Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialComparison of isoflurane, halothane and fentanyl in patients with decreased ejection fraction undergoing coronary surgery.
The aim of the study was to compare three anaesthetic agents in patients with ejection fraction below 0.40 subjected to coronary revascularization surgery. Twenty five elective coronary surgical patients with ejection fraction below 0.40 were prospectively studied. Premedication was pethidine 1 mg/kg and induction was fentanyl 0.03 mg/kg and pancuronium 0.1 mg/kg. ⋯ Neither pressure nor flow decreased in patients receiving fentanyl. Following weaning from cardiopulmonary bypass, systemic vascular resistance decreased significantly in all groups. Cardiac index, however, did not increase above control values and arterial pressure consequently decreased; there was no significant difference between groups.
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Anaesth Intensive Care · Oct 1996
Randomized Controlled Trial Comparative Study Clinical TrialMorphine for postoperative analgesia. A comparison of intramuscular and subcutaneous routes of administration.
Intermittent parenteral bolus doses of morphine are commonly used for postoperative analgesia. Morphine is typically given by intramuscular or intravenous injection but there are theoretical advantages for the subcutaneous route of administration. Fifty-nine patients entered a prospective randomized double-blind cross-over study comparing intermittent intramuscular and subcutaneous morphine boluses. ⋯ The majority of patients indicated a strong preference for the subcutaneous route. There were no significant differences in pain scores, respiratory rate, arterial oxygen saturation, heart rate, mean arterial pressure, sedation or nausea scores between intramuscular and subcutaneous administration of morphine. Postoperative analgesia by subcutaneous morphine bolus injection is as effective as intramuscular injection with a similar side-effect profile but with greater patient acceptance and less risk.
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Anaesth Intensive Care · Oct 1996
Comparative StudyInhaled aerosolized prostacyclin and nitric oxide as selective pulmonary vasodilators in ARDS--a pilot study.
Nitric oxide 10 ppm and inhaled aerosolized prostacyclin 50 ng/kg/min were compared as selective pulmonary vasodilators in five patients with hypoxaemia secondary to acute respiratory distress syndrome. Neither agent resulted in systemic haemodynamic changes, indicating true pulmonary selectivity. Inhaled aerolized prostacyclin improved oxygenation to a degree comparable to nitric oxide, as measured by the arterial alveolar oxygen partial pressure gradient and shunt fraction.
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Anaesth Intensive Care · Oct 1996
Alveolar overdistension is an important mechanism of persistent lung damage following severe protracted ARDS.
It is now widely accepted that mechanical ventilation may damage the lung, but the mechanism of lung damage is not clear. Possible causes include overdistension of aerated alveoli by inappropriately large tidal volumes (volutrauma), shear stresses generated during the recruitment and de-recruitment of lung units at the junction of aerated and collapsed lung, and infective or ischaemic necrosis of persistently collapsed lung. ⋯ All three patients had persistent abnormalities of lung structure which were most marked in the anterior regions of the lung. These findings suggest that overdistension of non-dependent lung regions in the main mechanism of lung damage persisting after recovery from severe protracted ARDS.