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Biomedical subjects

J C Raeder

Publications and source records attributed to J C Raeder.

At least 37 records · Page 2Linked to original sources
PubMed1998

1 MAC-incision sevoflurane prevents explicit awareness during surgical skin incision and tracheal intubation.

BACKGROUND: This study tested the hypothesis that 1 MAC-incision anesthesia secures unconsciousness during surgical skin incision and tracheal intubation. METHODS: Twenty patients scheduled for gynecological laparotomy were anesthetized with sevoflurane as the sole agent. At 1 MAC-incision steady-state conditions, the patients were observed for autonomic/movement responses and wakefulness (response to verbal commands) in the 1-min period following surgical skin incision and tracheal intubation. RESULTS: Blood pressure and heart rate increased significantly secondary to both stimuli, and significantly more after tracheal intubation than skin incision. Ten and 19 patients moved in response to skin incision and tracheal intubation, respectively. None of the patients showed wakefulness. CONCLUSION: It is concluded that 1MAC-incision sevoflurane secures unconsciousness during surgical skin incision and tracheal intubation.

Adult↗
PubMed1998

Changing preoperative fasting policies. Impact of a national consensus.

BACKGROUND: Liberalisation of preoperative fasting rules has been discussed and recommended in the anaesthesia literature in recent years. In Norway, a national consensus on this issue was reached in 1993. The aim of the present study was to investigate whether a national consensus on fasting recommendations led to a change in fasting policies in Norwegian anaesthesia departments. METHODS: A questionnaire on preoperative fasting routines was sent to all Norwegian anaesthesia departments in 1993 and repeated in 1996. RESULTS: Written local guidelines for preoperative fasting were present in 85% of the institutions in both surveys. Of the hospitals, 69% had changed their local guidelines after the national consensus. In 1996 more hospitals allowed less than 6 h fasting for clear liquids in children (93% versus 71% in 1993; P < 0.005). A similar tendency was noted in adults (79% versus 63% in 1993; P = 0.1). In contradiction to the national guidelines, 31% of the departments reported that they allowed less than 6 h fasting after a light breakfast in the morning of surgery in 1996. The corresponding number for 1993 was 21% (ns). CONCLUSION: The new, consensus-based national fasting guidelines have been associated with a change towards more liberal fasting policies in Norwegian departments of anaesthesia. However, as not all local changes were supported by the national consensus, other sources of information were used when local policies were decided.

Adult↗
PubMed1997

No analgesic effect of ibuprofen or paracetamol vs placebo for hysterectomies.

The aim of the present study was to evaluate the postoperative opioid-sparing effect of a pre-operative nonsteroidal anti-inflammatory drug (NSAID) (ibuprofen) vs paracetamol in a prospective, double-blind, placebo-controlled study. It was also investigated whether the use of ibuprofen or paracetamol would influence the amount of surgical bleeding. Sixty-six women scheduled for elective open hysterectomy were randomized into one of three groups. All patients received premedication (diazepam 10 mg) and test drugs orally 1 h before the start of anaesthesia: Group 1 (n=23) received 800 mg ibuprofen; Group 2 (n=22) received 1000 mg paracetamol; and Group 3 (n=21) received placebo. General anaesthesia was given with thiopentone-fentanyl-atracurium induction, and maintained with nitrous oxide-isoflurane. Postoperatively, the patients were evaluated hourly during the recovery period, and 1 and 4 days after the procedure. Postoperative pain was measured by visual analogue scale (VAS), verbal pain score and the need of standardized opioid rescue medication. Intra-operative bleeding was measured, as well as reduction in blood haemoglobin content 24 h and 4 days after the procedure. No differences were found between the groups in postoperative pain measured by any variable or opioid consumption at any time. The amount of surgical bleeding was equal in the three groups. Ibuprofen or paracetamol given pre-operatively to hysterectomy patients do not have a postoperative analgesic or opioid-sparing effect. Perioperative surgical bleeding is not influenced by these drugs.

Clinical Trial↗
PubMed1997

Post-operative epidural analgesia with low dose fentanyl, adrenaline and bupivacaine in children after major orthopaedic surgery. A prospective evaluation of efficacy and side effects.

The efficacy and side effects of 100 lumbar epidural treatments with low concentrations of bupivacaine (1 mg mL-1), fentanyl (2 micrograms mL-1) and adrenaline (2 micrograms mL-1) combined with rectal paracetamol were prospectively evaluated in children aged 4-14 years after femoral osteotomy. The mean treatment time was 43 h and the mean dose was 0.18 mL kg-1 h-1. Ninety-nine per cent of the children were either without pain or experienced very low pain at rest for at least 80% of the treatment time. The same was the case in 80% of children when pain evaluation was made on active movement. No cases of seizures, signs of catheter migration, hypotension or respiratory depression were observed. Sixty-three per cent of the patients experienced nausea or vomiting, but antiemetic treatment was indicated in only 11%. One epidural treatment had to be stopped in a child who did not respond to antiemetics. The incidence of pruritus was high (49%), but the symptoms were mild and limited.

