Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1998
Comparative StudyThoracoscopic microsurgical technique for vertebral surgery--anesthetic considerations.
The thoracoscopic microsurgical technique (TMT) for vertebral and spinal cord surgery is associated with the benefits of reduced postoperative pain, accelerated return to physical activity and reduced complication rates. However, because of the surgeon's requirement of a non-ventilated lung, it confronts the anesthesiologist with the need for extremely long duration of single-lung ventilation (SLV). ⋯ We conclude that despite the long duration of SLV, TMT is a reasonable alternative to open thoracotomy for thoracic neurosurgical spine procedures because of the substantial clinical benefits of accelerated return to physical activity, reduced complication rates and reduced intensive care unit and hospital stay.
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Acta Anaesthesiol Scand · Nov 1998
Randomized Controlled Trial Comparative Study Clinical TrialPuncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture.
This clinical study was conducted in order to investigate the effect of two different orientations of the bevel during dural puncture on development of postural postdural puncture headache (PPDPH). ⋯ Dural puncture with the bevel of the needle transverse to the longitudinal axis of the dural cylinder gave significantly more cases of PPDPH than puncture with the bevel parallel to this axis even when using a 27-g Quincke needle. When using Quincke bevelled needles care must be taken to assure that the orientation of the bevel is parallel to the longitudinal axis of the dural sac.
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Acta Anaesthesiol Scand · Nov 1998
Effects of recruitment of collapsed lung units on the elastic pressure-volume relationship in anaesthetised healthy adults.
The elastic pressure-volume (Pel-V) curve of the respiratory system can be used as a guide for improved ventilator management. The understanding of curves recorded for sick patients can be improved with better knowledge of the Pel-V relationship observed in healthy humans. Dynamic Pel-V curves were determined over an extended volume range in 15 anaesthetised and muscle-relaxed healthy humans. The influence of a recruitment manoeuvre was studied. ⋯ Pel-V curves recorded before and after the recruitment manoeuvre show that large lung compartments close during anaesthesia and that high pressures are needed to achieve recruitment even in the normal lung. Accordingly, the LIP does not define the end of recruitment during insufflation.
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Acta Anaesthesiol Scand · Nov 1998
Forward blood flow during cardiopulmonary resuscitation in patients with severe accidental hypothermia. An echocardiographic study.
The mechanism responsible for the forward blood flow associated with external chest compression is still controversial. Evidence for both blood flow caused by direct cardiac compression and blood flow generated by a general increase in intrathoracic pressure has been found in experimental as well as clinical studies. No data are available concerning the mechanism causing forward blood flow in hypothermic patients undergoing cardiopulmonary resuscitation. Therefore, echocardiographic findings during external chest compression in seven hypothermic arrest victims are reported. ⋯ In contrast to normothermic arrest victims, an open mitral valve during external chest compression is a common finding during hypothermia, indicating that thoracic pump mechanism is important for forward blood flow during cardiopulmonary resuscitation in hypothermic arrest victims. Aortic valve opening in two hypothermic arrest victims suggests forward blood flow also during active decompression of the thorax with the Cardiopump.