摘要:

The transurethral resection syndrome (“TUR syndrome”) is caused by absorption of electrolyte‐free irrigating fluid, and consists of symptoms from the circulatory and nervous systems. The clinical picture is inconsistent and the syndrome is easily confused with other acute disorders. Mild forms are common and often go undiagnosed, while severe forms of the TUR syndrome are rare and potentially life‐threatening. The pathophysiology is complex but includes four mechanisms: circulatory distress from the rapid absorption of electrolyte‐free irrigating fluid, adverse effects of glycine, dilution of the protein and electrolyte concentrations of the body fluids, and disturbance of renal function. The treatment of the TUR syndrome consists of general life support and in specific treatment directed towards hypotension, hyponatraemia and anuria. Methods to lower the uptake of irrigating fluid are widely used and probably reduce the incidence of the TUR syndrome. However, patient safety can be guaranteed only if the absorption is monitored. An irrigating fluid containing tracer amounts of ethanol can be used for this purpose. This permits the uptake of fluid to be indicated by measuring the concentration of ethanol in the patient's exhal

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03348.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Thoracic impedance at 2.5 (TI2.5) and 100 kHz (TI100), central venous pressure [CVP], and body fluid balance were recorded together with rectal temperature and arterial haematocrit in 15 consecutive patients subjected to coronary artery bypass grafting. I.v. fluid and blood were administered in an excess of 3.18 (1.38–9.35) I during the operation. TI2.5decreased from 51.7 (39.2–66.4) to 34.9 (21.1–45.7) ohm (P= 0.001), white TI100decreased from 41.9 (31.4–55.0) to 30.3 (18.3–40.8) ohm (P= 0.002). CVP, 6 (3–11) mmHg [0.8 (0.4–1.5) kPa], was the same before and after surgery. Temperature decreased during cardiopulmonary bypass from 35.4 (34.1–36.6) to 26.7 (22.9–31.0)d̀ C and haematocrit from 39 (34–46)% to a lowest value of 27 (23–32)% (P= 0.0001). A close linear correlation between Tt and body fluid balance was observed (Tl25.r = ‐0.96, TI100:r= ‐0.95,P= 0.0001). Corrections ofTI for temperature and/or haematocrit improved the correlation between TI and fluid balance to 0.99 (TI25) and 0.98 (TI2.5). The data indicate that changes in thoracic impedance can be used to monitor body fluid bala

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03349.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A comparison of plain prilocaine and bicarbonated prilocaine in intravenous regional anesthesia was studied in 30 patients undergoing upper extremity surgery. The patients were divided into two groups: one group was given anesthesia in the form of 1% prilocaine and the other group was given 1% prilocaine plus sodium bicarbonate. The onset of analgesia and anesthesia and recovery from analgesia and anesthesia were investigated in both groups. Bicarbonated prilocaine produced faster onset of analgesia when compared with plain prilocaine (P<0.01). The onset of anesthesia and recovery from analgesia and anesthesia were not statistically different between the two groups. Clinically, the intensity of anesthesia was better when bicarbonated prilocaine solution was used instead of plain prilocaine. We conclude that bicarbonated prilocaine is better than plain prilocaine during IVRA.

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03350.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

To compare the effectiveness of propofol given intravenously and rectally, ten piglets received propofol intravenously. On the next day, the same piglets and five other piglets were given suppositories containing propofol. Serial blood samples were collected for the analysis of propofol plasma concentration. The time course of the total plasma drug concentration was fitted into a bi‐exponential function using a least square fitting regression computer programme. The volume of distribution was 2.5–2.8 l‐kg‐1, mean elimination half‐life, 23.9 min and mean clearance 0.08 l‐kg‐1‐min‐1. The mean bioavailability by the rectal route was low. In contrast to the intravenously administered propofol, none of the piglets slept when given propofol rectally, reflecting the extremely low plasma propofol concentration. In veterinary medicine, propofol would seem to be clinically valuable for inducing intravenous anaesthesia, but would be ineffective when given rectally. The findings indicate that with the dosage forms used here, propofol would be clinically ineffective if given rectally to human inf

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03351.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The reliability of the double‐indicator dilution technique (dye/cold) for measuring extravascular lung water (EVLW) has been studied in lung‐healthy dogs after pleural fluid injection of saline (up to 20 ml/kg) during mechanical ventilation at zero and 10 cmH2O (1.0 kPa) end‐expiratory pressure (ZEEP and PEEP, respectively). Pleural fluid injection had no effect on EVLW at either ZEEP or PEEP. PEEP induced changes in cardiac output, and reduced both the intravascular (dye) and the thermal indicator volumes, but with no effect on the calculated EVLW. It is concluded that pleural fluid up to 20 ml/kg and ventilation with PEEP of 10 cmH2O (1.0 kPa) do not affect the reliability of the double‐indicator dilution technique for measuring extravascular lung water in

