Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2011
High-resolution solid-state manometry of the effect of rocuronium on barrierpressure.
The pressure in the lower esophageal sphincter (LES) is partly dependent on striated muscles derived from the crural portion of the diaphragm. The effect of neuromuscular blockade on the integrity of the esophagogastric junction is not well studied. We conducted a prospective interventional study to determine the effect of rocuronium on the barrier pressure (LES pressure - intragastric pressure) of the esophagogastric junction. We also studied the effect of positive pressure ventilation on the barrier pressure after neuromuscular blockade with rocuronium. ⋯ Neuromuscular blockade with rocuronium and conversion from spontaneous breathing to positive pressure ventilation does not decrease the barrier pressure during anesthesia induction.
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The present study was designed to investigate the possible effect of chronic alcohol intake on propofol and remifentanil requirements, which was determined by quantifying the 50% (EC(50) ) and 95% (EC(95) ) effective effect-site concentrations for propofol and remifentanil at loss of consciousness (LOC) and after a painful stimulus. ⋯ These findings suggest that the induction dose requirements of propofol are increased in alcoholic patients anaesthetized with propofol and remifentanil administered by target controlled infusion.
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Acta Anaesthesiol Scand · Oct 2011
Influence of prone positioning on the measurement of transpulmonary thermodilution-derived variables in critically ill patients.
Patients with respiratory failure undergoing prone positioning (PP) are often monitored by the transpulmonary thermodilution (TPTD) technique. However, it remains unclear whether the measurement of TPTD-derived variables is influenced by PP. We investigated the effects of 135° PP on the accuracy of TPTD-derived variables and their changes over an 8-10 h period of time. ⋯ EVLWI and GEDVI measurements are possibly influenced by prone positioning. In spite of statistical significance, the differences in EVLWI and GEDVI are low and presumably of no clinical relevance.
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Acta Anaesthesiol Scand · Oct 2011
Non-toxic alveolar oxygen concentration without hypoxemia during apnoeic oxygenation: an experimental study.
Oxygenation without tidal breathing, i.e. apnoeic oxygenation in combination with extracorporeal carbon dioxide removal, might be an option in the treatment of acute respiratory failure. However, ventilation with 100% O₂, which is potentially toxic, is considered a prerequisite to ensure acceptable oxygenation. We hypothesized that trapping nitrogen (N₂) in the lungs before the start of apnoeic oxygenation would keep the alveolar O₂ at a non-toxic level and still maintain normoxaemia. The aim was to test whether a predicted N₂ concentration would agree with a measured concentration at the end of an apnoeic period. ⋯ This study indicates that it is possible to predict and keep alveolar N₂ concentration at a desired level and, thus, alveolar O₂ concentration at a non-toxic level during apnoeic oxygenation.
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Cognitive impairments are common after critical illness. Aetiology and effects of cognitive impairments in this setting are not fully revealed. The aim of this study was to investigate the effect of critical illness and intensive care unit (ICU) treatment on cerebral function. ⋯ Cognitive impairments are common after critical illness and may be caused by the critical illness in itself. Incidences are high after ICU discharge (64%) but drops rapidly during the first 3 months after discharge.