European journal of anaesthesiology
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Comparative Study
Outcome from intensive care. I. A 5-year study of 1308 patients: methodology and patient population.
During a 5-year period, from 1979 to 1983, demographic and disease-related data were collected prospectively on 1308 adult patients from 1555 admissions to a multidisciplinary intensive care unit (ICU) in a Danish university hospital. The patients were followed during the stay in ICU, the ensuing hospital stay, and up to 8 years after discharge from hospital. The male: female ratio was 1:1. ⋯ The APACHE- and TISS-systems were simultaneously applied to a representative sample of 216 consecutive admissions. The average APACHE score was 14.9 +/- 8.2 and the average TISS score 28.3 +/- 11.1 points. The ICU patients presented in this paper do not differ much from ICU patients in other outcome studies.
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Randomized Controlled Trial Clinical Trial
Post-operative sore throat: effect of lignocaine jelly and spray with endotracheal intubation.
The effects of laryngeal lignocaine spray and/or lignocaine jelly as lubricants were studied on the incidence of sore throat, hoarseness, or tracheal irritability as evidenced by either a tendency to cough or frank coughing after intubation with a Sensiv tube (Searle Medical Products). Pressure in the medium-volume, low-pressure cuff was controlled and kept below 2.5 kPa (25 cmH2O) during anaesthesia. The side-effects of 94 surgical patients were recorded in a double-blind manner in the recovery room and on the first post-operative day. ⋯ In 42% of the patients receiving N2O a limiting value of 2.5 kPa (25 cmH2O) was reached during anesthesia in a mean time of 74 min (range 25-180 min). After the replacement of N2O with nitrogen, the cuff pressure decreased from 1.8 kPa (18 cmH2O) to 0.7 kPa (7 cmH2O) over 40 min. It is concluded that lignocaine jelly with the use of a spray significantly increases post-operative side-effects.
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Comparative Study Clinical Trial Controlled Clinical Trial
Suxamethonium-induced facilitation of spontaneous frontal EMG activity.
The behaviour of spontaneous frontal electromyographic activity (FEMG) was studied during the recovery from suxamethonium and vecuronium block. In order to obtain comparable conditions in the study groups, the duration of the suxamethonium block was prolonged with a suxamethonium infusion. The FEMG was continuously recorded and the evoked electromyographic (EEMG) and twitch tension (ETT) responses were measured every 10 s from the thenar muscles. ⋯ In the suxamethonium group there was an increase in FEMG in all six patients when EEMG had recovered to 10%, and significantly higher FEMG readings were obtained during further recovery from the block. Thus, early recovery of neuromuscular transmission is detected by FEMG more easily when suxamethonium is used instead of vecuronium. The different behaviour of FEMG may reflect a difference in the recovery ratio of ETT/EEMG or in the anaesthetic depth caused by the two types of neuromuscular blockers.
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Randomized Controlled Trial Clinical Trial
Administration of vecuronium, atracurium and pancuronium in divided doses: effect on onset and duration of action.
The time to onset of neuromuscular block (as assessed by single twitch stimulation at 0.1 Hz) and the duration to 25% recovery of twitch height were measured after administration of vecuronium 0.1 mg kg-1, atracurium 0.5 mg kg-1 or pancuronium 0.1 mg kg-1, administered either as a single bolus or in divided doses, 10% being administered 4 min prior to the remaining 90%. The patients were anaesthetized with thiopentone, nitrous oxide in oxygen and i.v. fentanyl. There was no significant difference between the single- and divided-dose groups, either in the onset times (2.8 and 2.9 min for vecuronium, 2.7 and 2.4 min for atracurium and 3.3 min each for pancuronium for single- and divided-dose groups, respectively) or the duration to 25% recovery of twitch height (35 and 29 min for vecuronium, 45 and 39 min for atracurium and 87 and 93 min for pancuronium for single- and divided-dose groups, respectively).
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This review describes the distribution of ventilation and blood flow in the anaesthetized subject, during spontaneous breathing and after muscle paralysis. Within minutes after induction of anaesthesia, the diaphragm is shifted cranially (supine position), functional residual capacity is reduced and collapse of dependent lung regions can be seen by means of computed tomography. These changes occur whether anaesthesia is intravenous (barbiturate) or inhalational (halothane) and whether ventilation is spontaneous or mechanical. ⋯ This causes a ventilation/perfusion mismatch, the hall-mark of which is shunt. Additional factors such as airway closure and release of hypoxic pulmonary vasoconstriction may contribute to the gas exchange disturbance. The major features of the lung function impairment are already present during spontaneous breathing in the anaesthetized subject, and muscle paralysis adds only little to the disturbance.