Evaluation of thoracic epidural catheter position and migration using radio-opaque catheters.

Migration of thoracic epidural radio-opaque catheters was evaluated in 25 patients scheduled for thoracic surgery in the supine position (n = 5) or in the lateral position with lateral extension of the thoracic spine (n = 20). Chest radiography was performed daily for 3 days after operation. Eighty-nine per cent of catheter tips were visualised in the epidural space.

Pharmacokinetics of epidurally administered nicomorphine with its metabolites and glucuronide conjugates in patients undergoing pulmonary surgery during combined epidural local anaesthetic block and general anaesthesia.

After epidural administration of 15 mg 3, 6-dinicotinoylmorphine (nicomorphine) in 10 patients undergoing pulmonary surgery, the parent compound was quickly metabolized into the metabolites 6-mononicotinoylmorphine and morphine. The mean apparent half-lives (+/- SD) of elimination were 10 min (0.165 h +/- 0.

Continuous high thoracic epidural administration of morphine with bupivacaine after thoracotomy.

Background And Objectives: The purpose of the study is to determine the ideal concentration of morphine when given with bupivacaine as a continuous high thoracic epidural infusion for postthoracotomy pain.

Methods: In a prospective study, 60 patients scheduled for thoracic surgery received a high thoracic epidural catheter. Postoperative analgesia was provided by a continuous epidural infusion for 3 days.

High thoracic epidural sufentanil with bupivacaine: continuous infusion of high volume versus low volume.

The purpose of the study was to investigate whether continuous infusion of a high volume of a sufentanil/bupivacaine mixture at a high thoracic level improves the analgesic effect of the mixture, compared with a dose-equivalent continuous low-volume infusion. In a prospective, observer-blind study, 60 patients scheduled for thoracic surgery received a thoracic epidural catheter for 3 days. The patients were randomly assigned by lot to one of two groups: a low-volume (LV) group (bupivacaine 0.

Thoracic epidural bupivacaine plus sufentanil: high concentration/low volume versus low concentration/high volume.

Background And Objectives: To compare the postoperative analgesic and side effects of a continuous epidural infusion of bupivacaine with sufentanil: high concentration/low volume versus low concentration/high volume.

Methods: In a prospective study, 30 patients scheduled for thoracic surgery had a thoracic epidural catheter inserted. Postoperative analgesia was provided by a continuous epidural infusion for 3 days.

Cardiac herniation after pneumonectomy.

Cardiac herniation is a rare, lethal complication of intrapericardial pneumonectomy demanding urgent treatment. It usually occurs within the first 24 h postoperatively. We present a patient with late cardiac herniation, 28 h postoperatively, where the electrocardiographic changes were evident several hours before the clinical picture became clear.

Accidental overdose of epidural bupivacaine and sufentanil.

Background And Objectives: A case is described of an accidental high thoracic epidural infusion of 337.5 mg 0.75% bupivacaine and 180 micrograms sufentanil in less than 30 minutes.

Coronary artery bypass grafting using two different anesthetic techniques: Part 3: Adrenergic responses.

Twenty patients were studied during and after coronary artery bypass grafting (CABG). The patients were randomly assigned to two groups. In 10 patients, intraoperative general anesthesia (GA) was based on a combination of intravenous (IV) sufentanil and midazolam.

Coronary artery bypass grafting using two different anesthetic techniques: Part 2: Postoperative outcome.

The aim of the present investigation was to study the effects of intraoperative and postoperative epidural pain management during and after coronary artery bypass grafting (CABG) on the recovery time, postoperative pulmonary and cardiac parameters, visual analog scale (VAS) scores, and sedation scores (SS) compared with patients anesthetized with general anesthesia (GA) whose postoperative pain was relieved with intermittent intravenous (IV) administration of nicomorphine. Fifty-four patients were studied postoperatively after uncomplicated CABG. In the thoracic epidural analgesia (TEA) group (n = 27), intraoperative analgesia was based on high TEA in combination with GA.

Coronary artery bypass grafting using two different anesthetic techniques: Part I: Hemodynamic results.

Hemodynamic changes were studied during two different anesthetic techniques in 54 patients undergoing coronary artery bypass grafting (CABG). All patients had normal to moderately impaired left ventricular function and were randomly assigned to two groups. In 27 patients, high thoracic epidural analgesia (TEA) with bupivacaine 0.

Epidural bupivacaine, sufentanil or the combination for post-thoracotomy pain.

Analgesia with epidural bupivacaine, sufentanil or the combination was studied in 50 patients who had undergone thoracotomy. During operation all patients received an initial dose of bupivacaine 0.5% with adrenaline 5 micrograms.

