Acta anaesthesiologica Scandinavica. Supplementum
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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.
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Acta Anaesthesiol Scand Suppl · Jan 1995
The role of muscle relaxants in total intravenous anaesthesia.
For total intravenous anaesthesia (TIVA), all drugs that are required as part of the anaesthetic method are administered intravenously. This is usually taken to imply the use of intravenous infusions. It is normal practice to administer muscle relaxants intravenously, although other routes have been used. ⋯ It should cause negligible side-effects. For administration by infusion, an agent with an intermediate (e.g., atracurium) or short (e.g., mivacurium) duration of action is essential to ensure a rapid recovery of effect on termination of the infusion. The routine use of neuromuscular monitoring is recommended when a continuous infusion of a relaxant is used.
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PvCO2 that would result from full O2Hb desaturation at a given O2-CO2 exchange ratio, in the absence of metabolic acid, may be termed maximum respiratory venous PCO2 (PvmrCO2). This theoretical condition of 100% O2 extraction, in the absence of metabolic acid, should simulate maximum aerobic PCO2 in tissue, provided that PCO2 of tissues and large veins is similar. Hence, the value of PvmrCO2 is of interest in identifying critical tissue PCO2. ⋯ It is concluded that the PvCO2 versus SO2 relation is not linear when arterial [Hb] and/or [BE] vary. An equation that predicts in vitro PvmrCO2 as a function of arterial [BE], [Hb], RQ, and PaCO2 is provided. It's accuracy in vivo should be testable.
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Acta Anaesthesiol Scand Suppl · Jan 1994
Adverse reaction to neuromuscular blockers: frequency, investigation, and epidemiology.
A survey is presented of neuromuscular drug involvement in 390 clinically severe anaphylactoid reactions (grades II-IV reported to a Sheffield laboratory from 1988 to the end of 1992 from hospitals throughout the UK. Despite advances in patient monitoring and newer drugs, the reporting frequency and individual drug involvement were remarkably similar to those of a previous report from the laboratory in 1988. The highly immunogenic drug suxamethonium still predominated (48% of reports), but there was now much reduced use of the similarly immunogenic drug, alcuronium. ⋯ The remaining reactions were judged to be non-immune, although most involved mast cell degranulation. These reactions were no less hazardous than Type 1 reactions (one death), and two deaths were recorded. The importance of laboratory investigation as a feature of postreaction care is emphasized.