摘要:

Substance abuse is a major socioeconomic problem. However, the ready availability of potent narcotic and sedative drugs probably constitutes a unique risk for anesthesiologists. Until recently, few anesthesia departments were prepared to recognize or safely manage afflicted colleagues. Because we felt it important to educate our staff and residents and to have a response mechanism establishedpriorto the advent of a substance abuse problem, a departmental committee was formed to develop a Substance Abuse Policy. The policy has served to increase our general awareness and to direct our actions effectively when dealing with physician impairment. It is presented here in the belief that other departments might find it useful in tailoring their approach to this problem.

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Transesophageal echocardiography (TEE) is a new monitoring technique that images the heart and provides information on regional wall motion and left ventricular filling. However, despite its potential for inaccuracy due to its retrocardiac position and angulation, TEE has not been validated by another imaging technique. Using direct on-heart echocardiography (OHE) as a standard, the authors evaluated the ability of TEE to measure accurately left ventricular end-diastolic area (EDa), end-systolic area (ESa), and ejection fraction area (EFa). Ten patients with coronary artery disease without evidence of valvular dysfunction undergoing myocardial revascularization were studied. A Diasonics® 3.5 MHz two-dimensional TEE probe was introduced into each patient's esophagus and positioned to obtain a view equivalent to the parasternal short-axis projection. A similar view was obtained by OHE using a sterilely prepared 3 MHz ATL® probe placed on either the pericardium or epicardium. In each patient, immediately prior to and after pericardiotomy, both transesophageal and on-heart short-axis views at the level of the papillary muscles were obtained. Using a dedicated Diasonics® computer echoanalyzer, EDaand ESafrom four consecutive cardiac cycles were outlined with a light pen and averaged. EFawas calculated by the formula EFa– (EDa– ESa)/EDa. Seventeen comparable transesophageal and on-heart echocardiograms were obtained. ESaby TEE correlated well with ESaby OHE (15.13 ± 9.62 cm2vs.14.92 ± 10.53 cm2; r = 0.94). Similar results were obtained for EDa(27.75 ± 9.88 cm2vs.30.40 ± 13.99 cm2; r = 0.88) and EFa(0.49 ± 0.17vs.0.54 ± 0.13; r = 0.92). TEE can accurately assess left ventricular filling and ejection.

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

It was hypothesized that the long lengths of sampling catheters required when a mass spectrometer is multiplexed to more than one operating room limit the upper frequency at which a gas concentration may be determined accurately. This possibility has not been investigated. Known step changes of CO2were generated by a solenoid valve driven by an electronic timer that was adjustable from 0.1 to 10 Hz. The valve alternated between 100% O2and 7% CO2in 50% O2and balance N2. CO2concentration was monitored by a mass spectrometer after the gas passed through a 3.7 m Teflon® catheter or through 30 m Teflon®, nylon, polyethylene (PE), or polyvinylchloride (PVC) catheters. Gas flow for all catheters was adjusted to 1.1 ml/s. The peak-to-peak output of the mass spectrometer was read from a storage oscilloscope. The 3.7 m catheter caused a 10% error at 5.5 Hz (330/min). In sharp contrast, 30 m catheters made from Teflon®, PVC, and PE caused errors greater than 10% at only 0.6 Hz (36/min). The 30 m nylon catheter passed 1.1 Hz (66/min) with a 10% error. Teflon®, PVC, and PE are not suitable materials from which to make long catheters sampling CO2. Because the frequency response of the nylon catheter appeared similar to that of a low-pass filter, an electronic circuit was designed and tuned to extend the high-frequency response of the catheter. With the circuit in place, the frequency at which a 10% error occurred in the measurement of CO2improved from 1.1 Hz (66/min) to 2.2 Hz (132/min). This simple circuit, which may be retrofitted to existing units, is an effective method to extend the frequency response and accuracy of long catheters sampling CO2.

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Hemoglobin affinity for oxygen in whole blood of ten normal nonpregnant women, ten normal pregnant women at first trimester, ten normal pregnant women at second trimester, 24 normal pregnant women at or near term, and 14 pregnant women with preeclampsia at or near term was studied. The mean P-50 values for normal non-pregnant women, normal pregnant women in first trimester, second trimester, and at or near term were 26.7 ± 0.11 mmHg, 27.8 ± 0.08 mmHg, 28.8 ± 0.17 mmHg, and 30.4 ± 0.20 mmHg, respectively. The mean P-50 of pregnant women with preeclampsia at or near term was 25.1 ± 0.38 mmHg. It is concluded that in normal pregnant women there was a significant shift of P-50 to the right compared with the normal nonpregnant women (P< 0.01), and the extent of this shift to the right is directly related to the duration of the pregnancy. In addition, preeclamptic parturients showed a significant shift of P-50 to the left when compared with normal pregnant women at or near term (P< 0.001).

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1986

数据来源: OVID