European journal of anaesthesiology
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Nucleoside analogue-induced lactic acidosis is an often fatal condition in patients with HIV. There is only one report of successful treatment with riboflavin. ⋯ Successful treatment of nucleoside analogue-induced lactic acidosis with a high dose of thiamine supports the hypothesis that vitamin deficiency is an important cofactor in the development of this rare and unpredictable condition in patients with HIV. We suggest that high dose B-vitamins should be given to any patient presenting with lactic acidosis under nucleoside analogue treatment.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of intra-articular fentanyl and intra-articular bupivacaine for post-operative pain relief after knee arthroscopy.
A randomized double-blinded study consisting of 107 patients was conducted to compare the effect on post-operative pain relief of intra-articular fentanyl and intra-articular bupivacaine after knee arthroscopy. The results showed that intra-articular bupivacaine produced superior analgesia in the immediate post-operative period. ⋯ After 2 h post-operatively, intra-articular bupivacaine and intra-articular fentanyl had a similar effect on pain scores. The mean pain score 18 h post-operatively was 2.7 for the intra-articular bupivacaine group (standard deviation 2.2, P value 0.6) compared with the intra-articular fentanyl group which had a mean pain score of 2.8 (standard deviation 1.9, P value 0.6).
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It has been suggested that epidural anaesthesia may increase blood flow in free flaps on the lower extremity. The objective of the present study was to test this hypothesis in 21 patients undergoing reconstructive surgery of the lower extremity with free muscle (n = 8), fasciocutaneous (n = 6) or musculocutaneous (n = 7) flaps. Microcirculatory blood flow was measured continuously with a multichannel laser Doppler flowmetry, both in muscle and skin of the free flap as well as in the intact skin and muscle on the same extremity. ⋯ The epidural block caused no change in microcirculatory flow in the intact skin and muscle, however, it resulted in a marked decrease in microcirculatory blood flow in all the free flaps studied (20-30%; P < 0.05). The epidural block also caused a significant decrease in mean arterial blood pressure, from 85 (+/- 2.8) mmHg to 68 (+/- 2.8) mmHg (P < 0.01). It was concluded that epidural anaesthesia may decrease microcirculatory blood flow in free flaps on the lower extremity by diverting flow away from the flap to normal intact tissues (a steal phenomenon).
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Optimal control of long-term sedation during therapy in the intensive care unit is difficult to achieve in a number of patients when based on commonly used clinical sedation scores alone. We therefore used the median frequency of the EEG power spectrum as a quantitative measure for closed-loop administration of propofol in 21 artificially ventilated patients (nine trauma, 12 non-trauma). ⋯ Non-trauma patients required sedation with an EEG median frequency between 2 and 3 Hz (propofol consumption: 1.4 +/- 0.8 mg kg-1 h-1) and sedation seemed to follow some circadian patterns, whereas trauma patients needed significantly deeper sedation (EEG median frequency: 1-2 Hz; propofol consumption: 2.6 +/- 0.8 mg kg-1 h-1). We conclude that the EEG closed-loop system could safely and reliably administer propofol to maintain a predetermined level of sedation for patients in intensive care unit over a protracted time.
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The aim of the study was to test the hypothesis that the requirement of sufentanil is reduced in elderly patients when the opiate is primarily used to facilitate mechanical ventilation in a medical intensive care unit. A further aim was to study whether elderly patients developed withdrawal symptoms after discontinuing prolonged sufentanil administration. We have studied prospectively two groups of patients requiring mechanical ventilation for more than 96 h; group 1 age < 60 years (n = 316 or 68%) and group 2 age > 70 years (n = 150 or 32%). ⋯ There was no statistical difference between the two groups in sufentanil requirement at any time during the study. This suggests that tachyphylaxis develops to a similar degree in patients in both age groups. In addition, weaning in the elderly was characterized by a similar degree of withdrawal-like symptoms suggesting that independent of age, there are similar receptor related reactions once the opiate is withdrawn.