Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1997
ReviewAcute weakness syndromes in critically ill patients--a reappraisal.
Over the last twenty years, increasing numbers of critically ill, mechanically ventilated patients who develop acute profound muscle weakness have been described. These acute weakness syndromes have not been well understood and they have been given many names including: acute steroid myopathy, acute quadriplegic myopathy, the floppy person syndrome, critical illness polyneuropathy, critical illness polyneuromyopathy, and prolonged neurogenic weakness. Many of these "syndromes" either overlap or represent the same disease process in different patients. ⋯ Neuropathies are divided into critical illness polyneuropathy and acute motor neuropathy. The anterior horn cell injury in Hopkins syndrome should also be considered in this group. Polyneuromyopathies include various combinations of neuropathy and myopathy in the same patients.
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Anaesth Intensive Care · Oct 1997
Comparative StudyContinuous measurement of arterial and end-tidal carbon dioxide during cardiac surgery: Pa-ETCO2 gradient.
There have been reports of a negative arterial to end-tidal CO2 gradient (Pa-ETCO2) during cardiac surgery, so we used capnometry and an intravascular blood gas sensor (Paratrend 7) to continuously monitor this gradient in 20 cardiac surgical patients. We also compared the values obtained from this sensor with those obtained from a standard blood gas analyser at seven time points. We found a significant change in Pa-ETCO2 after cardiopulmonary bypass (P < 0.001) though we were unable to demonstrate a negative Pa-ETCO2 at any time (95% CI 0-14%). There was clinically acceptable agreement between laboratory and Paratrend 7 measurements during and after cardiac surgery.
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Anaesth Intensive Care · Oct 1997
Comparative StudyAnaesthetists' attitudes towards an anaesthesia simulator. A comparative survey: U.S.A. and Australia.
Anaesthesia simulation has been suggested as a method to enhance the training of clinicians without exposing patient to risk. Recently, two anaesthesia simulators have become commercially available in the U. S. ⋯ The most frequent comment related to the cost. There is majority support for the purchase of an anaesthesia simulator but there is widespread concern for its high cost. In general, anaesthesia simulation is perceived more as an education tool rather than an instrument for (re)certification.
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Anaesth Intensive Care · Oct 1997
Case ReportsTricyclic poisoning--successful management of ventricular fibrillation following massive overdose of imipramine.
Serious complications from tricyclic antidepressant (TCA) overdose are uncommon. We present a case of massive imipramine overdose complicated by ventricular fibrillation and a prolonged period of cardiovascular collapse. A total of 400 mmol of sodium bicarbonate, 5 mg of adrenaline and 80 mg of sotalol were given during 50 minutes of cardiac arrest. ⋯ The highest TCA plasma level we could find in the published literature was 4873 ng/ml4; our patient's peak TCA level was 6000 ng/ml. Tricyclic antidepressant overdose is a common cause of intensive care unit admission. It has a low mortality rate.