Acta anaesthesiologica Scandinavica
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Nitric oxide (NO) is normally produced in the endothelium by the constitutive isoform of the NO synthase. This physiological production of NO is important for blood pressure regulation and blood flow distribution. Several lines of evidence suggest that a hyperproduction of NO by the inducible form of NO synthase (iNOS) may contribute to the hypotension, cardiodepression and vascular hyporeactivity in septic shock. ⋯ A main new aspect of this review is a critical discussion of previous reports measuring plasma nitrite/nitrate during septic shock and an evaluation of the validity of interpreting these data as evidence for a hyperproduction of NO. This review also emphasizes that many septic patients have preexisting endothelial dysfunction and lung diseases, which may contribute to adverse effects by systemic inhibition of NO synthesis. Another new aspect of the present review is a focus on the lack of direct evidence of iNOS expression in human septic shock.
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Acta Anaesthesiol Scand · Mar 1999
Randomized Controlled Trial Clinical TrialParacetamol 1 g given rectally at the end of minor gynaecological surgery is not efficacious in reducing postoperative pain.
We studied the analgesic effects of 1 g paracetamol given rectally at the end of surgery in a prospective, randomised, double-blind study. ⋯ The routine use of 1 g paracetamol given rectally at the end of surgery after termination of pregnancy seems not to be justified.
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Acta Anaesthesiol Scand · Mar 1999
Case ReportsOne-lung ventilation when intubation is difficult--presentation of a new endobronchial blocker.
One-lung ventilation utilizing a double-lumen endotracheal tube may be technically difficult or inappropriate in morbidly obese or critically ill patients. In patients requiring awake fiberoptic intubation, double-lumen tube placement may be impossible. Wire-guided endobronchial blockade through a conventional endotracheal tube is a new alternative for these patients. ⋯ The WEB system allows one-lung ventilation to be achieved with a conventional endotracheal tube. The need for reintubation at the end of surgery is eliminated and endotracheal tube cross-sectional area is conserved.
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Acta Anaesthesiol Scand · Mar 1999
Randomized Controlled Trial Clinical TrialPositive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration.
General anaesthesia impairs the gas exchange in the lungs, and moderate desaturation (SaO2 86-90%) occurred in 50% of anaesthetised patients in a blinded pulse oximetry study. A high FiO2 might reduce the risk of hypoxaemia, but can also promote atelectasis. We hypothesised that a moderate positive end-expiratory pressure (PEEP) level of 10 cmH2O can prevent atelectasis during ventilation with an FiO2 = 1.0. ⋯ PEEP = 10 cmH2O reduced atelectasis formation after a VCM, when FiO2 = 1.0 was used. Thus, a VCM followed by PEEP = 10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.
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Acta Anaesthesiol Scand · Mar 1999
A simplified method for separate measurements of lung and chest wall mechanics in ventilator-treated patients.
Airway pressure measurements above the endotracheal tube will be distorted because of endotracheal tube resistance. To separate lung and chest wall compliance, esophageal pressure is conventionally measured with an air-filled balloon catheter, which is difficult to insert in unconscious patients. We have developed a methodology with fluid-filled catheters for intratracheal and esophageal pressure measurements. ⋯ Y-piece pressures are not representative of intratracheal pressures, which can be measured by inserting a fluid-filled pressure line through the tube. Esophageal pressure is easily recorded with a fluid-filled Salem double-lumen catheter. Large changes in lung compliance may pass unnoticed when only total compliance is monitored. Monitoring of lung compliance may offer an improved basis for decisions about ventilator settings.