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Biomedical subjects

U Aromaa

Publications and source records attributed to U Aromaa.

At least 37 records · Page 2Linked to original sources
PubMed1980

The role of diazepam and fentanyl in the production of balanced anaesthesia.

The effects of diazepam-fentanyl combinations on consciousness, superficial nociception, respiration and circulation during N2O+O2 inhalation were studied in 40 premedicated patients during induction of anaesthesia. The balance between antinociception and anaesthesia was closest to the optimum in patients receiving 0.2 mg/kg of diazepam plus 1 micrograms/kg of fentanyl; the eyelid reflex was negative in all patients and only two out of ten patients reacted to abdominal pinching. When only 0.2 mg/kg of diazepam was given with N2O+O2, the eyelid reflex was negative in all patients, but half of them reacted to pinching. When the dose of diazepam was reduced to 0.1 mg/kg and patients received 1 or 2 micrograms/kg of fentanyl, the balance between anaesthesia and antinociception was good, but 30-50% of patients had a positive eyelid reflex and reacted to pinching. No distinct respiratory depression was observed in patients given 0.2 mg/kg of diazepam, whereas seven patients given 0.1mg/kg of diazepam plus 2 micrrograms/kg of fentanyl had apnoea lasting more than 60 s associated with a significant (P less than 0.05-0.001) increase in end-tidal CO2 and PCO2 in arterialised venous blood. No significant changes were observed in blood pressure or heart rate after any of the drug combinations studied. It appears that an optimal balance between anaesthesia and antinociception with minimal side-effects during balanced general anaesthesia requires reinforcement of N2O+O2 anaesthesia not only with fentanyl but also with hypnotics for sedatives.

Adult↗
PubMed1980

Venous complications after intravenous injection of diazepam, flunitrazepam, thiopentone and etomidate.

The occurrence of phlebitis, thrombosis, and thrombophlebitis after intravenous premedication with diazepam (0.15 mg/kg) dissolved in propylene glycol (Valium) or in polyethylene glycol (Diapam) or flunitrazepam (0.0125 mg/kg), and after intravenous induction of balanced general anaesthesia with thiopentone (4.0 mg/kg) or etomidate (0.3 mg/kg) was studied on the 7th and 14th postoperative days in 115 patients undergoing short-stay varicose vein surgery. Venous complications occurred most frequently after etomidate (43% at 14 days), thiopentone (23% at 14 days), and Valium (21% at 7 days). Diapam caused fewer venous sequelae (9% at 14 days) than Valium (18% at 14 days), but the smallest number of complications were noticed after flunitrazepam (8% at 7 days and none at 14 days). Venous sequelae were more severe and more extended after thiopentone and after etomidate than those after the diazepam preparations. It is concluded that venous complications after flunitrazepam premedication were mild and infrequent and that the incidence of such complications was unacceptably high after etomidate induction.

Adult↗
PubMed1979

Comparison of etomidate in combination with fentanyl or diazepam, with thiopentone as an induction agent for general anaesthesia.

In 104 premedicated patients undergoing general surgery, anaesthesia was induced either with etomidate 0.3 mg kg-1 preceded by fentanyl 1.25 or 2.5 microgram kg-1 i.v.or diazepam 0.0625 or 0.125 mg kg-1 i.v., or with thiopentone preceded by fentanyl 1.25 microgram kg-1 i.v. Despite the use of fentanyl or diazepam, the frequency of pain on injection in patients receiving etomidate was between 32% and 53%, being rated as severe in 5-20% of patients. No pain was experienced by patients receiving thiopentone. The frequency of involuntary movement was 15-35% with etomidate and 15% with thiopentone. The frequency of both pain and involuntary muscle movements was least when fentanyl 2.5 microgram kg-1 preceded the administration of etomidate. There was no significant relationship between the pain and muscle movement; three of 10 patients given etomidate into a central vein had such movements.

Adult↗
PubMed1979

Ornidazole and anaerobic bacteria: in vitro sensitivity and effects on wound infections after appendectomy.

