Acta anaesthesiologica Scandinavica. Supplementum
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Acta Anaesthesiol Scand Suppl · Jan 1995
ReviewReversal of conscious sedation by flumazenil: current status and future prospects.
Flumazenil is safe and highly effective at reversing both benzodiazepine-induced sedation and amnesia. Bolus intravenous injection is the most appropriate technique when the goal is to fully reverse conscious sedation. Currently, the proven effective dose of flumazenil is 0.5 mg. ⋯ Depression of ventilatory responsiveness induced by benzodiazepines can be reversed effectively and promptly by flumazenil. Flumazenil must be immediately available as an emergency drug in any area where benzodiazepines are used. The clinical and economic benefits of elective and routine use of flumazenil have been demonstrated, but yet to gain widespread acceptance.
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Acta Anaesthesiol Scand Suppl · Jan 1995
ReviewEffects of catecholamines on regional perfusion and oxygenation in critically ill patients.
Multiple organ failure is the major cause of death in patients with sepsis. Bacterial translocation from the gut is considered to induce and maintain sepsis. Therefore, the splanchnic region plays an important role in the pathogenesis and treatment of sepsis. ⋯ Catecholamines with beta mimetic effects are often used to increase DO2. The question as to whether dobutamine or dopamine should be used first in treatment of septic shock cannot be answered yet. Whether treatment with low dose dopamine or dopexamine actually improves renal function and splanchnic oxygenation is the purpose of ongoing studies.
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Acta Anaesthesiol Scand Suppl · Jan 1995
Review Comparative StudyFrom oxygen content to pulse oximetry: completing the picture in the newborn.
In recent years clinicians caring for sick preterm infants have come to depend on pulse oximetry to avoid hyperoxia, which means assuming saturation values for critical levels of oxygen tension. This prediction is made difficult by the shape of the haemoglobin-oxygen dissociation curve at critical values for arterial pO2 and by the effects of changes in acid-base balance on p50. Combined blood gas and co-oximetry measurements can be used to determine critical limits for pulse oximetry. ⋯ We demonstrated that, at 90% saturation, failure to use the fetal correction in the presence of high levels of fetal haemoglobin result in a 4% overestimate of saturation, with resultant underestimation of the safe range for pulse oximetry. Published values for extinction coefficients for fetal and adult blood at wavelengths used by pulse oximeters are inconsistent, but it appears that fetal haemoglobin does not bias pulse oximetry readings. Determining saturation limits by co-oximetry for use with pulse oximeters in preterm infants requires the description of the haemoglobin-oxygen dissociation curve with the correction for fetal haemoglobin.
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Acta Anaesthesiol Scand Suppl · Jan 1995
ReviewCentral antinociceptive effects of non-steroidal anti-inflammatory drugs and paracetamol. Experimental studies in the rat.
These studies were undertaken to investigate the site and nature of the antinociceptive effect of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) and paracetamol in the central nervous system (CNS). ⋯ The antinociceptive effect of diclofenac involves a central nervous component which may be elicited from several defined areas in the CNS. Part of the antinociceptive effect seems to be mediated by descending inhibitory opioid, serotonin and/or other neurotransmitter systems interfering with visceral pain impulse traffic at the spinal level. NSAIDs and paracetamol interfere with nociception associated with spinal NMDA receptor activation. This effect involves an inhibitory action on spinal nitric oxide (NO) mechanisms. Possibly, the supraspinal antinociceptive effect of NSAIDs may be explained by an analogous action.