Acta anaesthesiologica Scandinavica. Supplementum
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Acta Anaesthesiol Scand Suppl · Jan 1990
ReviewQuantitative surface electromyography (qEMG): applications in anaesthesiology and critical care.
During general anaesthesia and in lowered vigilance states such as after major trauma and during heavy sedation or analgesic medication, patients' ability to communicate with their surroundings is limited. Subjective intuitional interpretation may be the only means to ascertain a patient's emotional state, mood, and pain perception. Electromyographic detection and quantification of minimal and covert facial mimic muscle activity in anaesthesiology and critical care was an interesting concept worth further evaluation. ⋯ Inadequate anaesthesia was always reflected by an increase in facial qEMG, albeit this often was also evident to the naked eye. The arousal at the end of anaesthesia was always associated with an abrupt increase in facial qEMG activity, which often was preceded by a more gradual, predictive rise. Auditory stimulation was also effective in increasing qEMG.(ABSTRACT TRUNCATED AT 400 WORDS)
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A state exists after the induction of anaesthesia in which patients may be aware of their surroundings yet unable to communicate. This problem of awareness and recall during general anaesthesia is a recent one in the relatively short history of anaesthesia. Prior to the introduction of muscle relaxants in 1942 by Griffith and Johnson, it was felt that "light anaesthesia" would be signified by violent movements. ⋯ None has yet been found to be totally reliable and numerous reports of awareness can be found in the literature. Light inhalation and total intravenous anaesthesia have been blamed for the majority of these case reports. However, awareness during total intravenous anaesthesia is avoidable with the proper use of a combination of a hypnotic and an analgesic such as midazolam and alfentanil for general anaesthesia.
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Acta Anaesthesiol Scand Suppl · Jan 1989
Review Comparative StudyIn what respect does high frequency positive pressure ventilation differ from conventional ventilation?
The original rationale for HFPPV was that under certain conditions adequate alveolar ventilation could be achieved with high ventilatory frequencies and small tidal volumes. It was theorized further that increased ventilatory frequencies and low tidal volumes would decrease the airway pressures, barotrauma, and cardiovascular and other systemic consequences seen with conventional mechanical ventilation. The first clinical applications of HFPPV were in bronchoscopy and laryngoscopy for diagnostic and/or therapeutic purposes. ⋯ Although the role of HFPPV in the management of pulmonary diseases still remains to be clarified, it does provide effective ventilation in selected types of patients needing ventilatory support. New modes of pressure-controlled ventilation have not resolved all clinical problems in severe ARDS and/or acute respiratory failure. The search for means of optimal ventilatory support with minimal complications must continue, as conventional ventilation does not always offer the best treatment.