Adolescent↗
PubMed1997

Spinal, epidural or propofol anaesthesia for out-patient knee arthroscopy?

BACKGROUND: We have compared three different methods of anaesthesia for out-patient knee arthroscopy in terms of perioperative conditions, postoperative pain, time taken and economy. METHODS: 91 ASA I-II patients scheduled for elective knee arthroscopy were included. After premedication with diazepam 10 mg and naproxene 500 mg orally, they were randomly assigned into one of three groups: Group S (n=32) received spinal anaesthesia with lidocaine 50 mg/ml 1.5-2 ml in 7.5% glucose through a 27-G Quincke needle, Group E (n=29) received epidural anaesthesia with mepivacaine 20 mg/ml and epinephrine 5 microg/ml, 15-20 ml, and Group P (n=30) received propofol anaesthesia with a bolus induction of 2 mg/kg followed by infusion. RESULTS: The time from start of anaesthesia until start of operation was significantly less in Group P than in the two other Groups: 7.4+/-5.4 min as compared to 23.0+/-4.8 min in Group S and 31.0+/-9.1 min in Group E (mean+/-SD, P<0.05). After end of surgery, the duration of the postoperative regional block was 75+/-28 min in Group S and 125+/-79 min in Group E (P<0.05). In Group S and Group E the postoperative pain was significantly less than in Group P at admission to the recovery unit and 60, 120 and 180 min later (P<0.05). The overall incidence of post-operative nausea or vomiting was less than 5% with no differences between the groups. One patient in Group E had block failure and one patient in Group S had a post-spinal headache. The perioperative costs of drugs and disposables were highest in Group P (30 USD) and lowest in Group S (6.5 USD). CONCLUSION: Propofol anaesthesia results in the shortest stay in the operation theatre but a higher degree of postoperative pain and a higher cost of drugs and disposables.

Adolescent↗
PubMed1996

[What is anesthesia? Some reflections on the definition, measuring methods and mechanisms at the 150th anniversary].

Modern anaesthesia has developed over 150 years. In spite of this, we still do not know how to explain the state of anaesthesia exactly, how to measure anaesthesia nor what the basic mechanisms are. In this paper, a model for the state of anaesthesia, is presented, and some aspects of basic mechanisms and monitoring are discussed. Anaesthesia modulates or blocks the somatic and autonomic responses to injury, mainly by postsynaptic inhibition of impulses. Empirical dosing and clinical monitoring are still the rule, computerized and electronic systems need to be further refined.

Anesthesia↗
PubMed1996

[Ambulatory surgery--preoperative examinations].

The increasing use of ambulatory surgery has led to greater focus on the rationale for preoperative screening tests. What pre-operative tests are selected depends on the patient's history and a clinical examination with the focus on general health. A preoperative ECG of patients older than 60 years of age is the only test which should be performed as a routine prior to ambulatory surgery.

Adult↗
PubMed1996

[The extent of ambulatory surgery. A questionnaire study among hospital directors and senior physicians].

Hospital directors and surgical chairmen at 34 Norwegian hospitals were interviewed by questionnaire about the extent of day surgery, and their attitudes towards changes in capacity for the future. They were asked about medical, economic and administrative aspects in relation to the extent of day surgery. 88% responded. They estimated the average extent of day surgery to 24% of all surgical procedures. The estimates varied considerably, and those of the hospital directors were significantly higher than the estimates made by senior surgeons at the same hospitals. 64% considered the extent of day surgery to be less than ideal and 52% had plans for more use of day surgery. The majority of the respondents felt that an increase in the extent of day surgery was warranted, in terms of all three aspects investigated.

Ambulatory Surgical Procedures↗
PubMed1996

No additional analgesic effect of intra-articular morphine or bupivacaine compared with placebo after elective knee arthroscopy.

