Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 1978
The influence of staff and personnel on the safety of the patient during anesthesia.
The safety of the patient under anesthesia is directly correlated to the quality of the service delivered by the anesthetic department. A good organised work, supposes a staff, which accords to numerical and qualitative requirements. ⋯ The quality required for the persons who administer anesthesia, depends upon the intrinsic danger of the procedure. As the nature of anesthesia is still linked with the acute control of vital functions of the patient, the qualifications of the person who administer the narcosis should be of the highest level.
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The historical development of surgery and anesthesiology, has made the anesthetist an expert in the following fields: 1. Providing analgesia. 2. Homeostasis of the internal environment or respiratory, circulatory and metabolic resuscitation. 3. ⋯ The rules of conduct within this team are discussed. It is concluded that safety during anesthesia has increased, through the activities of the anesthetist outside of the operating theatre. One anesthetist should however remain available at any moment during anesthesia, for every one patient.
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Malignant hyperthermia is now recognized as a distinct entity in anesthetic practice and can be considered as a pharmacogenetic disease of obscure etiology occuring in man and pigs with a dominant inheritance. A close association with myopathy has been noted. Commonly used muscle relaxants or anesthetic drugs can act as triggering agents in genetically susceptible patients, who develop a real hypermetabolic state, characterized by a rapid rise in body temperature, muscular rigidity, tachycardia and tachypnoea, cyanosis and severe respiratory and metabolic acidosis, the lethality being about 60%. ⋯ A regime of treatment is suggested, based on current concepts of the pathogenesis. It consists in establishing effective and rapid cooling, reversal of tissue hypoxia and correction of respiratory and metabolic acidosis and hyperkalemia. Specific therapy with dantrolene sodium may prove to be an answer to this serious problem.
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Acta Anaesthesiol Belg · Jan 1978
Comparative StudyMonitoring of cardiac output by pulse contour method.
A pulse contour method for cardiac output determination was evaluated in sixteen cardiac surgery patients. Stroke volume was derived from the aortic pressure waveform by means of a formula developed by Wesseling and was calculated with an in-built computer (Philips cardiac output module). ⋯ The overall comparison of data (71 simultaneous measurements) yielded a correlation coefficient of 0.78 (regression y = 0.81 x + 1.07 liter) (p less than 0.001). Advantages and disadvantages of the pulse contour method are discussed.
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Intensive Medicine is always associated with the problem of handling the mass and assuring the quality of information on vital signs, fluid and blood balance, laboratory data, physiological calculations, etc., required in patient care. A computer based monitoring system for intensive care was introduced in 1973 at the Academic Hospital in Leuven. The basic software was developed at the Peter Bent Brigham Hospital of the Harvard Medical School and the medical division of the Hewlett Packard Company; the computer used was a H. ⋯ G.-analysis is being developed. The same computer serves the remotely located medical and coronary care units and one bed in the emergency department. An assessment of computer assistance in intensive therapy, on nursing labor and on quality of patient care is made.