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03352.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A controlled trial was performed to study the effect and any adverse reactions of continuously infused flumazenil in severe benzodiazepine overdosage. The study comprised 51 adults admitted to an intensive care unit with poisoning. Enrolment criteria were unconsciousness on admission and a clear response within 5 min after an i.v. bolus injection of 1 mg flumazenil. The level of consciousness was assessed according to a modified Glasgow coma scale immediately before and at defined intervals up to 12 h after injection. A double‐blind infusion was started 15 min after the bolus injection and administered for 5 h. The patients were randomly allocated to one of three groups: a group given flumazenil 0.5 mg/h, a group given flumazenil 0.1 mg/h and a placebo group. The groups were comparable in age, sex and toxicological laboratory results. There were no significant differences between the groups in the average coma score on admission or 15 min after the bolus injection. In the flumazenil 0.5 mg/h group the level of consciousness remained unchanged between the 15‐min recording and the subsequent assessments. In the two other groups the level of consciousness decreased significantly during the course of the infusion. The infusions were well tolerated. It is concluded that a continuous infusion of 0.5 mg of flumazenil per hour can prevent relapse into coma in patients with severe benzodiazepine poisoning aroused with a single injection of the antagon

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03353.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The effect of allowing patients unlimited access to oral water in the time up until 2 h pre‐operatively was the subject of a randomised, blind, controlled trial. No effect was seen on gastric volume or pH, or on plasma osmolality, and allowing water pre‐operatively was associated with a reduction in anxiety in the anaesthetic r

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03354.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

We have developed an animal model for the evaluation of pulse oximetry during severe hypoxaemia. Twelve rabbits were anaesthetized and mechanically ventilated via a tracheostomy tube. Increasing fractions of nitrogen were added to the gas mixture they inhaled to obtain severe hypoxaemia (saturation range 26%‐100%). On 412 occasions, simultaneous pulse oximeter (Spo2) and invasive haemoximeter (Sao2) measurements were compared. The regression analysis of the data gave the equation: y = 0.7 x + 26.7, r = 0.90. In the Sao2range ≤ 85%, the bias (mean value of Sao2‐Spo2) was higher when compared with Sao2>85%. In anin vitrostudy the light absorption characteristics of rabbit haemoglobin (Hb) were compared to human Hb. The millimolar extinction coefficients of both reduced and oxygenated Hb from rabbits were found to be similar to human Hb. We consider the animal model (rabbit) suitable for studies of pulse oximetry during physiological and pathophysiological condi

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03355.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The haemodynamic response to laryngoscopy and intubation was evaluated in 52 ASA I patients anaesthetized with thiopentone 4–6 mgkg‐1. Vecuronium 0.1 mgkg‐1, followed by 3 min mask ventilation with nitrous oxide in oxygen with (isoflurane group) or without (control group) 3% inspired isoflurane preceded tracheal intubation. In 21 of 52 patients, concentrations of noradrenaline (NA), adrenaline and 3,4‐dihydroxyphenylethyleneglycol (DHPG) were measured from central venous plasma. During the 3‐min ventilation, in the isoflurane group, heart rate increased by 22% but remained stable in the control group. A marked pressor response to laryngoscopy and intubation was seen in the control but not in the isoflurane group. During the 3‐min ventilation, the plasma concentration of NA was doubled in the isoflurane group and increased by 49% in the control group (P<0.05). The concentration of DHPG also increased in the isoflurane group. Peripheral skin temperature increased similarly after 3 min ventilation in both groups. After intubation, it was significantly higher in the isoflurane than in the control group (P<0.05). In conclusion, compared to nitrous oxide in oxygen, ventilation with isoflurane in nitrous oxide in oxygen causes a sympathetic activation combined with an increase in heart rate and peripheral temperature while the pressor response to laryngoscopy and intubation is

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03356.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

A 1‐year population of anaesthesias for cardioversion of supraventricular tachyarrhythmias was studied. Propofol and thiopentone were used alternately for every other procedure, and the anaesthetic‐ and monitoring procedures were prospectively standardized. Twenty‐one thiopentone‐ and 23 propofol‐anaesthetized patients, who had been subjected to elective cardioversions of atrial fibrillation were compared, particularly regarding possible differences in the energy requirements for cardioversion and in the time intervals to initial awakening. There were no significant differences between the two drugs in the maximum systolic blood pressure drop, in the total mean energy requirements per kg bodyweight, or in the distribution of the number of patients over the various energy levels needed for restoration of sinus rhythm. Somewhat unexpectedly, however, the mean time interval to initial awakening was significantly longer in the propofol‐anaesthetized group. Apart from this minor drawback, propofol proved to be as useful an anaesthetic agent as thiopentone for the cardioversion procedure, and may be considered as an alternative drug in sel

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1991.tb03357.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY