ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03967.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03968.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Multiple organ failure remains the leading cause of death in the intensive care unit. Increasing numbers of investigators have focused their attention on the role of gastrointestinal tract in the pathogenesis of this syndrome. Their data indicate that inadequate gut perfusion leads to a measurable imbalance between oxygen delivery and the needs of the tissues, i.e., ischaemia. Gut ischaemia of sufficient duration impairs gastrointestinal tract barrier function, facilitating the passage of enteric bacterial endotoxin into the circulation. It has been hypothesized that production of tumor necrosis factor α, and other biologic mediators by endotoxin–stimulated macrophages, triggers a generalized and uncontrolled inflammatory response that ultimately leads to multiple organ failure.Preliminary evidence suggests that survival can be improved significantly if gut ischaemia is promptly identifed and aggressively treated by administration of fluids and inotropic drugs, using gastric intramucosal pH as the therapeutic endpoint. Future studies are needed to determine whether additional treatment modalities can improve outcome once the inflammatory response has fully develop

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03969.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In acute lung injury (ALI), where pulmonary microvascular permeability is increased, transvascular fluid filtration depends mainly on the hydrostatic capillary pressure. In the presence of intrapulmonary vasoconstriction pulmonary capillary pressure (PCP) may increase thereby promoting transvascular fluid filtration and lung oedema formation. We studied the effect of 40 ppm inhaled nitric oxide (NO) on PCP and longitudinal distribution of pulmonary vascular resistance (PVR) in 18 patients with ALI.PCP was estimated by visual analysis of the pressure decay profile following pulmonary artery balloon inflation. Contribution of venous pulmonary resistance to total PVR was calculated as the percentage of the pressure gradient in the pulmonary venous system to the total pressure gradient across the lung.Inhalation of 40 ppm NO produced a prompt decrease in mean pulmonary artery pressure (PAP) from 34.1 6.8 to 29.65.7 (s.d.) mmHg; (P<0.0001). PCP declined from 24.86.2 to 21.65.2 mmHg; (P<0.0001) while pulmonary artery wedge pressure (PAWP) did not change. PVR decreased from 16673 to 12850 dyn sec cm‐5; (P<0.0001). Pulmonary venous resistance (PVRven) decreased to a greater extent (from 7641 to 5028 dyn. sec. cm‐5; (P<0.001) than pulmonary arterial resistance (PVRart) (from 9036 to 7929 dyn sec cm‐5; (P<0.01). The contribution of PVRven to PVR feU from 44.310.8 to 37.811.9%; (P<0.01). Cardiac output (CO) remained constant. The findings demonstrate that NO has a predominant vasodilating effect on pulmonary venous vasculature thereby lowering PCP in patients wit

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03970.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The controversies about the factors determining the spread of epidural analgesia are partly due to inappropriate methodology or sample size of previous studies. We performed a multivariate regression analysis on 803 ASA class 1–2 non–atherosclerotic adults, undergoing lumbar epidural anaesthesia according to a predefined standardised procedure. The spread of epidural analgesia is more accurately studied by analysing dose/ segment (R2= 0.671) instead of spread (R2= 0.271) as dependent variable. The impact of local anaesthetic (2% lidocaine C02 or 0.5% bupivacaine) and addition of adrenaline is not significant. Spread significantly increases with increasing age, weight, body–mass index, dose of local anaesthetic, addition of fentanyl, higher site of injection, and decreasing body height. The impact of age and dose is higher under the age of 40 and at doses lower than 20 ml. Increasing the total dose increases the dose needed to block one spinal segment. Unknown idiosyncratic factors still determine a certain proportion of the sample variance. The addition of adrenaline to lidocaine and the use of bupivacaine improve the predictability of spread. In conclusion, we found clinically significant correlations between a group of factors and epidural spread. Alternative anaesthetic solutions lead to different degrees of predictab

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03971.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The possible venous endothelial toxicity of 0.5% 2–chloroprocaine without additives in intravenous regional anaesthesia (IVRA) was evaluated in rabbits. After exsanguination of a hind limb with an Esmarch's bandage a neonatal blood pressure cuff around the thigh was inflated (250 mmHg). For IVRA 4 ml of either plain 0.5% 2–chloroprocaine (pH 3.7), 0.9% NaCl (pH 6.0) or acidified NaCl (pH 3.7) was injected i.v. to the exsanguinated limb in a randomized, double–blind fashion. Each group comprised 15 rabbits. Eleven rabbits received 4 ml of 0.5 M or 1.0 M KC1, for the production of positive controls. Two hours after injection of the test solution the tourniquet was deflated and venous biopsies were taken one and 24 hours later for histological and immunocytochemical examination. Five to eight 24–hour samples from each group were also processed for electron microscopy. A macroscopic thrombus formation was observed in four rabbits after KC1 and in two after acidified NaCl administration. No inflammatory changes were observed at histologic and immunocytochemical examination of any of the vein samples. Electron microscopy revealed that KC1 had caused severe damage to the venous endothelium of four out of five samples and acidified NaCl had caused moderate damage to the endothelium of two out of seven samples. 2–chloroprocaine had caused moderate damage in four and severe damage in two of the vein samples; two samples were normal. No thrombus formation occurred. It is concluded that additive–free 2–chloroprocaine caused damage to the venous endothelium in rabbits when

