Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1992
Gas exchange impairment and pulmonary densities after cardiac surgery.
In 11 patients with impaired respiratory function after coronary artery revascularization surgery, thoracic computed tomography (TCT) and cardiopulmonary profile were obtained. The patients were haemodynamically stable without clinical or radiological signs of lung oedema. Oxygenation was reduced in all patients (alveolo-arterial PO2-difference (PA-aO2) = 37.3 +/- 10.39 kPa, venous admixture (QVA/QT) = 26.4 +/- 4.4%) during mechanical ventilation with positive end-expiratory pressure (PEEP = 5 cmH2O) (0.5 kPa). ⋯ Atelectatic lung tissues were defined as areas presenting with attenuation values of -200 to +20 Hounsfield Units. The magnitude of non-ventilated areas correlated with QVA/QT (r = 0.875, P < or = 0.01), but not with the duration of either extracorporeal circulation, surgical procedure or general anaesthesia. It is concluded that atelectasis in dependent lung areas contributes to impaired gas exchange after cardiac surgery.
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Acta Anaesthesiol Scand · Nov 1992
Randomized Controlled Trial Comparative Study Clinical TrialSublingual premedication with brotizolam.
This randomized, double-blind and double-dummy study was carried out in order to compare the perioperative sedation after premedication with either brotizolam 0.25-0.50 mg sublingually or diazepam 5-10 mg orally. Sixty-two patients aged 18-60 years scheduled for minor gynaecological surgery in general anaesthesia were included. Assessments were: 1. auditory continued response time (ACRT); 2. coma scale; 3. anxiety scale; and 4. final patient questionnaire. ⋯ The final questionnaire showed (P < 0.05) that the brotizolam group was more satisfied with the effect of the premedication. Seven hours after the premedication the ACRT scores in both groups were similar to those before premedication and all the patients could walk about freely. In conclusion, as a premedicant in outpatients sublingual brotizolam appears to be a good alternative to diazepam.
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Acta Anaesthesiol Scand · Nov 1992
A device for measuring the lateral wall cuff pressure of endotracheal tubes.
A new method for measuring the lateral wall pressure on the trachea from cuffs of endotracheal tubes is presented. The method is based on measuring the force necessary to force a small, constant flow of air through a Teflon or silicone rubber envelope, placed between the cuff and the tracheal wall. ⋯ Dynamic recordings of the lateral wall pressure of high and low residual volume cuffs can be obtained for analysis of the interaction between the cuff and the tracheal compliance. No method for accurate, dynamic recording of the lateral wall cuff pressure has previously been published.
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Acta Anaesthesiol Scand · Nov 1992
Therapeutic intervention scoring system (TISS)--a method for measuring workload and calculating costs in the ICU.
The Therapeutic Intervention Scoring System (TISS) is an easily applicable method for measurement of workload in the intensive care unit (ICU). In the present study a modified TISS-scoring (mTISS) was performed daily during 1988-1989 on 2693 patients in a general ICU. Of these, 900 could be classified as 'true' ICU-patients (ICU-stay > or = 24 h or TISS > or = 20 points), whereas the rest were postoperative. ⋯ The cost of each mTISS-point was calculated. In conclusion, the present study showed that mTISS is a valuable tool when evaluating resource utilization in the ICU. Together with the proposed workload-index and calculation of costs, mTISS could be used for ICU management control.
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Acta Anaesthesiol Scand · Nov 1992
The effect of acute hypothermia and serum potassium concentration on potassium cardiotoxicity in anesthetized rats.
We examined the effects of hypothermia on serum K+ concentration and the interaction of body temperature and K+ load on cardiac toxicity in anesthetized rats. Serum K+ concentration significantly decreased to 2.61 +/- 0.13, 2.59 +/- 0.19 and 2.39 +/- 0.14 mmol/l at 31.0 degrees C, 28.0 degrees C and 25.0 degrees C, respectively, from the control value of 2.80 +/- 0.15 mmol/l at 37.0 degrees C. ⋯ These data indicate that the level at which an elevation of serum K+ concentration causes cardiac toxicity diminishes with progressive hypothermia. We conclude that hypothermia induces hypokalemia, possibly through redistribution, and that the myocardium appears to be more sensitive to the toxic effects of K+ as hypothermia deepens.