European journal of anaesthesiology. Supplement
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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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Eur J Anaesthesiol Suppl · Jan 1992
Multicenter Study Clinical TrialHaemodynamic and biological effects of intravenous milrinone in patients with a low cardiac output syndrome following cardiac surgery: multicentre study.
The haemodynamic and biological effects of intravenous milrinone were studied in 24 adult patients with a low cardiac output syndrome following cardiac surgery. The patients received a milrinone bolus of 50 micrograms kg-1 over 10 min followed by a 0.375-0.750 micrograms kg-1 min-1 infusion over 48 h. ⋯ These haemodynamic effects were maintained over the 48 h of treatment and persisted 3 h after discontinuation of treatment. Milrinone, which possesses inotropic and vasodilatory effects, increased cardiac performance and corrected the low cardiac output in all patients.
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Eur J Anaesthesiol Suppl · Jan 1991
Endotracheal intubation through the Laryngeal Mask--helpful when laryngoscopy is difficult or dangerous.
The correctly placed Laryngeal Mask will act as a guide to endotracheal intubation in over 90% of adult patients. Although the size of tube is limited to a 6-mm-internal-diameter cuffed oral or nasal pattern tube the technique is easy to learn and can provide a rapid solution when endotracheal intubation is necessary but conventional laryngoscopy is unexpectedly difficult or dental restorations are at risk. Application of cricoid pressure reduces the success rate of the technique; therefore, if this manoeuvre is indicated to reduce the risks of regurgitation, anaesthetists are advised to arrange for its momentary relaxation during the final stages of placement of the Laryngeal Mask and of the endotracheal tube.
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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.