ABSTRACT
The amount of pain experienced by the postoperative newborn remains one of the most challenging problems in neonatology. In this study, ethological methods were used to examine behaviours for 12 hours, commencing 24 hours postoperatively in three male full-term infants following chest surgery. The infants' facial expressions, body postures and movements were coded each minute from videotapes. The infants' heart rates and respiratory rates were also continuously recorded. Behavioural data were analysed using descriptive statistics and factor analysis. The six-factor solution accounted for 61.6% of the variance and identified indices of acute distress, subacute pain, quiet alertness, drowsiness and sleeping. Changes were evident when comparing behavioural or physiological variables before and after the administration of analgesia, treatments, nursing care or environmental noise. The authors conclude that ethological methods are appropriate to examine this problem, and recommend that the study be replicated.
Subject(s)
Child Behavior , Infant, Newborn/physiology , Nursing Assessment/methods , Pain, Postoperative/physiopathology , Psychology, Child , Child, Preschool , Humans , Infant, Newborn/psychology , Male , Pain, Postoperative/nursing , Pain, Postoperative/psychology , Videotape RecordingSubject(s)
Anesthesia, General , Intubation, Intratracheal , Vecuronium Bromide/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Electromyography/drug effects , Humans , Infusions, Intravenous , Neuromuscular Junction/drug effects , Prospective Studies , Randomized Controlled Trials as Topic , Single-Blind MethodABSTRACT
The effect of isoflurane-induced hypotension on reduction of blood loss, improvement of surgical field, and postoperative edema was investigated in 52 patients undergoing combined maxillary and mandibular osteotomies. Anesthesia was maintained with fentanyl, N2O, O2, and isoflurane. Deliberate hypotension was induced by increasing isoflurane inspired concentration. Blood loss in the hypotensive group (MAP 55-65 mm Hg) was significantly less than that in the control group (MAP 75-85 mm Hg); 454.0 +/- 211.3 mL versus 755.3 +/- 334.6 mL (P less than 0.001). Fewer patients had to be transfused in the hypotensive group, 12.0% versus 44.4% (P less than 0.02). The surgical field was significantly improved by the hypotensive technique, but operative time was not shortened. Subjective and objective measurements of postoperative edema failed to show any effect of deliberate hypotension. Our data suggest that isoflurane-induced hypotension effectively reduces blood loss and the number of transfusions in orthognathic surgery.
Subject(s)
Hypotension, Controlled/methods , Isoflurane , Mandible/surgery , Maxilla/surgery , Osteotomy , Adult , Edema/etiology , Female , Humans , Male , Postoperative Complications , Prospective StudiesABSTRACT
Two techniques of injection for epidural anaesthesia for Caesarean sections were studied. Forty-five patients were randomly divided into two groups. Patients in Group I received 20 ml of lidocaine two per cent with epinephrine via the needle at a rate of 5 ml.30 sec-1 after a 3 ml test dose. Patients in Group II received the same dose of the same solution in increments of 5 ml injected through a catheter after a 3 ml test-dose. Each increment was injected in one minute with a delay of two minutes between injections. Top-up doses were given in both groups to obtain a T4 sensory level. There was no difference between the two groups in the quality of sensory block before delivery. However, the quality was significantly better in Group II after delivery (P = 0.02). The incidence of hypotension was 52.2 per cent in Group I and 13.6 per cent in Group II (P = 0.014). There was no significant difference in maternal and umbilical venous lidocaine concentrations. We conclude that injection in fractional doses is a safer and more efficient technique for epidural anaesthesia for Caesarean section.
Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Cesarean Section , Lidocaine/administration & dosage , Catheters, Indwelling , Clinical Trials as Topic , Epinephrine/administration & dosage , Female , Humans , Hypotension/etiology , Injections, Intravenous , Lidocaine/blood , Postoperative Complications , Pregnancy , Random AllocationABSTRACT
Groups of Grad 1, high school students, and elderly subjects were tested for their ability to discriminate tactile forms. The performance of control subjects who received no prior training was compared with that of subjects who received prior visual training under normal viewing conditions (Vw), or prior visual training with special goggles restricting form perception to a series of part impressions (Vp). Both the visual and tactile versions of the task involved comparisons of standard figures matched either with themselves or with transformation figures. There was no evidence of transfer for the children, regardless of previous experience. Specific as well as nonspecific cross-modal transfer was found in the high school and elderly groups following Vp training. Positive transfer was also found for the high school students in the Vw condition, although there is some question whether this was the result solely of cross-modal effects. Whereas all age groups performed equally well on standard versus transformation comparisons, standard versus standard matches were highest in the high school students, lowest in the children, and intermediate in the elderly. The generally poor performance of the children and the inability on the part of the elderly to benefit from Vw training are discussed in terms of task difficulty and inefficient perceptual processing strategies.
