Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2003
Comparative StudyAn easy method of mentally estimating the metabolic component of acid/base balance using the Fencl-Stewart approach.
The Stewart approach defines acid/base abnormalities as resulting from changes in PCO2, strong ion difference (SID), and weak acids (mainly albumin) but needs a computer for calculation. The base excess (BE) is a measure of the net effect of changes in SID and weak acids, therefore, metabolic acid/base balance can be described as BE effects of their change from normal. We compared our mental estimation of BE effects with the more complex calculation. ⋯ However the bias (limits of agreement) for BE-gap and BE-gap(est) and strong ion gap were poor, being 1.1 (-4 to 14) mEq/l and 0.4 (-9.2 to 10) mEq/l respectively. The BE-gap and BE-gap(est) are unsuitable to quantify gap ions. However, our easy-to-perform estimation has a clinically acceptable bias compared to calculated BE effects and is a simple method for identifying the components of acid/base abnormalities.
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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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We describe a case of tracheal rupture diagnosed after an apparently routine endotracheal intubation for otherwise uneventful lower abdominal surgery in a 33-year-old woman. Risk factors for tracheal rupture, presenting symptoms and signs, management of tracheal rupture and methods of airway management during the surgical repair of the tracheal laceration are discussed. In this case, "side-by-side" microlaryngoscopy tubes, one endobronchial and the other with the tip in the upper trachea, placed with fibreoptic assistance were used for airway management during the tracheal repair.