The sensitivities of 68 clinical isolates of Bacteroides fragilis, 18 of Clostridium perfringens, and 11 of other Clostridium species were tested against ornidazole alone and in combination with ampicillin and gentamicin. A concentration of 3.1 microgram of ornidazole/ml inhibited 98% of the strains of B. fragilis, with greater sensitivity when ampicillin and gentamicin were also present. A concentration of 6.2 microgram of ornidazole/ml inhibited 16 of 18 strains of C. perfringens and all 11 strains of other Clostridium species. Concentrations in serum and tissue were determined after intravenous infusion of 500 mg of ornidazole 15 min prior to appendectomy. During the operation the concentration in serum was 7.90 +/- 0.57 microgram/ml, and in appendix tissue, 5.26 +/- 0.60 microgram/g. In the series of 200 patients undergoing appendectomy, six patients treated with ornidazole and 12 patients treated with placebo developed a wound infection. In patients with perforated appendix, the rate of wound infection was 7.1% in those given ornidazole and 63.6% in those given placebo (P = 0.004). Not a single B. fragilis was isolated from appendix swabs or wound exudates after prophylaxis with ornidazole.

Adult↗
PubMed1979

Premedication for out-patient endoscopy of the upper gastro-intestinal tract.

Upper gastrointestinal endoscopy was performed on 342 out-patients. The patients were allocated to four groups according to premedication given. The premedication used was atropine 0.1 mg/10 kg (A), atropine 0.1 mg/10 kg and diazepam 5 mg (AD), atropine 0.1 mg/10 kg and fentanyl 0.2 mg (AF), atropine 0.1 mg/10 kg diazepam 5 mg and fentanyl 0.2 mg (ADF). Premedication was given about 30 minutes before the procedure intramuscularly; the mouth and pharynx were sprayed with 10% lidoc,ine. The patients as well as the endoscopist considered the premedication in groups A and AD to be satisfactory. From the patient's point of view there were hardly any differences between the var;ous groups, except in drowsiness, which occurred more often in groups where fentanyl had been used. From the endoscopist's point of view groups A and AD were preferred because they offered better working conditions for the procedure. The longest period of observation was required in group ADF. On the basis of these results premedication with only atropine or if desired a combination of atropine and diazepam in addition to local sprayed anaesthesia of the mouth and pharynx is sufficient, and is recommended for endoscopy of the upper gastrointestinal tract.

Aged↗
PubMed1978

Streptokinase and concomitant oral anticoagulants in the treatment of deep venous thrombosis.

Fourty-four patients with deep venous thrombosis of the leg diagnosed by phlebography and not more than five days old were treated with streptokinase. Oral anticoagulant therapy was started at the same time. Complete lysis of thrombi was obtained in 6 cases and partial one in 25 cases. Lysis of proximal thrombi was better than that of distal ones. The age of the thrombi had no effect on the lysis. Urticaria and anaphylactic reactions occurred in 8 patients and treatment was discontinued. Haemorrhagic complications were present in 8 cases but remission was obtained by dicontinuing streptokinase infusion. Commencing oral anticoagulant therapy simultaneously with streptokinase reduces duration of treatment without increasing the risks and the results of lysis are equally good as with earlier studies. The use of streptokinase is recommended in the treatment of proximal deep venous thrombosis. This treatment offers a possibility of preventing a postthrombotic syndrome. The frequency of various complications should however be borne in mind.

Adult↗
PubMed1978

A comparison of naproxen, indomethacin and acetylsalicylic acid in pain after varicose vein surgery.

Oral naproxen in doses of 500 mg and 750 mg daily was compared with oral indomethacin, 75 mg daily, in a double-blind, completely randomized study of patients with post-operative pain after out-patients varicose vein surgery. Altogether, 120 patients were studied. In the study 750 mg naproxen proved to be equal in respect of analgesic efficacy to 75 mg indomethacin, and it was clearly superior to 1500 mg acetylsalicylic acid. Naproxen, 500 to 750 mg daily, afforded adequate post-operative analgesia in 98% of patients. The side-effects were mild. On the basis of the study, naproxen can be recommended as a pain-relieving drug after minor surgery, particularly when an antiphlogistic effect is also desirable.

Adolescent↗
PubMed1977

Anaesthesia for short-stay varicose vein surgery.

