Acta anaesthesiologica Scandinavica. Supplementum
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Mivacurium has been little studied in infants and children without a volatile anaesthetic agent. We analysed onset time and maximal neuromuscular response after mivacurium 0.1 mg/kg, and the infusion requirement of mivacurium to maintain a 50, 90, or 95% neuromuscular block in 76 infants and children under N2O-O2-alfentanil anaesthesia. Furthermore, we assessed the time course of potentiation of 1 MAC end-tidal halothane or isoflurane on the infusion requirement of mivacurium. ⋯ In conclusion, mivacurium is easy to administer as bolus doses or continuous infusion in paediatric patients because its potency is similar in all patients from 1 month to 15 years of age. Halothane and isoflurane produce their maximal potentiation of neuromuscular block only after 30-60 min of administration. This potentiation is similar in magnitude in all patients, but takes place fastest in the youngest children.
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Acta Anaesthesiol Scand Suppl · Jan 1995
The influence of arterial carbon dioxide on cerebral oxygenation and haemodynamics during ECMO in normoxaemic and hypoxaemic piglets.
To investigate the cerebrovascular response to changes in arterial CO2 tension during extracorporeal membrane oxygenation (ECMO) in normoxaemic and hypoxaemic piglets. ⋯ Since cerebrovascular reactivity to CO2 remains intact during ECMO in piglets, it is important to keep arterial CO2 tension stable and in normal range during clinical ECMO.
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Acta Anaesthesiol Scand Suppl · Jan 1995
Optimal values for oxygen transport during hypothermia in sepsis and ARDS.
Mild hypothermia (33 degrees C to 35.5 degrees C) is reported to improve oxygenation and survival in patients with lung failure (1). Although hypermetabolism may account for about 50% of the ventilatory demand in ARDS patients, the concept of reducing oxygen consumption (VO2) by lowering metabolic rate, has only recently gained attention (2). Our study was aimed to test whether mild hypothermia established by continuous veno-venous haemofiltration (CVVHF), could optimize values for oxygen kinetics in ARDS patients. ⋯ These results suggest that the inability to achieve optimal values for DO2 and VO2 during mild hypothermia induced by CVVHF could serve as a prognostic sign for fatal outcome. Although oxygen consumption is decreased during hypothermia, hypoxaemia may result due to alterations of the oxygen transport on a cellular basis. The relationship between oxygen transport and temperature during CVVHF therefore deserves further studies.
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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.