RESUMO
Celiac plexus block for upper abdominal cancer pain was performed on 26 patients from April, 1977 to April, ]979 at the Pain Clinic of Yonsei Medical Center. Patients were placed in prone position and the location of the tip of needles was conformed by fluoroscopy and on image intensifier. Immediately after the assesment of the effect of test blocks with 1% lidocaine, permaneat blocks with 50% aIcohol were performed. The results obtained were as follows: 1} Under flouroscopic control, the interval from the test to the permanent block was less than 15 min, thus economical in both time and expense. Also no patient refused the alcohol block after the test block and alcohol injection was painless. 2) The test and permanent blocks were effective in all cases, but repeated permanent block was necessary in 7 cases within 2 weeks after the initial alcohol block. 3) As to complications, hypotension, nausea and face flushing developed in 10, 3 and 8 cases respectively. There were no postponements and no mortality. 4) These cases were discharged from hospital without pain 2 to 18 days after block. 5) Two cases with recurrent cancer pain had repeated alcohol block with excellent effect 3 and 6 months after the initial alcohol block. 6) The block to death interval was l to 4 months in 6 cases in which follow up was possible. From the above results. we may conclude that by using fluoroscopyic control with needle placement only once, the test and permanent blocks were performed safely, effectively and painlessly.
Assuntos
Humanos , Plexo Celíaco , Equidae , Fluoroscopia , Rubor , Seguimentos , Hipotensão , Lidocaína , Mortalidade , Náusea , Agulhas , Clínicas de Dor , Decúbito VentralRESUMO
To provide optimal obstetric anesthetic care, it is essential for the anesthetist to know well the maternal physiological alterations produced by pregnancy, labor and paturition, physiology and pharmacology of the fetal placental complex and how these are altered by analgesics and anesthetics (Bonica, 1972). Recently, the tendency to cesarean section has increased; the cesarean section rate was 8.1. (Lee et al., 1974) and 15% (Dripps et al., 1977). Choice of regional or general anesthesia for cesarean section depends on many factors. As, the paturient is considered to have a full stomach, regional anesthesia is advantageous. However, if the indication is fetal distress or maternal hemorrhage, the necessity for rapid delivery overrides all other considerations. For elective cesarean section the choice of anesthesia largely relates to patients condition and physicans preference, although the somewhat. longer time required for delivery in a repeated cesarean section may indicates regional rather than general anesthesia (Dripps et al., 1977; James et al., 1977). The problem of anesthetic management of cesarean section was fetal depression due to sedatives, analgesics and anesthetics during delivery. In emergency cesarean section, the major problem in general anesthesia is aspiration of gastric contents and in regional anesthesia it is hypotension. Regarding fetal and neonatal depression associated with anesthesia, the effects of general or regional anesthesia or. the neonatal neurobehavioral status have been reported by many authors (Standley et al., 1974; Tronick et al., 1976; Hollmen et al., 1978). Thus we have made a clinical analysis of anesthesia for 300 cases by random sampling among 1725 cesarean sections. including emergency and elective operations, performed from July 1973 to June 1978 in Severance Hospital at Yonsei University College of Medicine. Clinical analysis was made of frequency of cesarean section, age distribution, parity, indication of cesarean section, physical status (A.S.A. classification), premedication, anesthetic method, relationship between Apgar score and the type of anesthesia, relationship between induction to delivery time and one minute Apgar score, time to initial blood pressure drop after spinal anesthesia, blood loss, the methods of cardiopulmonary resuscitation of the newborn, perinatal mortality and neonatal neurobehavioral states. The result are as follows: 1) The incidence of cesarean action was 18.4 percent of total deliveries and the tendency is increasing. 2) One minute Apgar score in spinal anesthesia is better than in general anesthesia (0. 01 < p < 0.025). 3) Blood loss in spinal anesthesia (566+/-146 ml) is less than in general anesthesia(796+/-388ml). 4) Blood pressure showed a drop within ten minutes in 83 percent of cases after induction of spinal anesthesia. 5) Perinatal mortality of general anesthesia (3.9%) is more than spinal anesthesia (1.9%). Even though clinical results of spinal anesthesia seem to be more favorable than those of general anesthesia, from the above observation it may be concluded that choice of anesthesia for cesarean section depends on each maternal condition and only one anesthetic method should not be exclusively used.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Distribuição por Idade , Analgésicos , Anestesia , Anestesia por Condução , Anestesia Geral , Raquianestesia , Anestésicos , Índice de Apgar , Pressão Sanguínea , Reanimação Cardiopulmonar , Cesárea , Depressão , Emergências , Sofrimento Fetal , Hemorragia , Hipnóticos e Sedativos , Hipotensão , Incidência , Paridade , Mortalidade Perinatal , Farmacologia , Fisiologia , Pré-Medicação , EstômagoRESUMO
The effects of sodium hypochlorite for the destruction of P. aeruginosa, E. coli, K. pneumonias and S. anreas and for the prevention of contamination of irrigation fluid, which is either exposed to ICU environment or used for cleansing oral or trachea catheter tips, were tested and the following results were obtained. 1) The sodium hypochlorite solution 1: 800 destroyed P. aeraginosa, E. coli, K. pneomoniue and S. aweas in 5 minutes. This bactericidal effect was observed to be retained after the solution had stood 24 hours. 2) Viable P. aeraginosa was not detected immediately, 5 minutes and 10 minutes after exposure to 1: 500, 1: 800 and 1: 1000 sodium hypochloride solutions respectively. 3) The sodium hypochlorite solution 1: 800 prevented contamination of the irrigation fluids during a 24 hour exposure to the ICU environment. 4) P. aeraginosa and other gram-negative bacilli were frequently isolated from the plain fluid used for irrigating and holding the suction tips which had been used for patients. However, no organisms were isolated from fluid containing sodium hypochlorite 1: 800 even after 24 hour usage. It is concluded that the use of fluid containing sodium hypochlorite for the irrigation of catheter tips can reduce development of infections in the ICU patients.