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
Point-of-care (POC) testing of lactate in the intensive care patient. Accuracy, reliability, and costs of different measurement systems.
Point-of-care (POC) monitoring may facilitate diagnostic and therapeutic interventions in the critically ill. In a prospective study reliability and costs of two POC lactate testing devices were compared to the central laboratory lactate monitoring method. ⋯ The trend towards miniaturizing laboratory monitoring devices will continue, resulting in greater flexibility of management of the critically ill. Blood lactate can rapidly, easily, accurately, and economically be measured at the bedside with the hand-held monitor apparatus Accusport and the bench-top blood gas analyser.
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* Mechanically ventilated patients with severe acute lung insufficiencies dramatically improve their gas exchange when treated in the prone position. * ventilation heterogeneity is greater in the supine then in the prone position during CMV. * the dominant dorsal Q while supine is not turned into a dominant ventral Q in the prone position. * in the presence of an abdominal distension, the prone position more clearly improves gas exchange than at normal abdominal pressures. * CPAP enhances the dominant dorsal lung perfusion while supine. In the prone position lung perfusion is more uniform. * V/Q matching is improved in the prone position during CMV.
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Acta Anaesthesiol Scand · Jan 2001
Clinical TrialValidation of a new respiratory inductive plethysmograph.
The respiratory inductive plethysmograph (RIP) can be used to monitor changes in end-expiratory lung volume (deltaEELV), and thus, used in intensive care when evaluating positive end-expiratory pressure (PEEP)-induced changes in lung volumes in order to optimise the ventilator settings. We validated the newest model of RIP (Respitrace Plus), both under laboratory and clinical conditions, and made a comparison with a previously validated RIP (Respigraph) in the measurement of tidal volume (V(T)), long-term EELV and PEEP-induced acute deltaEELV. ⋯ The new RIP is accurate enough for clinical and research purposes in the measurement of V(T). Semiquantitative measurements of acute deltaEELV can be done with accuracy sufficient for clinical use, but long-term deltaEELV monitoring is not possible. The new RIP should be kept on for several hours before measurements to minimise the drift.
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Acta Anaesthesiol Scand · Jan 2001
Randomized Controlled Trial Clinical TrialThe influence of halothane, isoflurane and sevoflurane on rocuronium infusion in children.
Rocuronium is a non-depolarizing neuromuscular blocking agent with intermediate duration of action and without significant cumulative properties, suitable for continuous infusion. This study was designed to determine the infusion requirements in children under nitrous oxide and fentanyl, halothane, isoflurane or sevoflurane anaesthesia. ⋯ The rocuronium infusion rate required to maintain stable 90-99% T1 depression was reduced by approximately 20% with halothane and isoflurane anaesthesia, and by 50% with evoflurane anaesthesia when compared to fentanyl-nitrous oxide anaesthesia. Significant patient-to-patient variability of infusion rate makes monitoring of neuromuscular transmission necessary.