Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 1989
Comparative StudySurvival compared to the general population and changes in health status among intensive care patients.
In order to evaluate intensive care, all adult patients (980) admitted to a multidisciplinary intensive care unit (ICU) during 1 year were followed prospectively. The ICU mortality was 9.6%. One year after admission the survival was 73.6%. ⋯ Increased age and length of stay in the ICU were associated with higher mortality but not with changes in health status. We conclude that the outcome of intensive care can be evaluated by studying only the survival, since the survival rate is correlated to changes in health status among survivors in the different admission groups. One year after admission most of the surviving patients had regained their previous health status and their further survival was almost the same as that of the general population.
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Acta Anaesthesiol Scand · Jan 1989
Continuous interscalene brachial plexus block: clinical efficacy, technical problems and bupivacaine plasma concentrations.
Continuous interscalene brachial plexus block with a single dose of 0.5% bupivacaine 1.25 mg/kg, continued with an infusion of 0.25% bupivacaine 0.25 mg/kg/h, was performed on 24 patients to provide analgesia during shoulder surgery and in the postoperative period. The drugs for general anaesthesia included glycopyrrolate, thiopentone, vecuronium, enflurane and N2O/O2. All patients had signs of regional analgesia 30 min after the block without haemodynamic problems. ⋯ During the 24-h period, the alpha 1-acid glycoprotein (AAG) concentration (mean +/- s.e.mean) in plasma rose from 0.41 +/- 0.04 g/l to 0.54 +/- 0.04 g/l (P less than 0.001). The concentration of free bupivacaine was below detectable levels (less than 0.01 micrograms/ml) after the 24-h infusion. The rise in AAG probably increases binding of bupivacaine to plasma proteins, diminishing the risk of systemic toxicity.
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Acta Anaesthesiol Scand · Nov 1988
Cardiac arrest during anaesthesia. A computer-aided study in 250,543 anaesthetics.
With the aid of a computer-based anaesthetic record-keeping system, all cardiac arrests during anaesthesia at the Karolinska Hospital between July 1967 and December 1984 were retrieved. There were a total of 170 cardiac arrests and 250,543 anaesthetics in the data file, which gives an incidence of 6.8 cardiac arrests per 10,000 anaesthetics. Sixty patients died, constituting a mortality of 2.4 per 10,000 anaesthetics: 42 were considered as inevitable deaths (rupture of aortic or cerebral aneurysm, multitrauma, etc.); 13 cases of cardiac arrest were considered as non-anaesthetic, i.e. complications due to surgery and other procedures. ⋯ The most common cause of cardiac arrest due to anaesthesia was hypoxia because of ventilatory problems (27 patients), postsuccinylcholine asystole (23 patients) and post-induction hypotension (14 patients). The highest mortality was seen when spinal or epidural anaesthetics were given to patients with impaired physical status including hypovolaemia. The incidence of cardiac arrest has declined considerably during the period studied, and this coincides with an increasing number of qualified anaesthetists employed in the department during the same period.
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Acta Anaesthesiol Scand · Nov 1988
Continuous-flow apneic ventilation with small endobronchial catheters.
This study compares gas exchange and hemodynamic parameters during bronchial insufflation with two different internal diameter (ID) catheters (2.5 and 1.4 mm) at a constant mean gas exit velocity. Anesthetized, paralyzed dogs were instrumented to monitor arterial, central venous, and airway pressures, blood gases, temperature, ECG, and ventilated using continuous flow apneic ventilation (CFAV) via 2.5-mm or 1.4-mm ID bronchial insufflation catheters positioned 1.25 bronchial diameter units (BDU) beyond the carina. Initially, flow was adjusted to provide adequate oxygenation and ventilation through the 2.5-mm ID catheters. ⋯ After a 30-min stabilization period, physiological parameters were again recorded. No significant differences were noted in arterial, central venous, or airway pressures, temperature, heart rate, pH, PaCO2, and PaO2 between the 2.5-mm and 1.4-mm ID bronchial insufflation catheters. However, significantly less bronchial insufflation flow (69.7%) was required to maintain oxygenation and ventilation for the 1.4-mm ID bronchial insufflation catheters.
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Acta Anaesthesiol Scand · Nov 1988
Randomized Controlled Trial Comparative Study Clinical TrialQT interval of the ECG, heart rate and arterial pressure using five non-depolarizing muscle relaxants for intubation.
The QT interval, heart rate and arterial pressure were measured during anaesthetic induction in 186 patients without cardiovascular diseases or any preoperative drugs. The study was randomized and double-blind. The patients were premedicated with either pethidine 1 mg/kg + atropine 0.01 mg/kg or with only pethidine 1 mg/kg i.m. ⋯ The QT intervals were prolonged only in relation to the increased heart rate. At 6.5 min, the values in all groups were decreased to about the same level as before intubation. The mean control values of the heart rate were between 80 and 90 b.p.m. in the atropine-treated groups and between 70 and 80 b.p.m. in the other groups.(ABSTRACT TRUNCATED AT 250 WORDS)