Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2001
Randomized Controlled Trial Clinical TrialOn-site coagulation monitoring does not affect hemostatic outcome after cardiac surgery.
Rapid coagulation tests are now available for monitoring of bleeding patients after cardiac surgery. As inappropriate blood use in these patients may be due to lack of timely coagulation data, we studied the effect of an algorithm with on-line coagulation monitoring on transfusions in these patients. ⋯ Algorithm-based therapy increased utilization of hemostatic interventions during the immediate recovery period without any obvious benefit to the hemostatic outcome. Re-evaluation of the platelet transfusion trigger seems warranted.
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Acta Anaesthesiol Scand · Feb 2001
Direct tracheal airway pressure measurements are essential for safe and accurate dynamic monitoring of respiratory mechanics. A laboratory study.
All monitoring of respiratory mechanics should depend on tracheal pressures (Trach-P) as endotracheal tube resistance (ETT-Res) will otherwise distort them. The aim of this study was to investigate factors that may vary ETT-Res, causing difficulties in ETT-Res estimation clinically, and to evaluate a method for direct Trach-P measurements to obviate these problems. ⋯ ETT connections and secretions cause a variance in resistance. Tracheal pressure can be measured with high precision with an air- or liquid-filled catheter. An end hole catheter placed within 2 cm above or below the ETT tip will give sufficiently precise measurements for clinical purposes.
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Acta Anaesthesiol Scand · Feb 2001
Clinical TrialDescending aortic blood flow and cardiac output: a clinical and experimental study of continuous oesophageal echo-Doppler flowmetry.
Several studies have demonstrated that perioperative optimisation of oxygen delivery and haemodynamics can reduce mortality and morbidity for high-risk surgical patients. To optimise cardiac output, reliable, continuous and "less invasive" methods for measuring cardiac output are urgently needed. ⋯ A combined echo-Doppler technique can be valuable for continuous monitoring of haemodynamic changes in the perioperative setting, and changes in aortic blood flow agree well with corresponding changes in cardiac output intermittently obtained by thermodilution cardiac output measurements. With the combined echo-Doppler technique a proper position of the Doppler beam is greatly facilitated by the M-mode echo visualisation of the aortic wall and aortic cross-sectional area is continuously measured.
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Acta Anaesthesiol Scand · Feb 2001
Randomized Controlled Trial Comparative Study Clinical TrialBronchial blocker compared to double-lumen tube for one-lung ventilation during thoracoscopy.
Video-assisted thoracoscopic surgery (VATS) requires one-lung ventilation with a properly collapsed lung. This study compared the Broncho-Cath double-lumen endotracheal tube with the Wiruthan bronchial blocker to determine the advantages of one device over the other during anaesthesia with one-lung ventilation for thoracoscopy. ⋯ It took significantly longer to place a left BB than a DLT (P<0.0006) or a right BB (P<0.008). The number of initial malpositionings of the left BB was significantly greater than in the other groups (P<0.001). The quality of lung deflation was better in the BBL and in the DLT groups than in the BBR group. We conclude that for routine use during left-sided VATS, the use of a DLT is preferable to a left BB because of its greater ease of placement. For right-sided VATS, DLT and right BB showed the same facility of placement but the DLT provided a better quality of lung deflation.
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Acta Anaesthesiol Scand · Feb 2001
Randomized Controlled Trial Comparative Study Clinical TrialReversal of rocuronium with edrophonium during propofol versus sevoflurane anesthesia.
The use of volatile anesthetics for maintenance of anesthesia can enhance the action of non-depolarizing muscle relaxants and interfere with the reversal of neuromuscular blockade. In this study, we studied the antagonism of rocuronium with edrophonium-atropine during propofol- versus sevoflurane-based anesthesia. ⋯ We conclude that the clinical duration of action after a single dose of rocuronium, 0.6 mg kg(-1) i.v., was similar during both propofol- and sevoflurane-based anesthesia. However, the reversal of rocuronium-induced residual blockade was slower and more variable in the presence of sevoflurane.