<p>Propofol is an intravenously administered, hypnotic and short- acting pharmaceutical. One common sideeffect (>1:10) and therefore a disadvantage with propofol is the local pain that arise when the initial injection is given. Why the pain arise is not clearly understood. A majority of different pharmacological treatments, different doses and combinations, alternative administrations methods and physical interventions have been tried to reduce the pain when injection of propofol is given. One important task for the nurse is to relieve pain for patients. It is important for all patients to be painless and not experience discomfort caused by procedure in health care. The purpose of this study was to examine if administration of lidocaine and/ or remifentanil could in connection with injection of propofol reduce pain incidence and intensity at the injection. A literature study based on twenty-eight scientific articles was conducted. The result shows that a combination of lidocaine andremifentanil give the best pain relief. Howewer there is no difference in propofolinduced injection pain when lidocaine or remifentanil alone is compared. Other factors that could affect injection pain are use of a tourniquet which enhances the pain reduction, but the time that the tourniquet is applied is not decisive. The placement of the iv-catheter should be in the largest vein possible. By using this knowledge the incidence and intensity of pain could be reduced with drugs commonly used in Swedish aneasthetic care. Thereby patients' suffering could also be reduced.</p>

No description available.

<p>Neuropathic pain of central and peripheral origin presents a substantial clinical problem as it is often resistant to pharmacological treatment.</p><p>The health related quality of life of 126 patients with peripheral neuropathic pain was studied, to provide a cross sectional description from this point of view. Two generic health-related quality of life instruments; the SF-36 and the Nottingham Health Profile were used together with pain assessments, global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors.</p><p>The analgesic effect of ketamine, lidocaine and morphine were assessed in a double blind, placebo-controlled, randomized study design. Three groups of patients were studied: patients with peripheral neuropathic pain of traumatic origin, patients with central post-stroke pain and patients with neuropathic pain after spinal cord injury. Somatosensory function was examined to see if this could predict response to treatment and to investigate if the drugs caused changes in thermal or mechanical sensibility.</p><p>The results shows that the intense pain, limited efficacy and tolerability of available treatments, the low overall rating of health, reduced work status and troublesome symptoms constitute a substantial impact on the quality of life for patients with peripheral neuropathic pain.</p><p>The NMDA-antagonist ketamine yielded substantial pain relief to patients with peripheral neuropathic pain and patients with neuropathic pain after spinal cord injury. However, the reported side effects limit the clinical usefulness of the treatment. Lidocaine did not give significant pain relief to the patients in the three studied groups. Morphine may represent a therapeutic alternative for some patients with central post-stroke pain, although only a small group of this category of patients responded with analgesia.</p><p>Assessment of baseline somatosensory functions could not be used to identify responders to treatment with either drug, nor did ketamine, lidocaine or morphine cause any changes in thermal or mechanical sensibility.</p>

Background:     The microdialysis (MD) technique is widely spread and used both experi­mentally and in clinical practice. The MD technique allows continuous collection of small molecules such as glucose, lactate, pyruvate and glycerol. Samples are often analysed using the CMA 600 analyser, an enzymatic and colorimetric analyser.  Data evaluating the performance of the CMA 600 analysis system and associated sample han­dling are sparse. The aim of this work was to identify sources of variability related to han­dling of microdialysis samples and sources of error associated with use of the CMA 600 analyser. Further, to develop and compare different application techniques of the micro­dialysis probes both within an organ and on the surface of an organ.  Material and Methods:  Papers I and II are mainly in vitro studies with the exception of the No Net Flux calibration method in paper I where a pig model (n=7) was used to exam­ine the true concen­tration of glucose and urea in subcutaneous tissue. Flow rate, sampling time, vial and caps material and performance of the analyser device (CMA 600) were examined. In papers III and IV normoventilated anaesthetised pigs (n=33) were used. In paper III, heart ischemia was used as intervention to compare microdialysis measurements in the myocardium with corresponding measurements on the heart surface. In paper IV, microdialysis measurements in the liver parenchyma were compared with measurements on the liver surface in associa­tion with induced liver ischemia. All animal studies were approved by the Animal Experi­mental Ethics Committee at Umeå University Sweden. Results:  In paper I we succeeded to measure true concentrations of glucose (4.4 mmol/L) and Urea (4.1 mmol/L) in subcutaneous tissue. Paper II showed that for a batch analyse of 24 samples it is preferred to store microdialysis samples in glass vials with crimp caps. For reliable results, samples should be centrifuged before analysis. Paper III showed a new application area for microdialysis sampling from the heart, i.e. surface sampling. The sur­face probe and myocardial probe (in the myocardium) showed a similar pattern for glucose, lactate and glycerol during baseline, short ischemic and long ischemic interventions. In paper IV, a similar pattern was observed as in paper III, i.e. data obtained from the probe on the liver surface showed no differences compared with data from the probe in liver paren­chyma for glucose, lactate and glycerol concentrations during baseline, ischemic and reperfusion interven­tions. Conclusion:  The MD technique is adequate for local metabolic monitoring, but requires methodological considerations before starting a new experimental serie. It is important to consider factors such as flow rate, sampling time and handling of samples in association with the analysis device chosen. The main finding in this thesis is that analyses of glucose, lactate and glycerol in samples from the heart surface and liver surface reflect concentra­tions sampled from the myocardium and liver parenchyma, respectively.

Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing non-cardiac surgery, cardiovascular complications will remain a significant clinical problem in the future. The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery. The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden. The correlation between postoperative myocardial damage and short- and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short- as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III &amp; IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups. In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

Neuropathic pain of central and peripheral origin presents a substantial clinical problem as it is often resistant to pharmacological treatment. The health related quality of life of 126 patients with peripheral neuropathic pain was studied, to provide a cross sectional description from this point of view. Two generic health-related quality of life instruments; the SF-36 and the Nottingham Health Profile were used together with pain assessments, global rating of health and verbal rating scales of pain and other symptoms, as well as patient descriptors. The analgesic effect of ketamine, lidocaine and morphine were assessed in a double blind, placebo-controlled, randomized study design. Three groups of patients were studied: patients with peripheral neuropathic pain of traumatic origin, patients with central post-stroke pain and patients with neuropathic pain after spinal cord injury. Somatosensory function was examined to see if this could predict response to treatment and to investigate if the drugs caused changes in thermal or mechanical sensibility. The results shows that the intense pain, limited efficacy and tolerability of available treatments, the low overall rating of health, reduced work status and troublesome symptoms constitute a substantial impact on the quality of life for patients with peripheral neuropathic pain. The NMDA-antagonist ketamine yielded substantial pain relief to patients with peripheral neuropathic pain and patients with neuropathic pain after spinal cord injury. However, the reported side effects limit the clinical usefulness of the treatment. Lidocaine did not give significant pain relief to the patients in the three studied groups. Morphine may represent a therapeutic alternative for some patients with central post-stroke pain, although only a small group of this category of patients responded with analgesia. Assessment of baseline somatosensory functions could not be used to identify responders to treatment with either drug, nor did ketamine, lidocaine or morphine cause any changes in thermal or mechanical sensibility.

No description available.

Background: Several studies have suggested that the likelihood of paraesthesia may depend on the local anaesthetic (LA) used. The purpose of this study was to analyze reports of paraesthesia among dental LAs used in the U.S. Methods: Reports of paraesthesia involving LAs between November 1997 through August 2008 were obtained from the U.S. Food and Drug Administration Adverse Event Reporting System. Chi-Square analysis compared expected frequencies, based on U.S. LA sales data, to observed reports of oral paraesthesia. Results: During the study period 248 cases of paraesthesia following dental procedures were reported. Most (94.5%) cases involved mandibular nerve block. The lingual nerve was affected in 89.0% of cases. Reports involving 4%-prilocaine and 4%-articaine were 7.3-times and 3.6-times, respectively, greater than expected (χ2, p<0.0001) based on LA usage by U.S. dentists. Conclusions: Consistent with previous reports, these data suggest that paraesthesia is more common following use of 4% LA formulations.

Background: Several studies have suggested that the likelihood of paraesthesia may depend on the local anaesthetic (LA) used. The purpose of this study was to analyze reports of paraesthesia among dental LAs used in the U.S. Methods: Reports of paraesthesia involving LAs between November 1997 through August 2008 were obtained from the U.S. Food and Drug Administration Adverse Event Reporting System. Chi-Square analysis compared expected frequencies, based on U.S. LA sales data, to observed reports of oral paraesthesia. Results: During the study period 248 cases of paraesthesia following dental procedures were reported. Most (94.5%) cases involved mandibular nerve block. The lingual nerve was affected in 89.0% of cases. Reports involving 4%-prilocaine and 4%-articaine were 7.3-times and 3.6-times, respectively, greater than expected (χ2, p<0.0001) based on LA usage by U.S. dentists. Conclusions: Consistent with previous reports, these data suggest that paraesthesia is more common following use of 4% LA formulations.

Introduktion: Patientkontrollerad epidural smärtlindring (PCEA) är idag en vedertagen metod för postoperativ smärtlindring med få komplikationer. Försök har gjorts för att titrera fram den mest gynnsamma kombinationen med fokus på att maximera smärtlindringen och minimera sidoeffekterna. Syftet med studien är att identifiera smärta, sidoeffekter och behandlingstid samt patientens subjektiva skattning av smärtlindring vid postoperativ PCEA-behandling med bupivacaine, fentanyl och epinephrine. Metod: Studien är retrospektiv inkluderande 1088 patienter vilka postoperativt behandlats med PCEA och kombinationslösningen bupivacaine (1mg/ml), fentanyl (2μg/ml) och epinephrine (2μg/ml). Studien har undersökt skillnaden mellan kön, ålder och typ av kirurgi avseende smärta i vila respektive smärta vid mobilisering/hosta, infusionshastighet, givna och begärda bolusdoser, behandlingstid, sidoeffekter samt patientens subjektiva skattning av smärtlindringen. Resultat: Smärta i vila och vid mobilisering/hosta var under de studerade dygnen generellt låg, smärtan kulminerade under dygn 2. De yngre patienterna visade sig skatta smärta högre under behandlingstiden. Studien visade att smärta vid mobilisering/hosta var högre vid längre behandlingstid. Kvinnor hade mer illamående och klåda, vilket inte entydigt påverkade behandlingstiden. Patienter vilka hade haft smärta både i vila och vid mobilisering/hosta skattade ett lägre betyg gällande smärtlindringen vid hemgång. Andelen patienter som avslutade PCEA-behandlingen relaterat till minskat behov var 78%. Konklusion: Patienterna upplevde att den postoperativa smärtlindringen med PCEA med kombinationslösningen var mycket god. Typ av kirurgi, kön och smärta vid mobilisering/hosta visade sig påverka behandlingstiden. Förekomsten av sidoeffekter var hög men påverkade inte patientens betyg negativt. Smärtan hos patienterna var generellt låg.