Anesthesia and analgesia
-
Anesthesia and analgesia · Sep 2001
Clinical TrialDifferential secretion of atrial and brain natriuretic peptide in critically ill patients.
Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are cardiac hormones with natriuretic, vasorelaxant, and aldosterone-inhibiting properties. We analyzed the plasma of 178 critically ill patients for ANP, BNP, aldosterone, and serum sodium concentration, as well as serum and urine osmolality and sodium filtration fraction. Mean plasma concentrations of ANP and BNP were increased in critically ill patients compared with healthy controls (ANP, 14.3 +/- 5.8 pmol/L versus 8.8 +/- 3.2 pmol/L, P < 0.05; BNP, 26.2 +/- 10.7 pmol/L versus 4.6 +/- 2.8 pmol/L, P < 0.0001). ⋯ Our data support a regulatory role for ANP in the maintenance of water and electrolyte balance. The physiologic role of BNP, by contrast, is less clear. ANP and BNP are not predictors for the severity of illness and mortality in critically ill patients.
-
Anesthesia and analgesia · Sep 2001
Case ReportsOpioid overdose in a patient using a fentanyl patch during treatment with a warming blanket.
This case describes the narcotic overdose associated with the use of a fentanyl transdermal patch in a patient being rewarmed with an external warming blanket during surgery. The clinical manifestation and the presumed pharmacokinetic mechanism responsible for the fentanyl overdose are discussed.
-
Anesthesia and analgesia · Sep 2001
Case ReportsPropofol-induced bronchoconstriction: two case reports.
Bronchoconstriction was induced by anesthetic induction with propofol in two patients with allergic diseases. One had severe bronchospasm improved by epinephrine. Propofol should be used with caution in patients with allergic disease.
-
Anesthesia and analgesia · Sep 2001
The relationship between pneumatic tourniquet time and the amount of pulmonary emboli in patients undergoing knee arthroscopic surgeries.
Near-fatal pulmonary embolism can occur immediately after tourniquet release after orthopedic surgeries. In this study, we determined the relationship between tourniquet time and the occurrence of pulmonary emboli in 30 patients undergoing arthroscopic knee surgeries, by using transesophageal echocardiography. The right atrium (RA) was continuously monitored by transesophageal echocardiography, and the number of emboli present was assessed with the following formula: Amount of emboli = 100 x [(total embolic area in the RA after tourniquet release) - (total area of emboli or artifact in the RA before tourniquet release)]/(RA area). ⋯ The peak amount of emboli appeared approximately 50 s after tourniquet release. In addition, there was a significant correlation between amount of emboli (Ae [%]) and tourniquet time (Ttq [min]): (Ae = 0.1 x Ttq - 1.0, r = 0.795, P < 0.01). This study suggests that acute pulmonary embolism may occur within 1 min of tourniquet release and that the number of emboli is dependent on Ttq.
-
Anesthesia and analgesia · Sep 2001
Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest.
To improve the efficiency of standard cardiopulmonary resuscitation (CPR), we evaluated the potential value of impeding respiratory gas exchange selectively during the decompression phase of standard CPR in a porcine model of ventricular fibrillation. After 6 min of untreated cardiac arrest, anesthetized farm pigs weighing 30 kg were randomized to be treated with either standard CPR with a sham valve (n = 11) or standard CPR plus a functional inspiratory impedance threshold valve (ITV(TM)) (n = 11). Coronary perfusion pressure (CPP) (diastolic aortic minus right atrial pressure) was the primary endpoint. ⋯ After 6 min of CPR, mean +/- SEM left ventricular and global cerebral blood flows were 0.10 +/- 0.03 and 0.19 +/- 0.03 mL. min(-1). g(-1) in the Control group versus 0.19 +/- 0.03 and 0.26 +/- 0.03 mL. min(-1). g(-1) in the ITV group, respectively (P < 0.05). Fifteen minutes after successful defibrillation, 2 of 11 animals were alive in the Control group versus 6 of 11 in the ITV group (not significant). In conclusion, use of an inspiratory impedance valve during standard CPR resulted in a marked increase in CPP and vital organ blood flow after 6 min of cardiac arrest.