Ann Acad Med Singap
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Ann Acad Med Singap · Nov 1994
Physiologic chart for rapid identification of causes of abnormal haemodynamics.
The systemic haemodynamic state is expressed by paired values of Mean Arterial Pressure (MAP) and Stroke Index (SI), varying for every heart beat. Algebraic product of SI and Heart Rate (HR) then defines the perfusion-related Cardiac Index (CI), which is the dynamic modulator of Oxygen Delivery Index (DO2I). Since MAP, SI and CI can each attain a normal, infranormal or supranormal level, there is a total of 9 haemodynamic states, plus 3 CI states. ⋯ The deviation in CI from its normal level then determines the deviation in chronotropy. In contrast to current management methodology of trial and error, the HMC enables the clinician to continuously manage a patient's haemodynamics within the HTG. This is expected to produce a shorter therapy and improved outcome.
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Although epidural and spinal blocks are well-accepted regional techniques in obstetrics, they have several disadvantages. Combined spinal-epidural (CSE) technique reduces or eliminates the risks of these disadvantages. The sequential CSE technique can reduce the incidence and severity of maternal hypotension. ⋯ Before any injection in the epidural catheter, its position should always be confirmed by aspiration test. The technique should be used only by those who are experienced in spinal and epidural blocks. CSE is an important addition to the armamentarium of the obstetric anaesthesiologist.
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Thirty-nine patients with 46 limbs at risk underwent arterial embolectomy. The overall mortality was 36% (14 patients). Seventeen limbs (37%) had a poor result. ⋯ The delay from onset of symptoms to the operation varied between a few hours to over a week and this was not related to the outcome. Thirteen percent of the arterial occlusions were in the upper limb. All of these were due to embolism and there was no mortality for this group with all affected arms achieving a good outcome.