Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 1997
Randomized Controlled Trial Clinical TrialThe effect of succinylcholine on atracurium-induced neuromuscular block.
The interaction between prior succinylcholine and atracurium has been found only after full recovery of succinylcholine block. We investigated whether the effect of succinylcholine on atracurium block may depend on the level of recovery from succinylcholine. ⋯ The effect of prior administration of succinylcholine on atracurium block depends on the state of recovery from succinylcholine and concerns both its potency, onset and duration characteristics.
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Cardiopulmonary resuscitation (CPR) has the potential to save many lives. Used indiscriminately though, it may be harmful and not in the best interest of the patient. An advance directive to refrain from resuscitation in selected patients is probably not uncommon in Sweden, but guidelines ruling this are still generally lacking. This study was performed to evaluate the use and documentation of do-not-resuscitate orders in a Swedish university hospital. ⋯ We conclude that a decision to refrain from resuscitation is often not made, even when considered medically and ethically justifiable. Also, the use of coded information as a sole indicator for a patient not to be resuscitated is still common practice. The patient or his/her relatives are rarely involved in this decision.
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Acta Anaesthesiol Scand · Nov 1997
Randomized Controlled Trial Clinical TrialEffects of cisatracurium on cerebral and cardiovascular hemodynamics in patients with severe brain injury.
For neuroanesthesia and neurocritical care the use of drugs that do not increase or preferentially decrease intracranial pressure (ICP) or change cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) are preferred. The current study investigates the effects of a single rapid bolus dose of cisatracurium on cerebral blood flow velocity, ICP, CPP, mean arterial pressure (MAP) and heart rate (HR) in 24 mechanically ventilated patients with intracranial hypertension after severe brain trauma (Glasgow coma scale <6) under continuous sedation with sufentanil and midazolam. ⋯ The results from this study suggest that cisatracurium is a safe neuromuscular blocking agent for use in adult severe brain-injured patients with increased ICP under mild hyperventilation and continuous sedation.
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Acta Anaesthesiol Scand · Nov 1997
Randomized Controlled Trial Clinical TrialInfluence of anaesthesia and muscle relaxation on intubating conditions and sympathoadrenal response to tracheal intubation.
The study aimed to assess the relative influence of anaesthesia and muscle relaxation on intubating conditions and the haemodynamic and catecholamine responses to tracheal intubation. ⋯ The results of the study demonstrate that the sympathoadrenal response to intubation is attenuated by adding fentanyl (2.5 X kg[-1]) to an induction regimen with thiopentone, whereas provision of complete muscle relaxation at the adductor pollicis muscle is necessary to attain smooth intubating conditions.
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Acta Anaesthesiol Scand · Nov 1997
Case ReportsDeep accidental hypothermia and cardiac arrest--rewarming with forced air.
During the last two cold winters we have treated 5 severely hypothermic patients (temperature below 30 degrees C) with active external rewarming rather than with extracorporal circulation and heat exchanger. ⋯ We conclude that external rewarming with forced air is a feasible alternative to cardiopulmonary bypass in severely hypothermic patients with electrical activity. This method can be used even in patients with VF because defibrillation can be successfully performed in deep hypothermia. Although after-drop during external rewarming is feared, we did not observe this phenomenon. Rewarming with forced air is inexpensive, easy to perform and direct access to the patient is possible at any time. It does not require heparinisation and can be used in hospitals where they do not have cardiopulmonary bypass facilities. Thus, this method is particularly useful in situations when the hypothermic patient cannot be transferred to a major medical center.