Pharmacokinetics of nicomorphine and its metabolites in man after epidural administration.

In ten patients who received an epidural injection of 15 mg of nicomorphine, the compound was relatively slowly released from the epidural space and was found in plasma for approximately 1.5 h. Nicomorphine is relatively slowly metabolized into 6-nicotinoylmorphine and morphine.

Ventilatory function and continuous high thoracic epidural administration of bupivacaine with sufentanil intravenously or epidurally: a double-blind comparison.

Variables of ventilation were obtained preoperatively and during the first two postoperative days in 28 patients after thoracic surgery. All patients received 0.5% bupivacaine with epinephrine, 5 micrograms.

Continuous high thoracic epidural administration of bupivacaine with sufentanil or nicomorphine for postoperative pain relief after thoracic surgery.

In a prospective study, 40 patients who had undergone thoracotomy for lung resection were investigated. During operation, all patients received intravenous anesthesics, halothane and an initial dose of bupivacaine 0.5% with epinephrine 5 micrograms.

Migration of thoracic epidural catheters. Three methods for evaluation of catheter position in the thoracic epidural space.

Migration of thoracic epidural catheters was evaluated in 25 patients by three methods either after placement of the catheter or immediately after surgery. The first method was the determination of the depth of the catheter from the skin, the second the determination of the level of sensory blockade which resulted from a test dose of a local anesthetic agent, while the third consisted of radiological visualisation of the catheter tip in the epidural space with radiopaque dye. The evaluations were repeated on the third or fourth day after operation.

The effect of continuous epidural analgesia with sufentanil and bupivacaine during and after thoracic surgery on the plasma cortisol concentration and pain relief.

The effect of continuous epidural analgesia with bupivacaine 0.125% and sufentanil 0.83 micrograms.

Spread of radiopaque dye in the thoracic epidural space.

A radiological study was performed in 23 patients to look for the position of thoracic epidural catheters and the spread of the contrast medium iohexol 300 mg/ml and 180 mg/ml when used in volumes of 3 and 8 ml. The dye was injected through the epidural catheter just after thoracic surgery. The spread of the dye showed no relation to the injected volume or the sensory spread after 2% lignocaine 3 ml.

The influence of high thoracic epidural analgesia on the cardiovascular system.

The effect of high thoracic epidural analgesia (TEA) on the cardiovascular system was investigated in 10 patients (5 with cardiovascular disease and 5 without known cardiovascular disorder), who were scheduled for a thoracotomy. An epidural catheter was inserted at T1-T2 level. Plain bupivacaine (Marcaine) 0.

Post-operative analgesia by high thoracic epidural versus intramuscular nicomorphine after thoracotomy. Part III. The effects of per- and post-operative analgesia on morbidity.

One hundred and twenty-nine patients were subjected to three different types of thoracic operations. The patients were randomly allocated to balanced intravenous anaesthesia including i.v.

Postoperative analgesia by nicomorphine intramuscularly versus high thoracic epidural administration. Effects on ventilatory and airway occlusion pressure responses to CO2.

In this study the effects of nicomorphine, administered either intramuscularly or by high thoracic epidural route, on the ventilatory and airway occlusion pressure response to CO2 were investigated and compared. Twenty-four patients scheduled for thoracic surgery were allocated randomly to postoperative pain relief by i.m.

Anaesthesia for bullectomy. A technique with spontaneous ventilation and extradural blockade.

A patient with severe bullous emphysema in whom one bulla occupied more than 25% of the hemithorax, with a shift of the mediastinum to the opposite side, was anaesthetised for bullectomy with a combination of intravenous gamma-hydroxybutyric acid and a high thoracic extradural catheter technique. During the operation the patient breathed 100% oxygen through a double-lumen endobronchial tube in the lateral thoracotomy position. Extradural analgesia during the operation was provided by bupivacaine 0.

Post-operative analgesia by epidural versus intramuscular nicomorphine after thoracotomy. Part I.

One hundred and sixty-three patients subjected to three different types of thoracic operation were allocated randomly either to balanced intravenous anaesthesia including i.v. opiates with post-operative intramuscular opiates (intramuscular group) or to balanced intravenous anaesthesia without i.

Post-operative analgesia by epidural versus intramuscular nicomorphine after thoracotomy. Part II.

One hundred and sixty-three patients subjected to three different types of thoracic operation were allocated randomly either to balanced intravenous anaesthesia including i.v. opiates with post-operative intramuscular opiates (intramuscular group) or to balanced intravenous anaesthesia without i.