Acta anaesthesiologica Scandinavica. Supplementum
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Acta Anaesthesiol Scand Suppl · Jan 1995
Comparative StudyPharmacokinetics of 51W89: preliminary data.
The pharmacokinetics of the 1R cis-1'R cis-isomer of atracurium (51W89) and its metabolite, laudanosine, were studied in 11 healthy patients with normal renal function and in 12 patients with chronic renal failure undergoing regular dialysis. A bolus dose of 51W89 (0.1 mg/kg) was given, and the plasma concentration was measured at regular intervals for 480 min. The elimination half-life of 51W89 was significantly longer in renal failure patients than in healthy controls (38.9 min vs 30.6 min; P < 0.05). The plasma laudanosine levels were lower than those reported after an equipotent dose of atracurium besylate. 51W89 may have a prolonged effect in renal failure patients.
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Acta Anaesthesiol Scand Suppl · Jan 1995
Comparative Study Clinical TrialAdministration of 51W89 by infusion--a comparison with atracurium--preliminary communication.
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Acta Anaesthesiol Scand Suppl · Jan 1995
Comparative StudyCentral venous versus mixed venous oxygen content.
Mixed venous oxygen content (commonly measured as oxygen saturation) is a highly relevant parameter in the monitoring of critically ill patients; unfortunately, its measurement requires catheterization of the pulmonary artery. Though less invasive, the central venous oxygen saturation is an unsatisfactory substitute, due to fluctuations in perfusion distribution and regional oxygen extraction in the course of illness. The present study examined the relation of oxygen contents in simultaneously withdrawn central venous and mixed venous blood samples from critically ill patients, in order to validate a hypothetical algorithm for the estimation of mixed venous oxygen content from a central venous sample: Although the proposed algorithm had a fairly high power of prediction, its merits in comparison to assuming simple proportionality between central venous and mixed venous oxygen content seemed marginal. However, as it is likely that the results so far are mathematically coupled, further prospective studies are necessary.
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Acta Anaesthesiol Scand Suppl · Jan 1995
Case ReportsHow far can we go with permissive hypercapnia? A case presentation and some biased comments with emphasis on maintaining normal haemoglobin level.
The respiratory management strategy of small tidal volume with permissive hypercapnia has been adopted to avoid further aggravation of lung injury due to high airway pressure with some impressive success (1). No consensus, however, has been established in terms of the rate of increase in PaCO2 and its upper limit. ⋯ The fact that PaCO2 may reach a very high level in the clinical setting and the well-known role of haemoglobin (Hb) in buffering CO2 led us to study effects of different Hb levels on pH and haemodynamic changes in response to acute CO2 loading in the blood. We will summarize the case report first with permission of authors (the case report was published in Japanese) (2) and then discuss the studies conducted in our animal laboratory.
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A quantitative evaluation of metabolic acid-base component is described. The model is based on Stewart's analysis of acid-base chemistry. ⋯ The efficiency of the model is sufficient, quantitative partial results are given in the same units as base excess. In complex acid-base disturbances, such as are seen in critically ill patients, a detailed analysis of the specific components of the metabolic acid-base status allows one to plan specific therapeutic interventions.