Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2003
Case ReportsThe Bispectral Index and induced hypothermia--electrocerebral silence at an unusually high temperature.
The optimal temperature for deep hypothermic circulatory arrest remains undefined. We present a case in which Bispectral Index monitoring during hypothermic cardiopulmonary bypass showed electrocerebral silence at a higher temperature than previously reported. Bispectral Index monitoring may be a potentially useful tool in surgery employing deep hypothermic circulatory arrest.
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Anaesth Intensive Care · Oct 2003
Case ReportsOrthodeoxia--an uncommon presentation following bilateral thoracic sympathectomy.
We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.
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Anaesth Intensive Care · Oct 2003
Outcome prediction in a surgical ICU using automatically calculated SAPS II scores.
The objective of this study was to establish a complete computerized calculation of the Simplified Acute Physiology Score (SAPS) II within 24 hours after admission to a surgical intensive care unit (ICU) based only on routine data recorded with a patient data management system (PDMS) without any additional manual data entry. Score calculation programs were developed using SQL scripts (Structured Query Language) to retrospectively compute the SAPS II scores of 524 patients who stayed in ICU for at least 24 hours between April 1, 1999 and March 31, 2000 out of the PDMS database. The main outcome measure was survival status at ICU discharge. ⋯ The Hosmer-Lemeshow goodness-of-fit statistics showed good calibration (H = 5.55, P = 0.59, 7 degrees of freedom; C = 5.55, P = 0.68, 8 degrees of freedom). The technique used in this study for complete automatic data sampling of the SAPS II score seems to be suitable for predicting mortality rate during stay in a surgical ICU. The advantage of the described method is that no additional manual data recording is required for score calculation.
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Anaesth Intensive Care · Oct 2003
Case ReportsAnaesthetic management of the parturient with protein S deficiency and lumboperitoneal shunt.
Protein S, a vitamin K-dependent plasma protein, is a cofactor for protein C, an essential component of the regulatory system of coagulation. We describe the anesthetic management of a parturient with protein S deficiency and an indwelling lumboperitoneal shunt, which was placed following transverse and sagittal sinus thrombosis. She was treated with aspirin and enoxaparin during pregnancy and underwent caesarean section under general anaesthesia without complication.
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Anaesth Intensive Care · Oct 2003
Case ReportsCombined spinal and epidural anaesthesia for caesarean section in a parturient with severe primary pulmonary hypertension.
We describe the management of a parturient with severe primary pulmonary hypertension who underwent caesarean section. A multi-disciplinary approach was used. ⋯ Anaesthesia was provided by combined spinal-epidural block. We discuss controversies about the management of obstetric patients with this rare and serious condition.