constructed fatigue scale model. One third of the patients had a remarkable increase in fatigue which continued throughout the first postoperative month. The fatigued patients showed a more pronounced postoperative loss in weight (P less than 0.001), triceps skinfold caliper (P less than 0.001) and arm muscle circumference (n.s.) and had lower levels in serum transferrin (P less than 0.02). No correlation was found between postoperative fatigue and postoperative changes in blood haemoglobin, lymphocyte count, plasma albumin, electrolytes and various minerals. Development of late postoperative fatigue was unpredictable from pre-operative nutritional status, serum transferrin, albumin, electrolytes, haemoglobin, lymphocyte count and various minerals, as well as from age, sex and duration of surgery. These results suggest future therapeutic measures against the postoperative fatigue syndrome.

Adolescent↗
PubMed1984

Value of the 30 min ACTH-test in assessing hypothalamic-pituitary-adrenocortical function after pituitary surgery in Cushing's disease.

Adrenocortical responses to a 30 min ACTH-test were measured before pituitary surgery and 8-12 d, 2-3 months and 6 months after, in 13 patients with Cushing's disease. The decrease in adrenocortical response to the short ACTH-test performed 8-12 d postoperatively correlated with the outcome as assessed 6 months after surgery. Adrenocortical response to ACTH became subnormal or borderline 8-12 d after surgery in patients demonstrating postoperative HPA insufficiency. These results add further support to the value of the short ACTH-test in assessing integrated HPA function in various clinical situations.

Adrenal Cortex↗
PubMed1984

Failure of epidural analgesia to modify postoperative depression of delayed hypersensitivity.

Delayed hypersensitivity to four common antigens was assessed in 32 patients undergoing major abdominal surgery randomly allocated to either general anesthesia (fentanyl + O2/N2O + postoperative pain relief with systemic opiates) or general anaesthesia + epidural analgesia (local anaesthetics + morphine) continued for 72 h. Skin-test responses were performed 2 days before surgery and 1 day after surgery and compared to a similar retesting schedule in 16 comparable non-operative control patients. Cumulated mean skin-test responses increased from 1290 to 2330 mm2 (P less than 0.0001) during retesting in the non-operative control group. In contrast, mean skin-test responses in patients operated during general anaesthesia + systemic opiates for postoperative pain relief fell from 1422 to 1227 mm2 (P = 0.3) and in patients receiving epidural analgesia from 1228 to 890 mm2 (P = 0.06), without statistically significant differences between these two groups (P greater than 0.5). Thus, surgery leads to depression of delayed hypersensitivity and this impairment in immunofunction is not modified by an epidural analgesic regimen providing adequate pain relief.

Aged↗
PubMed1984

The modifying effect of spinal anaesthesia on intra- and postoperative adrenocortical and hyperglycaemic response to surgery.

Plasma cortisol and glucose were measured in 24 patients undergoing abdominal hysterectomy during spinal anaesthesia with 0.5% hyperbaric tetracaine or neurolept anaesthesia. The sensory level of analgesia to pinprick extended to at least T4 before skin incision in the spinal group. The mean sensory analgesic level regressed almost linearly, reaching the fourth lumbar segment 4 h after incision. Plasma cortisol and glucose measurements from before to 9 h after skin incision showed significant increases in both parameters during and after surgery. Plasma cortisol and glucose levels were significantly lower during and immediately after surgery in the spinal group, but later postoperatively the mean levels were similar in the two groups. The increase in plasma cortisol 1 h after skin incision in the spinal group correlated to the segmental level of analgesia at that time (r = 0.77, P less than 0.01) and a similar correlation was found with regard to plasma glucose changes (r = 0.60, P less than 0.05). The regression lines showed that maintenance of a sensory analgesic level about the fourth thoracic segment prevented the adrenocortical and hyperglycaemic response to surgery. These findings are in accordance with the anatomical assumption that the upper segmental level of visceral afferent input to the spinal cord is about the fourth thoracic segment. Our results further demonstrate that the inhibitory effect of spinal anaesthesia on the stress response to surgery is transient, and correlates to the regression of sensory analgesia.

Adult↗
PubMed1984

Influence of regional anaesthesia on postoperative morbidity.

A short review on the influence of regional anaesthesia on various parameters of postoperative morbidity is given. Only data from controlled studies have contributed to the conclusions. It appears that regional anaesthesia with local anaesthetics reduces intraoperative blood loss and postoperative thromboembolic complications after hip surgery and prostatectomy, while data from other procedures are inconclusive. Mortality is probably minimized by regional anaesthesia after acute hip surgery. No firm conclusion can be made with regard to the influence on postoperative cardial or pulmonary complications, mental dysfunction, infective complications, restoration of gastro-intestinal function as well as on convalescence, but several pieces of evidence from studies including only a limited number of patients suggest that regional anaesthesia may mitigate various aspects of postoperative morbidity. Future studies should be directed to give final answers on these points and furthermore consider the possible differing effect of a single dose infiltration anaesthesia or spinal anaesthesia versus continuous epidural analgesia, the optimal duration and extent of the neuronal block, and the effect of postoperative pain relief by epidural opiate administration.

Anesthesia, Conduction↗
PubMed1984

Effects of intravenous bupivacaine on cardiovascular function and plasma catecholamine levels in humans.

The effects of the intravenous infusion of bupivacaine (2 mg/min for 3 hr) on cardiovascular function and various endocrine metabolic parameters were studied in a randomized single-blind crossover study in eight normal subjects. Bupivacaine infusion resulted in plasma concentrations about 1-2 micrograms/ml. Heart rate increased significantly from approximately 60 to 70 beats/min. Mean arterial blood pressure increased from 87 to about 100 mm Hg, and cardiac output decreased about 20%, both of these statistically significant. Oxygen consumption did not change significantly. Plasma epinephrine concentrations increased significantly from 0.03 to 0.08 ng/ml, but plasma norepinephrine levels did not change significantly, nor did blood concentrations of glucose, lactate and plasma cortisol, and free fatty acids. These results demonstrate that systematically administered bupivacaine results in plasma concentrations of bupivacaine comparable to those that may be observed during regional anesthesia, including a positive chronotropic and an arterial vasoconstrictive effect. These effects are probably caused mainly by a direct effect of bupivacaine on the cardiovascular system, because only quantitatively minor changes in plasma catecholamines and other endocrine metabolic parameters were observed.

Adult↗