Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 1999
Randomized Controlled Trial Clinical TrialEffects of sevoflurane and isoflurane anesthesia on arterial ketone body ratio and liver function.
The purpose of this study was to compare the effect on arterial ketone body ratio (AKBR), which indicates hepatic mitochondrial energy charge in relation to hepatic blood flow, and liver function test (serum levels of liver enzymes) between sevoflurane and isoflurane anesthesia. ⋯ Isoflurane induced an elevation of serum levels of liver enzymes more frequently than did sevoflurane 3 to 14 days after anesthesia, while AKBR until 12 h after anesthesia did not show any significant difference between sevoflurane and isoflurane anesthesia.
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Acta Anaesthesiol Scand · Mar 1999
Case ReportsOne-lung ventilation when intubation is difficult--presentation of a new endobronchial blocker.
One-lung ventilation utilizing a double-lumen endotracheal tube may be technically difficult or inappropriate in morbidly obese or critically ill patients. In patients requiring awake fiberoptic intubation, double-lumen tube placement may be impossible. Wire-guided endobronchial blockade through a conventional endotracheal tube is a new alternative for these patients. ⋯ The WEB system allows one-lung ventilation to be achieved with a conventional endotracheal tube. The need for reintubation at the end of surgery is eliminated and endotracheal tube cross-sectional area is conserved.
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Acta Anaesthesiol Scand · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialComparative effects of intravenous ketorolac and pethidine on perioperative analgesia and postoperative nausea and vomiting (PONV) for paediatric strabismus surgery.
Corrective strabismus surgery is associated with moderate pain and a very high incidence of postoperative nausea and vomiting (PONV). Ketorolac tromethamine, a nonsteroidal anti-inflammatory drug, is a popular analgesic in adults. There are only limited published data on the use of intravenous ketorolac for paediatric analgesia perioperatively. This study evaluated and compared the emetic and analgesic effect of ketorolac with pethidine and its suitability for this kind of surgery. ⋯ Ketorolac in a dose of 0.9 mg kg-1 i.v. at the induction of anaesthesia is as effective as pethidine 0.5 mg kg-1 i.v. as an analgesic and is associated with significantly less PONV.
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Acta Anaesthesiol Scand · Mar 1999
Randomized Controlled Trial Clinical TrialPositive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration.
General anaesthesia impairs the gas exchange in the lungs, and moderate desaturation (SaO2 86-90%) occurred in 50% of anaesthetised patients in a blinded pulse oximetry study. A high FiO2 might reduce the risk of hypoxaemia, but can also promote atelectasis. We hypothesised that a moderate positive end-expiratory pressure (PEEP) level of 10 cmH2O can prevent atelectasis during ventilation with an FiO2 = 1.0. ⋯ PEEP = 10 cmH2O reduced atelectasis formation after a VCM, when FiO2 = 1.0 was used. Thus, a VCM followed by PEEP = 10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.
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Nitric oxide (NO) is normally produced in the endothelium by the constitutive isoform of the NO synthase. This physiological production of NO is important for blood pressure regulation and blood flow distribution. Several lines of evidence suggest that a hyperproduction of NO by the inducible form of NO synthase (iNOS) may contribute to the hypotension, cardiodepression and vascular hyporeactivity in septic shock. ⋯ A main new aspect of this review is a critical discussion of previous reports measuring plasma nitrite/nitrate during septic shock and an evaluation of the validity of interpreting these data as evidence for a hyperproduction of NO. This review also emphasizes that many septic patients have preexisting endothelial dysfunction and lung diseases, which may contribute to adverse effects by systemic inhibition of NO synthesis. Another new aspect of the present review is a focus on the lack of direct evidence of iNOS expression in human septic shock.