European journal of anaesthesiology
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and objective Inflammatory liver dysfunction in rats leads to a prolonged vecuronium-induced neuromuscular blockade due to insufficient metabolism. A coexisting resistance against the drug partly counteracts this prolongation. The present study investigates the pharmacodynamics of atracurium whose metabolism does not depend on liver function. ⋯ A systemic inflammatory response syndrome with liver dysfunction results in decreased sensitivity to atracurium. Further investigations are needed regarding a possible up-regulation of acetylcholine receptors or an increased protein binding of atracurium during sepsis to clarify reasons behind this phenomenon.
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Patient attitudes to medical information are changing. We audited patient attitudes to an information leaflet provided at the preadmission clinic as part of standard day-case protocol. The booklet is a simplified version of the booklet Anaesthesia and Anaesthetists--Information for Patients and Relatives published in London, UK, by the Association of Anaesthetists of Great Britain & Ireland. ⋯ Thirty-five per cent of patients found it worried them. Thirty-two per cent discussed the information with others but only 3% discussed the information provided with the anaesthetist. Although patients like to receive information about the process of anaesthesia, we must be careful that by providing it in an inappropriate form, e.g. as a leaflet, we do not increase their preoperative anxiety.
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and objective The purpose of this study was to investigate retrospectively what factors contribute to the development of the type of hyperlactatemia which may follow cardiopulmonary bypass despite well-maintained oxygen delivery and a normal perioperative course. ⋯ It is suggested that the pathophysiology observed is based on impairment of tissue oxygen utilization. The duration of cardiopulmonary bypass and especially the occurrence of hypotension at the start of the bypass period appears to be related to the development of lactic acidosis.
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Comparative Study Clinical Trial
Hypotension during endotoxemia in aged humans.
and objective The aim of this study was to determine possible age-associated differences in human blood pressure regulation during an immunological challenge in healthy subjects. ⋯ In conclusion, healthy elderly subjects fail to maintain a constant mean arterial pressure in response to the immunological challenge of endotoxemia.
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A case is presented in which memory of events during emergence from anaesthesia resulted in serious psychological sequelae. Communication with patients should begin almost immediately after anaesthesia has been terminated and should have prevented this unfortunate incident.