The Swedish Society of Anaesthetists conducted a nationwide retrospective survey of clinical experience with extradural and intrathecal opiates Special interest was focused on the frequency and type of ventilatory depressfon. The questionnaire was answered by 84 of 93 departments (90%). Up to May 1981 extradural morphine had been given to approximately 6000-9150 patients, extradural pethidine to 220-450 and intrathecal morphine to 90-150 patients Ventilatory depression requiring treatment with naloxone was reported in 23 patients treated with extradural morphine (0.25-0.40%) and in six given uitrathecal morphine (4_7%). In 22 patients the administration of extradural morphine was considered as a major contributory factor for the occurrence of ventilatory depression Only two of these 22 patients experienced ventilatory depression later than 6h after the last dose of opiates (s.c, i.m., i.v. or extradural). Patients aged 70yror more, those receiving thoracic extradural puncture and those with reduced ventilatory capacity seemed to be oyerrepresented
The Swedish Society of Anaesthetists conducted a nationwide retrospective survey of clinical experience with extradural and intrathecal opiates. Special interest was focused on the frequency and type of ventilatory depression. The questionnaire was answered by 84 of 93 departments (90%). Up to May 1981 extradural morphine had been given to approximately 6000-9150 patients, extradural pethidine to 220-450 and intrathecal morphine to 90-150 patients. Ventilatory depression requiring treatment with naloxone was reported in 23 patients treated with extradural morphine (0.25-0.40%) and in six given intrathecal morphine (4-7%). In 22 patients the administration of extradural morphine was considered as a major contributory factor for the occurrence of ventilatory depression. Only two of these 22 patients experienced ventilatory depression later than 6 h after the last dose of opiates (S.C., i.m., i.v. or extradural). Patients aged 70 yr or more, those receiving thoracic extradural puncture and those with reduced ventilatory capacity seemed to be overrepresented.
The endocrine response, and the relief of pain, following the extradural administration of morphine or a local anaesthetic agent bupivacaine (0.5%) were studied for 24h after abdominal surgery and compared with a control group given conventional i.v. morphine after operation. Samples were taken before and at 2, 4, 6, 12 and 24 h after skin incision. Pain relief in both extradural groups was significantly better when compared with the control group. In all three groups, the plasma concentration of cortisol was increased immediately after surgery. Thereafter, significantly lower values were seen in the extradural groups. Plasma adrenaline concentration was lower immediately after surgery only in the group given the extradural local anaesthetic. Plasma noradrenaline concentration remained unchanged after extradural local anaesthesia while an intermediate increase occurred after extradural morphine. Plasma noradrenaline concentration was significantly greater in the controls compared with both extradural groups. Our results indicate that extradural analgesia with a local anaesthetic drug can suppress the increases in the plasma concentrations of the catecholamines and cortisol after surgery. In contrast to extradural local anaesthetic extradural morphine cannot suppress the endocrine response immediately after surgery. However, later in the postoperative period, extradural morphine can suppress the endocrine response, thus indicating that postoperative pain is a factor involved in the stress response following surgery.
The plasma concentrations of atropine following i.v. or i.m. administration to surgical patients were determined by radioimmunoassay. When atropine sulphate 1 mg was given i.v. there was a rapid initial removal of the drug from the circulation in the first 10 min; thereafter the plasma concentration decreased more slowly. Atropine i.m. was rapidly absorbed with peak concentrations occurring at 30 min following injection. The plasma atropine concentration then decreased slowly, probably because of uptake of atropine by muscarinic cholinergic receptors. The chronotropic effect of atropine appeared to correspond to the concentration in plasma following i.m. administration. We conclude that i.m. atropine, as a premedication, should be given not later than 30 min before induction of anaesthesia.
In 22 patients undergoing elective surgery, adrenal function was assessed before and on the day of surgery. Patients receiving corticosteroid therapy but with a normal cortisol response to a corticotropin stimulation tcit (group II, n = 8) were not given hydroconisone on the day of operation. Their cortisol concentration increased in a manner similar to patients (group I, n = 8) who had never had corticosteroid treatment. The plasma cortisol concentrations in these two groups were less than in subjects (group III, n = 6) with an impaired cortisol response to corticotropin stimulation, who were given hydrocortisone 25 mg at the induction of anaesthesia followed by a continuous infusion of hydrocortisone 100 mg during the next 24 h. There were no clinical signs of circulatory insufficiency in any group. The low-dose hydroconisone therapy regimen is sufficient for substitution of adrenal function during surgery and in the early postoperative phase. It could lead to mild oversubstitution in patients with impaired adrenal insufficiency undergoing major surgery.
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