The study was undertaken in order to elucidate the suitability of four different types of general anaesthesia and of epidural block in short-stay varicose vein surgery. Special consideration was given to recovery after anaesthesia. The series consisted of 230 female patients subjected to varicose vein surgery of one lower extremity. The patients' recovery after surgery was observed through tests measuring visual-motor coordination and through questionnaires. The general anaesthesias used were halothane-nitrous oxide-oxygen anaesthesia with spontaneous respiration (Ha), relaxant-dominated combined anaesthesia (Re), analgesic-dominated combined anaesthesia (An), and analgesic-dominated combined anaesthesia with hyperventilation (Hy). Of the general anaesthesias, halothane nitrous-oxide inhalation anaesthesia gave the fastest recovery, although there were no major differences between it and analgesic-dominated combined anaesthesia. In contrast, immediate recovery was prolonged after hyperventilation and after relaxant-dominated anaesthesia. Epidural blockade provided a good alternative to general anaesthesia.

Adult↗
PubMed1977

The role of different components of balanced anaesthesia in tolerance to endotracheal intubation.

In order to demonstrate the role of anaesthesia, analgesia and muscle paralysis in suppressing the responses to nociceptive stimuli during balanced anaesthesia, the effect of tolerance to endotracheal intubation was used as a model during recovery from a suxamethonium block after different combinations of thiopental and fentanyl. The induction groups were: Thiopental, 4, 6 or 8 mg/kg, and thiopental, 4 mg/kg, supplemented with fentanyt, either 1 microgram/kg or 2 microgram/kg. All 107 patients received suxamethonium 1.5 mg/kg, after precurarization and recovery of muscle strength had been recorded by measuring the twitch tension of thumb adduction caused by indirect supramaximal stimulation of the ulnar nerve. With 4 mg/kg thiopental 60% of the patients reacted against the tube before the suxamethonium block had subsided. Increasing the dose to 8 mg/kg or supplementing the 4 mg/kg thiopental with 1 microgram/kg fentanyl reduced the reactions to about 30%. After supplementing with 2 microgram/kg fentanyl, 90% of the patients tolerated the tube. Reactions against the tube, if any, usually occurred before the twitch tension had recovered by more than 30%. After 4 and 6 mg/kg thiopental, about 10% of the patients started reacting before there were signs of recovery of twitch tension. The results show that if bucking or coughing are used as an indication of inadequate muscle paralysis overcurarization can easily occur. Tolerance to the endotracheal tube is more rationally achieved by small doses of narcotic analgesics (e.g. fentanyl, 0.5 to 1 microgram/kg) than by increasing the dosage of thiopental. This simple model has been found useful in demonstrating the basic principles of balanced anaesthesia at the beginning of training in the specialty.

Adult↗
PubMed1976

Short-stay varicose vein surgery.

From 1967 patients attending for varicose vein surgery at the Meilahti Hospital, Helsinki University Central Hospital, have been operated on on the day of admission, spend the following night in the bed ward and are discharged the morning after the operation. The operation is performed under general anaesthesia with as radical approach as possible stripping the long saphenous vein and, if required, the short saphenous vein, excising the superficial side branches and ligating incompetent perforators. In the study a follow-up examination was carried out on 2334 patients. Wound infections occurred in 1.8%. Two patients had transient arrhythmia, and one a late haemorrhage. More serious complications were absent. During the follow-up period 5.2% of patients were operated on for recurrent varicose veins. 84.6% were subjectively satisfied. The number of hospital days per patient averaged 1.2. It was possible to follow the above planned course of action in 93.4%. The organization and surgical technique can be recommended in order to achieve savings in hospital days and to produce permanent and good surgical results.

Adolescent↗
PubMed1976

Short-stay varicose vein surgery.

From 1967 patients attending for varicose vein surgery at the Meilahti Hospital Helsinki University Central Hospital, have been operated on on the day of admission, spend the following night in the bed ward and are discharged the morning after the operation. The operation is performed under general anaesthesia with as radical approach as possible stripping the long saphenous vein and, if required, the short saphenous vein, excising the superficial side branches and ligating incompetent perforators. In the study a follow-up examination was carried out on 2334 patients. Wound infections occurred in 1.8%. Two patients had transient arrhytmia, and one a late haemorrhage. More serious complications were absent. During the follow-up period 5.2% of patients were operated on for recurrent varicose veins. 84.6% were subjectively satisfied. The number of hospital days per patient averaged 1.2. It was possible to follow the above planned course of action in 93.4%. The organization and surgical technique can be recommended in order to achieve savings in hospital days and to produce permanent and good surgical results.

Adolescent↗