Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 1986
Self-poisoning treated in an ICU: drug pattern, acute mortality and short-term survival.
A total of 1558 admissions to an ICU over 5 years because of severe self-poisoning with drugs provides the basis for this study. Three drugs accounted for 60% of the admissions: overdose with barbiturates in 28%, with tricyclic antidepressants in 19% and with propoxyphene in 14%. The annual incidence of poisonings with barbiturates and tricyclic antidepressants was the same during the period, whereas the incidence of propoxyphene intoxication increased by 80%. ⋯ By 36 months after the overdose, 235 patients (18%) had died. The expected number of deaths was 39 (3%). The suicide rate in the follow-up period was 10%, in the majority (75%) of whom death was caused by a new episode of self-poisoning.
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Acta Anaesthesiol Scand · Feb 1986
Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis.
Pulmonary gas exchange and the development of atelectasis were studied in eight essentially lung-healthy patients, awake and during halothane anaesthesia with mechanical ventilation. Gas exchange was evaluated by a multiple inert-gas elimination technique and conventional blood-gas analysis, and atelectasis was studied by computerized tomography (CT). Ventilation and lung perfusion were well matched in the majority of the patients when awake. ⋯ Densities in dependent lung regions (interpreted as atelectasis) were seen on the CT scans in six patients. The extent of atelectasis was significantly correlated both to the magnitude of shunt (r = 0.93, P less than 0.01) and to the impairment of arterial oxygenation (r = 0.99, P less than 0.001). The findings indicate that atelectasis in dependent lung regions during halothane anaesthesia creates shunting of blood flow and that atelectasis is the major or sole cause of impaired gas exchange in the lung-healthy, anaesthetized subject.
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Acta Anaesthesiol Scand · Feb 1986
Randomized Controlled Trial Comparative Study Clinical TrialVentilation and ventilatory CO2 response in children during halothane anaesthesia after non-opioid (midazolam) and opioid (papaveretum) premedication.
The influence of non-opioid (NO) and opioid (O) premedication on ventilation and ventilatory CO2 response was studied in 18 spontaneously breathing children during halothane anaesthesia. Eight patients in Group NO and 10 in Group O were comparable in age, body weight and type of surgery performed. The sedative effect was evaluated and measurements by pneumotachography and in-line capnography were made immediately after induction of sleep, just before the start of surgery, during surgery and after surgery both before and after 3 min of about 2% CO2 inhalation. ⋯ ETCO2 was similar in the two groups before, during and after surgery. The ratio of VE to CO2 elimination (VCO2) and of dead space (VD) to tidal volume (VT) was higher in Group NO, but ventilatory response to CO2 inhalation immediately before the postoperative period was similar in both groups. It was concluded that opioid premedication resulted in more efficient ventilation during anaesthesia and surgery, and that CO2 response at the end of surgery was maintained in both groups.
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Acta Anaesthesiol Scand · Feb 1986
Comparative StudyAtelectasis during anaesthesia and in the postoperative period.
Transverse sections of lung tissue were studied in patients by computerized tomography during anaesthesia and in the postoperative period. Eight patients were studied during intravenous (thiopentone) and six during inhalational (halothane) anaesthesia. The latter patients were studied during both spontaneous and mechanical ventilation. ⋯ The densities remained in nine of ten patients 1 h postoperatively, and they remained in five of ten patients 24 h after anaesthesia. The densities are considered to be compression atelectases which may develop as a result of relaxation of the diaphragm. They may be important contributors to postoperative pulmonary complications.
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Acta Anaesthesiol Scand · Feb 1986
Comparative StudyPharmacokinetics of physostigmine after intravenous, intramuscular and subcutaneous administration in surgical patients.
The pharmacokinetics of physostigmine after intravenous, intramuscular or subcutaneous administration as well as its arousal effect after anaesthesia have been studied in surgical patients in the early postoperative period. After intravenous administration physostigmine had a very rapid plasma elimination with a plasma clearance ranging from 47 to 163 l/h with a mean +/- s.d. of 92.5 +/- 37.7 l/h. The volume of distribution was 46.5 +/- 19.2 l, while distribution and plasma elimination half-lives were 2.3 and 22 min, respectively. ⋯ The duration of action was similar after intramuscular injection but onset was delayed by 20-30 min. It was concluded that a plasma concentration of 3-5 ng/ml of physostigmine should be exceeded if an adequate analeptic effect is to be achieved, meaning that 2 mg of physostigmine had to be administered subcutaneously in order to achieve a satisfactory reversal of sedation. The short duration of action may hamper the use of physostigmine as an agent for reversal of drug-induced sedation and anticholinergic effects after surgery.