Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1989
Right ventricular dysfunction in septic shock: assessment by measurements of right ventricular ejection fraction using the thermodilution technique.
Right ventricular ejection fraction (RVEF) was measured by the thermodilution technique in a series of 127 consecutive critically ill patients monitored with a modified pulmonary artery (PA) catheter equipped with a fast response thermistor. Thermodilution RVEF was significantly lower in septic shock (23.8 +/- 8.2%, 93 measurements) than in sepsis without shock (30.3 +/- 10.1%, 118 measurements) or in the absence of sepsis or cardiopulmonary impairment (32.5 +/- 7.1%, 62 measurements). ⋯ Initial RVEF in septic shock was 27.8 +/- 8.6% in 11 patients who survived but only 20.9 +/- 6.7% (P less than 0.02) in the 23 patients who eventually died. Thus, RV dysfunction is common during septic shock, is directly related to its severity, and can easily be recognized in patients monitored with a PA catheter.
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Acta Anaesthesiol Scand · Jan 1989
Randomized Controlled Trial Clinical TrialChest wall rigidity during fentanyl- and midazolam-fentanyl induction: ventilatory and haemodynamic effects.
In a double-blind randomised study, we examined if pretreatment with small doses of midazolam, given before anaesthesia induction with fentanyl, influences the occurrence of fentanyl-induced thoracic rigidity (FITR). At the same time, the effect of rigidity on the cardiovascular and respiratory system was assessed. Sixteen patients undergoing coronary artery bypass surgery were divided into two groups. ⋯ The incidence of FITR was high in both groups: 63% in Group M and 75% in Group P (n.s.); however, its severity was less in Group M. The appearance of rigidity affected the cardiovascular and the respiratory system: central venous and pulmonary capillary wedge pressures showed a sharp increase in patients with FITR accompanied by CO2 retention, due to an inability to ventilate these patients adequately. We conclude that small doses of midazolam do not prevent, but may attenuate, FITR and that the appearance of rigidity causes alterations of haemodynamic and respiratory variables during induction.
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Acta Anaesthesiol Scand · Jan 1989
Randomized Controlled Trial Clinical TrialThe effect of continuous intravenous indomethacin infusion on bleeding time and postoperative pain in patients undergoing emergency surgery of the lower extremities.
Fifty-four orthopaedic patients were given either indomethacin (25-50 mg bolus plus infusion, 5-7.5 mg h-1) or only lactated Ringer solution intravenously over 20 h in a randomized and double-blind fashion. The study was started at the casualty department as soon as possible after the decision to operate was made. The patients were given a spinal block with bupivacaine, and the evaluation included postoperative analgesia and IVY bleeding times. ⋯ The mean IVY bleeding time was prolonged in the indomethacin group after 20 h of infusion (P less than 0.05). No abnormal bleeding was observed immediately postoperatively. However, at the end of the infusion there were more patients who bled through their bandages and casts in the indomethacin group (4/28 vs. 1/26).
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Acta Anaesthesiol Scand · Jan 1989
Comparative StudySurvival compared to the general population and changes in health status among intensive care patients.
In order to evaluate intensive care, all adult patients (980) admitted to a multidisciplinary intensive care unit (ICU) during 1 year were followed prospectively. The ICU mortality was 9.6%. One year after admission the survival was 73.6%. ⋯ Increased age and length of stay in the ICU were associated with higher mortality but not with changes in health status. We conclude that the outcome of intensive care can be evaluated by studying only the survival, since the survival rate is correlated to changes in health status among survivors in the different admission groups. One year after admission most of the surviving patients had regained their previous health status and their further survival was almost the same as that of the general population.
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Acta Anaesthesiol Scand · Jan 1989
Continuous interscalene brachial plexus block: clinical efficacy, technical problems and bupivacaine plasma concentrations.
Continuous interscalene brachial plexus block with a single dose of 0.5% bupivacaine 1.25 mg/kg, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h, was performed on 24 patients to provide analgesia during shoulder surgery and in the postoperative period. The drugs for general anaesthesia included glycopyrrolate, thiopentone, vecuronium, enflurane and N2O/O2. All patients had signs of regional analgesia 30 min after the block without haemodynamic problems. ⋯ During the 24-h period, the alpha 1-acid glycoprotein (AAG) concentration (mean +/- s.e.mean) in plasma rose from 0.41 +/- 0.04 g/l to 0.54 +/- 0.04 g/l (P less than 0.001). The concentration of free bupivacaine was below detectable levels (less than 0.01 micrograms/ml) after the 24-h infusion. The rise in AAG probably increases binding of bupivacaine to plasma proteins, diminishing the risk of systemic toxicity.