Lung volumes, the incidence and severity of atelectasis, and alveolar gas exchange were comparable in patients given 30% and 80% perioperative oxygen. The authors conclude that administration of 80% oxygen in the perioperative period does not worsen lung function. Therefore, patients who may benefit from generous oxygen partial pressures should not be denied supplemental perioperative oxygen for fear of causing atelectasis.
In a prospective study, experiences with peri-operative thoracic epidural analgesia (TEA) for thoracic surgery were documented. Two hundred and seven patients scheduled for elective thoracotomy were investigated. All patients received thoracic epidural catheters 2 h pre-operatively. The catheters were inserted between T4-5 and T8-9 intervertebral spaces. Epidural medication with bupivacaine and fentanyl was started preoperatively, maintained throughout surgery and was continued post-operatively via patient controlled analgesia (PCA) devices. Patients were anaesthetized with propofol and tracheal intubation was performed following neuromuscular blockade with vecuronium. Ninety-five percent of the patients were extubated immediately after surgery. 70.5% of all the patients had excellent post-operative analgesia (VAS pain scoring 0-2) on the day of surgery, 78% the day after surgery and 91% on the second day after surgery. Additionally early post-operative mobilization could be started in 63% of all patients. No neurological sequelae caused by thoracic epidural catheterization was seen in the early post-operative period.
Peri-operative thoracic epidural analgesia for thoracotomy Summary following neuromuscular blockade with vecuronium. Ninety-five percent of the patients were extubated In a prospective study, experiences with peri-operative immediately after surgery. 70.5% of all the patients thoracic epidural analgesia (TEA) for thoracic surgery had excellent post-operative analgesia (VAS pain scorwere documented. Two hundred and seven patients ing 0-2) on the day of surgery, 78% the day after scheduled for elective thoracotomy were investigated.surgery and 91% on the second day after surgery. All patients received thoracic epidural catheters 2 h Additionally early post-operative mobilization could pre-operatively. The catheters were inserted between be started in 63% of all patients. No neurological T4-5 and T8-9 intervertebral spaces. Epidural medsequelae caused by thoracic epidural catheterization ication with bupivacaine and fentanyl was started prewas seen in the early post-operative period. operatively, maintained throughout surgery and was continued post-operatively via patient controlled Keywords: thoracic epidural analgesia, postanalgesia (PCA) devices. Patients were anaesthetized operative pain, surgery thoracic. with propofol and tracheal intubation was performed
Total atelectasis of the left lung occurred in a 61-year-old woman after several weeks ventilator-assisted breathing following an operation for ileus, when the tracheal cannula was removed. It was quickly replaced and artificial ventilation resumed. But despite daily bronchoscopic suction for three weeks the patient's state failed to improve (vital capacity 39%, arterial pO2 47 mm Hg, pCO2 37 mm Hg). Mechanical ventilation with an "iron lung" was therefore instituted over a six month period, at first for two hours daily (as an in-patient) and then weekly (as out-patient). During this time her condition and general state clearly improved. On re-hospitalization to remove the tracheal cannula her vital capacity was 75%, pO2 78 mm Hg and pCO2 38 mm Hg.
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