Ugeskrift for laeger
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Ugeskrift for laeger · Feb 1998
Comparative Study[Quantitative EEG in assessment of anesthesia depth. Methods of comparison].
Methodology for assessment of depth of anaesthesia based on analysis of the electroencephalogram (eeg) is controversial. Techniques range from display of single measures, for example median value of the frequency spectrum, to dedicated pattern recognition systems based on measures of several eeg features. We have compared the performance of four techniques using tape-recorded data from 23 patients anaesthetised with either halothane or isoflurane using standardised regimens. ⋯ Dose-response curves are presented for stepwise increases in stable end-tidal concentrations of each agent. Results indicated considerable inter-patient variability and showed the limitations of single eeg measures, particularly with deeper anaesthesia producing burst suppression patterns in the eeg. Pattern recognition techniques reduced these difficulties and appeared to be promising over a wide range of anaesthetic levels.
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Crush syndrome or traumatic rhabdomyolysis constitutes the systemic changes seen after crush injury, i.e. the damages seen after a prolonged period of pressure on a muscle group. The pressure causes necrosis of muscle, and during revascularisation diffusion of calcium, sodium and water into the damaged muscle cells is seen, together with loss of potassium, phosphate, lactic acid, myoglobin and creatinine kinase. Untreated these changes can lead to: hyperkalaemia, acidosis, acute renal failure and hypovolaemic shock. ⋯ The crush injuries are treated conservatively without fasciotomy, despite high or increasing intracompartmental pressure. The only indications for fasciotomy are lack of a distal pulse or open lesions. If fasciotomy is performed, radical removal of all necrotic muscle is essential.
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This review article highlights the prerequisites and consequences of a possible implementation of trauma systems in Denmark. Denmark is a small densely populated country, with a population of approximately 5 mill. people. ⋯ A successful reorganisation of Danish trauma care depends on respect for the present national advantages and internalisation of international experiences. The author recommends a nationally co-ordinated reorganisation in accordance with the guidelines of American College of Surgeons Committee on Trauma.