European journal of anaesthesiology. Supplement
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Eur J Anaesthesiol Suppl · Jan 1992
Multicenter Study Clinical Trial Controlled Clinical TrialMilrinone in the treatment of low output states following cardiac surgery.
Milrinone is known to have beneficial haemodynamic and clinical effects in patients with congestive heart failure. An investigation into the safety and efficacy of milrinone in patients following heart surgery was undertaken by the European Milrinone Multicentre Trial Group. This paper reports the efficacy, the effects on left heart function, and the adverse events in the study. ⋯ At 15 min and 60 min there was a dose-related decrease in systolic and diastolic arterial pressure; however, there was no significant difference in the mean arterial pressure measurements. In all groups there was an improvement in cardiac index at 15 min following the start of milrinone, which was sustained during and up to 4 h after the infusion. This was closely associated with changes in stroke volume index and systemic vascular resistance, and not solely due to a change in heart rate.
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Eur J Anaesthesiol Suppl · Jan 1992
ReviewOverview of the effects of intravenous milrinone in acute heart failure following surgery.
We have reviewed the current data evaluating the effects of intravenous milrinone in patients following cardiac surgery. Milrinone has been shown to be effective in the treatment of acute low output syndrome, and a loading bolus infusion of 50 micrograms kg-1 over 10 min causes an increase in cardiac index and a fall in pulmonary capillary wedge pressure. These effects are easily maintained by a continuous infusion regimen. ⋯ These effects are not confined to one patient group, but the increase in cardiac index does appear to be more pronounced in those patients with poor haemodynamics prior to treatment. There is a low incidence of adverse events including arrhythmias and hypotension. Thus milrinone appears to be well tolerated in a broad group of adult patients recovering from cardiac surgery.
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Lateral soft-tissue radiography was used to determine the location of the Laryngeal Mask (LM) in relation to the larynx and surrounding structures in 24 elderly male patients undergoing general anaesthesia. In a majority of cases (16 of 24) the epiglottis was within the cuff of the mask but without causing discernable airway obstruction in any case. ⋯ Supplementary information was obtained in 13 patients by the use of fibre-optic endoscopy, via the lumen of the LM, confirming the inclusion of the epiglottis within the mask and demonstrating a characteristic distortion by the LM of the normal laryngeal anatomy. It is concluded that inclusion of the epiglottis within the LM is commonplace, and misplacements may occur without clinical evidence of a compromised airway.
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The Laryngeal Mask (LM) can be used to intubate patients in whom conventional direct laryngoscopy is difficult. Tracheal intubation can be achieved using the LM alone but the use of a fibre-optic laryngoscope increases the chances of success.
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Eur J Anaesthesiol Suppl · Jan 1991
Biography Historical ArticleThe development of the Laryngeal Mask--a brief history of the invention, early clinical studies and experimental work from which the Laryngeal Mask evolved.
The history of the invention and development of the Laryngeal Mask in the East End of London during the years 1981-88 is briefly described. The concept evolved from home-made prototypes built from the Goldman Dental Mask through a complex series of one-off latex models culminating in a primitive factory-made silicone cuff in 1986. ⋯ From this experience a number of important lessons were learned relating to safe and effective use, which are summarized in the inventor's Instruction Manual. The importance of referring to this volume before use is stressed.