BACKGROUND: Intra-articular pain prophylaxis is a controversial measure, adding costs although the benefits are still disputed. We wanted to evaluate the effects of intra-articular opioid or local anaesthesia or a combination of the two on postoperative analgesia and analgesic consumption after elective knee arthroscopy. METHODS: 107 patients with little or no preoperative pain and a minor surgical procedure were studied in a prospective, randomized double-blind design. The patients received midazolam 0.03 mg/kg intravenously before induction of general anaesthesia with fentanyl 1-2 micrograms/kg and propofol 2.0 mg/kg intravenously. Anaesthesia was maintained by a total intravenous technique with propofol infusion supplemented with alfentanil 10 micrograms/kg when needed. The patients breathed oxygen/ air through a laryngeal mask. By the end of the surgery they received 20 ml of test drug into the knee-joint: Group I (BM): 20 ml of bupivacaine 2.5 mg/ml with 3 mg of morphine; Group II (B): 20 ml of bupivacaine 2.5 mg/ml; Group III (M): 20 ml isotonic saline with 3 mg morphine; Group IV (P): 20 ml of isotonic saline (placebo). RESULTS: There were no significant differences between the groups in: time to first analgesic administered, analgesic consumption during the pre-or post-discharge period, nausea, somnolence, side-effects or postoperative pain perception during the first week. CONCLUSIONS: Intra-articular administration of morphine or bupivacaine is not indicated after elective knee-arthroscopy in patients with minor pre-operative pain and a small surgical trauma.

Adult↗
PubMed1996

Pre-emptive effect of pre-incisional versus post-incisional infiltration of local anaesthesia on children undergoing hernioplasty.

BACKGROUND: Although promising in experimental studies of post-traumatic pain, the concept of pre-emptive analgesia is still controversial in a clinical setting. Thus, we wanted to compare the clinical efficacy of wound infiltration with local anaesthesia before surgery with wound infiltration after hernioplasty in children. METHODS: Fifty children aged 2-10 years scheduled for hernioplasty were randomly assigned into two groups. Group 1 (n = 28) was infiltrated before surgery with bupivacaine 2.5mg/ml, 1mg/kg after induction of general anaesthesia. After surgery they were infiltrated with the same volume of 0.9% saline. Group 2 (n = 22) was infiltrated with 0.9% saline before surgery and bupivacaine 2.5 mg/ml, 1mg/kg after surgery. The study was performed double-blindly. In both groups anaesthesia was induced with thiopenthone and maintained with nitrous oxide and halothane, adjusted to keep haemodynamic measurements stable. All children were given paracetamol 15-20 mg/kg rectally when admitted to the recovery ward. Painscore (OPS) and analgesic requirements were registered postoperatively. After 48 h the parents completed a standardised questionnaire and they were interviewed by telephone after one week. RESULTS: The pre-incisional group needed significantly less halothane during the procedure compared with the post-incisional group (P < 0.05). The pre-incisional group also had a tendency towards faster awakening after the end of anaesthesia and a significantly lower OPS-pain score 30 min after the operation (P < 0.03). There were no differences between the two groups regarding need for additional analgesia: meperidine i.v. during the first 5 h postoperatively, and paracetamol thereafter. There were no differences between the groups regarding activity level, appetite and quality of sleep in the first week. In both groups the need for opioid analgesics was low: 54% in the pre-incisional group and 45% in the post-incisional group did not receive any opioid analgesic treatment. The children were virtually fully recovered after the first 24 h. CONCLUSION: Perioperative infiltration with a local anaesthetic in children undergoing hernioplasty results in a smooth recovery with little need for opioids postoperatively. Apart from a lower anaesthetic requirement and a reduced postoperative pain level after 30 min in the pre-incisional bupivacaine group, there was no difference between infiltration before (pre-emptive) or after surgery.

Analgesia↗
PubMed1995

Prophylactic oral ibuprofen or ibuprofen-codeine versus placebo for postoperative pain after primary hip arthroplasty.

The postoperative analgesic effect of ibuprofen was compared with a combination of ibuprofen and codeine versus placebo. The study was prospective, randomized, double blind with 123 consecutive hip arthroplasty operations. All the patients received oral diazepam as premedication and spinal anaesthesia with bupivacaine 5 mg/ml 3-4 ml. Postoperatively, when the spinal anaesthesia started to wear off, the patients were randomly assigned to one of three groups; the ibuprofen group (n = 48) received 800 mg of ibuprofen orally. The ibuprofen/codeine group (IC, n = 48) received 800 mg of ibuprofen combined with 60 mg of codeine. The placebo group (P, n = 25), received oral placebo medication. The patients were observed for the need of additional opioid (e.g. ketobemidone), pain score (verbal and VAS), bleeding and side effects for five hours. The patients in the placebo group (P) had significantly higher pain scores (P < 0.05) compared with the two other groups after 2 and 4 hours, with no significant differences after 1, 3 and 5 hours. The P group also received 45% more opioids (P < 0.001) compared with the two other groups during the same period. No significant differences in bleeding or side-effects were observed between the groups. There were no significant differences between the ibuprofen group and the ibuprofen/codeine group. We conclude that a prophylactic dose of 800 mg ibuprofen orally has an opioid sparing effect with a tendency of less pain experience during the first hours after hip arthroplasty.

