Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Apr 2012
ReviewStrategies of empiric antibiotic therapy in severe sepsis.
Severe sepsis and septic shock remain the leading causes of multiple organ failure and mortality in surgical intensive care units. Early antibiotic therapy recently became a challenge, because of the increased number of infections caused by multiple drug resistant bacteria, with Gram-negative bacteria such as Klebsiella pneumoniae and Pseudomonas aeruginosa being the most frequently cultured pathogens. In this review, detailed recommendations for the treatment of various infections are presented and discussed, with particular emphasis on the determination of empiric antibiotic therapy in the early stages of sepsis and localised infections.
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Anaesthesiol Intensive Ther · Apr 2012
ReviewAnaphylactic reactions during anaesthesia and the perioperative period.
Allergy and hypersensitivity occurring during anaesthesia remains a major cause of concern for anaesthesiologists. Drugs administered during surgery and various anaesthetic procedures can elicit two major groups of adverse reactions. The first group includes reactions that are usually dose-dependent and related to the pharmacological properties of a drug and/or its metabolites. ⋯ Multiple organ failure, beginning with bronchospasm and cardiovascular collapse, is typical of latex reactions. An increased serum tryptase concentration confirms the diagnosis of an anaphylactic reaction, and triggers can be identified by skin prick, intradermal injection, or serologic testing. The elimination of triggers during subsequent medical episodes is essential to avoid major mortality and morbidity.
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Anaesthesiol Intensive Ther · Apr 2012
Randomized Controlled Trial Comparative StudyComparison of cuff-pressure changes in silicone and PVC laryngeal masks during nitrous oxide anaesthesia in spontaneously breathing children.
The purpose of this study was to evaluate the cuff pressures of four different laryngeal masks in paediatric patients undergoing routine surgery and to determine whether there is a substantial increase in cuff pressure when silicone masks are used compared to PVC laryngeal mask airways. ⋯ This study demonstrated a substantial increase in cuff pressure during anaesthesia for children in whom a silicone-based LMA-C was used, whereas PVC-based extra glottic airway devices showed a much lower increase.
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Anaesthesiol Intensive Ther · Apr 2012
Randomized Controlled TrialEffect on cognition of galanthamine administered for neuromuscular block reversal in octogenarians undergoing cataract surgery.
The purpose of the study was to determine the possible effect of the cholinesterase inhibitor, galanthamine, on cognition when administered to antagonise neuromuscular blockade after anaesthesia. ⋯ In octogenarians, impaired organ function as well as changes in body composition, are factors which affect the pharmacodynamics and pharmacokinetics of drugs.
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Methods for the restoration of circulating blood volume, including the use of intravenous fluids, have been widely discussed over many years. There are no clear guidelines regarding the type of solutions, the total volume that should be transfused, or time schedules. Colloid solutions, usually hydroxyethyl starch compositions, are probably the most commonly used volume expanders in resuscitation, despite the lack of convincing trials and possible nephrotoxicity. ⋯ Among crystalloid solutions, balanced preparations such as acetates, lactates, malates or citrates are recommended to avoid hyperchloraemia, a common side effect of saline infusion. There is no agreement regarding colloid solutions. The fluid transfusion regimen in critically ill patients should therefore be based on clinical assessment and patient responses.