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03972.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The use of anaesthesiologists in prehospital emergency care is controversial. We wanted to assess the impact of an anaesthesiologist and a short time interval from acceptance of a mission to take–off at survival rates in a rural/urban emergency medical service. Prospectively registered data for 991 consecutive patients through a 12–month period were retrospectively evaluated by an independent foreign expert. Of all primary missions, 3.3% were considered probably lifesaving from site of injury to receiving hospital. Of these, the lifesaving result in 50% were dependent on both the qualifications of the anaesthesiologist and a short response time. Survival from hospital admission to discharge was 44%. All patients were discharged to their own homes, able to live a fully functional life. The consistent use of anaesthesiologists compared to less qualified personnel and the maintaining of response times below presently required minima doubles the potential for lives saved in services comparable to the one stud

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03973.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Total intavenous anaesthesia (TIVA) with propofol and alfentanil was compared with balanced anaesthesia (BA) in 30 uraemic patients undergoing renal transplantation. TIVA (n=15) was induced with propofol and alfentanil and maintained with propofol and alfentanil infusions, which were started immediately after induction. Thereafter the infusion rates were adjusted as needed. Ventilation was with oxygen in air. BA (n= 15) was induced with thiopentone and fentanyl and maintained with isoflurane/N20/fentanyl. Vecuronium was used for muscle relaxation in both groups. Mean infusion rates for propofol and alfentanil were 10 1.8 mg kg‐1h‐1and 70 9 μg kg‐1h‐1, respectively. To control hypertension during TIVA, larger amounts of propofol and alfentanil were needed and slower recovery was observed than in previous studies in ASA 1–2 patients. Also, significantly more vecuronium was needed during TIVA than during BA (P<0.05). The recovery parameters were similar in both groups, except for the occurrence of nausea, which was less after TIVA. In conclusion, TIVA had no clinical advantag

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03974.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The effects were studied postoperatively of an infusion of atrial natriuretic peptide (ANP) 7.5 pMol–kg‐1–min‐1on renal function and haemodynamics in seven patients who had been operated with insertion of an abdominal aortic graft. Urine flow, glomerular filtration rate (GFR), renal plasma flow (RPF) and excretion of electrolytes and osmoles were measured for three periods of 20 minutes during infusion of ANP, in the morning of the day after surgery. Haemodynamic studies were conducted, and serum levels of ANP, catecholamines and plasma renin activity were measured.ANP levels increased from 52 to approximately 250 pMol–L‐1during ANP infusion and decreased after infusion to a level equal to baseline. GFR increased from 92 mL–min“1by 58, 20 and 21%, respectively. RPF was unchanged. Urine flow rate increased from 1.99 mL–min”‘ by 81, 151 and 173%, respectively. Fractional clearances of sodium, chloride and osmoles were increased during the second and third ANP periods whereas fractional potassium clearance did not change during the study. There were no changes in catecholamine levels or plasma renin activity during the study. Heart rate, mean arterial pressure and calculated systemic and pulmonary vascular resistance did not change whereas reductions occurred in cardiac index, mean pulmonary artery pressure, pulmonary artery wedge pressure and mean right atrial pressure. We conclude that infusion of ANP also in the postoperative situation increases GFR, diuresis

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03975.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

A physical lung model for simulation of volatile anaesthetic uptake is described. Two communicating water–fined chambers simulate pulmonary mechanics allowing adjustment of functional residual capacity, resistance and compliance. The uptake of the volatile anaesthetics is reproduced by pumping gas from the lung chamber through a charcoal absorber at different rates; using a second pump for a bypass an arterial to end–tidal gradient can be generated. Changes of cardiac output are simulated by adjusting pump speed and of alveolar ventilation by adapting the ventilator setting. The results are reproducible and correspond with patient studies and computer stimulation, not necessitating empirical correction factors as in a previously described oil–based lung model. The model can serve as a teaching instrument, for the comparison and testing of anaesthetic equipment and the development of feedback sy

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1994.tb03976.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY