Southern medical journal
-
Southern medical journal · May 1992
Perioperative complications of long-term central venous catheters in high-risk patients: predictors versus myths.
A prospective cohort of 126 patients having long-term central venous catheterization was collected over a 10-month period. The patients were preoperatively assessed for the following risk factors: previous catheter placement, an absolute neutrophil count less than 500/mm3, a platelet count less than 50,000/mm3, a BUN value greater than 60 mg/dL or a serum creatinine level greater than 2.5 mg/dL, a prothrombin time greater than 1.5 times control, recent sepsis, and a Western blot test positive for HIV. The incidence of perioperative complications was 23%. ⋯ In the subpopulation of patients having two or more risk factors, the complication rate was 50%, with the majority of these being failed placement attempts. We conclude that inserting a permanent central venous catheter is not a benign procedure, but it can be safely done in critically ill patients. Furthermore, evaluation of preoperative risk factors in candidates for catheterization can be helpful to the surgeon with respect to counseling and operative planning.
-
Electrically induced seizures have been used widely to treat psychiatric disease since their introduction in 1938. Seizure activity is the therapeutic aspect of this form of treatment, but it is accompanied by untoward physiologic consequences. Cardiovascular responses consist of generalized autonomic nervous system stimulation with initial parasympathetic outflow, followed immediately by a sympathetic response. ⋯ Methohexital, 0.75 to 1.0 mg/kg intravenously, is the most frequently used agent for induction of anesthesia for ECT; muscle relaxation usually is accomplished with succinylcholine, 0.5 to 1.0 mg/kg. In patients at risk for ill effects from the tachycardia and hypertension that may accompany sympathetic nervous system response to ECT, nitroglycerin, propranolol, hydralazine, or other sympatholytic agents should be used to attenuate the potentially harmful sequelae of ECT. The efficacy of ECT requires a knowledge of anesthetic precepts, an understanding of the interaction between anesthetic drugs and seizure activity, and an awareness of the physiologic effects of ECT as well as the treatment of those effects.