Anaesthesiology intensive therapy
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The aim of the presented review is to highlight the clinical problem of postoperative residual curarization (PORC) following general anaesthesia in the elderly. Possible complications of PORC are described along with age-induced changes in pharmacokinetics of long and intermediate-acting neuromuscular blocking agents. This is intended to facilitate the selection and to promote appropriate intraoperative use of muscle relaxants in patients over the age of 65 years.
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Anaesthesiol Intensive Ther · Jan 2016
ReviewThe influence of regional anaesthesia and local anaesthetics on cardiac repolarization.
The normal function of the heart muscle is the result of electro-mechanic and hemodynamic coupling. Modification of the structure and activity of ion channels within the cardiomyocytes may induce cardiac arrhythmias. Electrophysiological mechanisms of arrhythmia, generated by a prolonged period of repolarization, result either from conduction disturbances (reentry mechanism) and/or the induction of beats (early after-depolarizations). ⋯ Stellate ganglion block on the right side causes a significant prolongation of the QT interval and QT dispersion. Regardless of the reasons for prolongation of the repolarization period (congenital or acquired), vigilance is required within the perioperative anaesthetic management of a patient, so as not to lead to the occurrence of ventricular arrhythmias. Regional anaesthesia techniques and properly used local anaesthetic drugs are regarded as being safe in these patients.
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Anaesthesiol Intensive Ther · Jan 2016
Randomized Controlled Trial Comparative StudyDexmedetomidine for attenuating haemodynamic response to intubation stimuli in morbidly obese patients anaesthetised using low-opioid technique: comparison with fentanyl-based general anaesthesia.
Anaesthesiologists are facing the problem of an increasing population of morbidly obese patients. In order to minimize the risk of opioid-induced postoperative respiratory failure, the intraoperative administration of opioids should be reduced or replaced with other drugs. The purpose of this study was to compare haemodynamic response elicited by intubation in morbidly obese patients between two variants of anaesthesia induction: fentanylbased or low-opioid using dexmedetomidine. ⋯ The study revealed no advantage of fentanyl over low opioid dexmedetomidine-based induction of general anaesthesia in attenuating cardiovascular response to intubation in morbidly obese patients.
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The aim of this study was to review all published articles in the literature in English regarding percutaneous cervical cordotomy in cancer pain. Percutaneous cordotomy may be used to relieve unilateral pain below the level of the neck arising from a variety of causes. ⋯ Reports were also located through references of articles. This review leads us to conclude that percutaneous cervical cordotomy can be recommended even before considering the use of strong opioids.
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Anaesthesiol Intensive Ther · Jan 2016
ReviewInfraclavicular access to the axillary vein - new possibilities for the catheterization of the central veins in the intensive care unit.
Central vein cannulation is one of the most commonly performed procedures in intensive care. Traditionally, the jugular and subclavian vein are recommended as the first choice option. ⋯ In this narrative review, we evaluate the usefulness of the infraclavicular access to the axillary vein. The existing evidence suggests that infraclavicular approach to the axillary vein is a reliable method of central vein catheterization, especially when performed with ultrasound guidance.