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
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
Recollections of general anaesthesia: a survey of anaesthesiological practice.
In order to identify the factors to which patients attach importance when undergoing general anaesthesia, 678 patients were retrospectively asked about their recollections of previous anaesthetics during routine preoperative screening over a period of 14 months. The most frequently mentioned recollections concerned the post-anaesthetic period, followed by recollections of the induction of anaesthesia. From the post-anaesthetic period, nausea/vomiting and drowsiness were most often cited. ⋯ More than a quarter of the patients were not satisfied with the anaesthesia. No correlation was found between the assessment of the anaesthesia and complaints about nausea/vomiting and drowsiness. The possible role of psychological factors in the origin of complaints about anaesthesia is discussed.
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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
Elimination of apparatus dead space--a simple method for improving CO2 removal without increasing airway pressure.
During mechanical ventilation the apparatus dead space can be eliminated by insufflating through one lumen of a tracheal double-lumen tube and allowing expiration through the other. In six intravenously anesthetized pigs, this technique resulted in an 18% (1 kPa) decrease in PaCO2 compared with insufflating through both lumens (32 ml rebreathing volume). ⋯ Flushing the trachea with fresh gas during the expiratory phase did not improve the efficiency of ventilation. It is concluded that elimination of apparatus dead space improves CO2 removal without increasing airway pressures and tidal volumes, and it is suggested that minimization of apparatus dead space should be tried before more advanced ventilatory modes are considered.