Administration, Oral↗
PubMed1994

[Postoperative nausea and vomiting].

Nausea and vomiting are frequent problems in the postoperative period. The introduction of 5-HT3 receptor antagonists has stimulated interest and research in this area. The paper reviews the etiology, physiology, prophylaxis and treatment of postoperative nausea and vomiting. Before using specific antiemetic prophylaxis it is important to evaluate patient risk factors, surgical stimuli and method of anaesthesia. The choice of antiemetic drugs for treatment and prophylaxis should be guided by consideration of effect mechanism, side-effects, clinical documentation and total costs. No single drug is fully effective and combination therapy should be considered in resistant cases.

Antiemetics↗
PubMed1993

[Sterilization of women. Waiting lists, surgical techniques and type of anesthesia].

The surgical and anaesthesiological techniques of tubal sterilization in Norway were studied by means of questionnaire. All hospitals returned the questionnaire. 94% of the operations were performed by gynaecologists, and in 99% of the cases by bipolar or endothermal laparoscopy. Local analgesia was used in one of the 60 hospitals. There were significant regional differences in sterilization rates and waiting time. We found no simple relation between sterilization technique and waiting lists.

Adult↗
PubMed1993

[Ambulatory laparoscopic sterilization--should local analgesia and intravenous sedation replace general anesthesia? A comparative clinical trial].

A prospective, randomized study comprised 125 outpatient laparoscopic sterilization patients who had received either general anaesthesia or local anaesthesia together with intravenous sedation. The patients who had received local anaesthesia suffered significantly less postoperative pain and sore throat. Recovery and discharge were similar in the two groups, but those given a general anaesthetic were more drowsy in the evening on the day of operation. The time spent in the operating theatre was significantly shorter for the group given local anaesthesia, and the costs were lower. The majority of patients from both groups would prefer local anaesthesia and sedation for a similar procedure in the future. We conclude that local anaesthesia by intravenous sedation is the method of choice for laparoscopic sterilization.

Adult↗
PubMed1993

[Prevention of aspiration--preoperative fasting. Time for reevaluation of old routines?].

The article reviews the epidemiology, pathophysiology and recent clinical research on aspiration prophylaxis and preoperative fasting before surgical procedures. Elective, pain-free patients should be allowed a glass of clear fluid up to two hours before start of anaesthesia. A light meal should be allowed up to four hours before the procedure. The anaesthesist should always make an individual evaluation of patients with pain or gastrointestinal obstruction, or who have received opioids. Aspiration of gastric contents and/or prophylactic use of histamine H2 antagonist or sodium citrate may be considered. The use of prophylactic treatment should always be evaluated against the side-effects of such treatment and the very low occurrence of serious sequelae from aspiration of gastric contents into the lungs.

Fasting↗
PubMed1993

Laparoscopic sterilization under local or general anesthesia? A randomized study.

OBJECTIVE: To assess the safety, acceptability, and economy of local anesthesia and intravenous (IV) sedation versus short-term general anesthesia for laparoscopic sterilization. METHODS: We randomly allocated 125 of 150 consecutively sterilized women to either local or general anesthesia. No women were excluded, but 25 chose not to participate. The women were interviewed before surgery, and they returned a standardized questionnaire after discharge from the hospital. All laparoscopic tubal sterilizations were performed by senior gynecologists. Midazolam was used as premedication. In the local-anesthesia group, lidocaine with adrenaline was infiltrated infraumbilically and bupivacaine was applied to each tube. Midazolam and alfentanil were used as IV sedation. In the general-anesthesia group, intubation anesthesia was accomplished with alfentanil and propofol; atracurium was used for muscle relaxation. RESULTS: In the local-anesthesia group, operation time was shorter, perioperative discomfort was modest, and the costs of equipment were lower than in the general-anesthesia group. There was less postoperative abdominal pain and less need of analgesics, and the patients were more awake in the evening. The rise in heart rate and blood pressure were higher in the local-anesthesia group, and external oxygen was necessary to avoid apnea. Anesthetic surveillance was therefore mandatory. CONCLUSIONS: Local analgesia was highly acceptable to the majority of patients as well as to the gynecologists. The operation time was less, postoperative recovery was quicker, and the women were less bothered by abdominal pain and sore throat. There was a substantial reduction in anesthesia costs. Anesthetic surveillance during surgery was necessary.

Adult↗