Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1999
Comment Letter Biography Historical ArticleThe Marrett apparatus.
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Anaesth Intensive Care · Feb 1999
Review Case ReportsSurgical emphysema following percutaneous tracheostomy.
We report two patients in whom a Portex GWDFT was complicated by surgical emphysema. Subsequent examination revealed posterior tracheal wall tears in these patients. The exact aetiology of these tears is unknown, although the tracheostomy tube introducer may have been implicated. We suggest a management plan for this complication.
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Anaesth Intensive Care · Feb 1999
Randomized Controlled Trial Clinical TrialThe effect of midazolam on persistent postoperative nausea and vomiting.
The effect of intravenous midazolam on persistent postoperative nausea and vomiting (PONV) was compared to placebo in a prospective randomized double-blind study. Twenty patients aged 18 to 82 years with persistent PONV resistant to standard anti-emetics and present for greater than six hours were randomized to receive either an intravenous infusion of midazolam 1.0 mg/h or placebo. Nausea (P = 0.04), vomiting (P = 0.02) and the use of rescue anti-emetics (P = 0.003) were significantly less in the midazolam group. We conclude that low-dose intravenous infusion of midazolam significantly reduces persistent PONV.
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Anaesth Intensive Care · Feb 1999
Comparative StudyEpidural analgesia reduces the release of amino acids from peripheral tissues in the ebb phase of the metabolic response to major upper abdominal surgery.
The purpose of this prospective cohort study was to compare metabolic effects of epidural or patient controlled analgesia (PCA) in patients undergoing major upper abdominal surgery. Seventeen patients undergoing major upper abdominal surgery were included: 10 received perioperative epidural analgesia (Group I) and the remainder received morphine via a PCA device for postoperative analgesia (Group II). A number of measures compared between one day preoperatively (day 1) and day 2 postoperatively included femoral arterial and venous blood concentrations of glucose, lactate, pyruvate and amino acids. ⋯ The efflux of glycine, methionine, amino benzoic acid, alanine, and lysine was less in Group I than Group II on day 2 (P < 0.05). There was a significant difference in the total amino acid flux on day 2 (Group I = -1.2 mumol. (100 ml tissue)-1.min-1 cf Group II = -2.5 mumol. (100 ml tissue)-1.min-1; P = 0.04). In conclusion, perioperative epidural analgesia was associated with a reduced postoperative amino acid efflux two days following major upper abdominal surgery.
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Anaesth Intensive Care · Feb 1999
Comparative StudyHaemodynamic measurements (continuous cardiac output and systemic vascular resistance) in critically ill patients: transoesophageal Doppler versus continuous thermodilution.
Ten critically ill patients underwent this prospective study to assess the reliability of the continuous thermodilution versus transoesophageal Doppler techniques in the determination of continuous cardiac output (CO) and systemic vascular resistance (SVR). A total of 145 pairs of CO and SVR measurements were obtained by both a pulmonary artery catheter with a heated filament and a transoesophageal Doppler apparatus (ODM II). ⋯ Transoesophageal Doppler accurately measures continuous CO and SVR in critically ill patients. It should be viewed as complementary to pulmonary catheterization.