European journal of anaesthesiology
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It is hypothesized that tissue dysoxia and O2 debt are major factors in the development and the propagation of multiple organ failure in critically ill patients. Dysoxia is the result of an abnormal relationship between O2 supply (DO2) and O2 demand and translates into increased anaerobic metabolism and tissue and blood lactate concentration. ⋯ The adequacy of cardiac output towards tissue metabolic requirements may be appreciated by venous-to-arterial and gut mucosal-to-arterial PCO2 differences. This review details these strategies and discusses their usefulness in current practice.
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Clinical Trial
Continuous spinal anaesthesia/analgesia for the perioperative management of high-risk patients.
The intraoperative effects of continuous spinal anaesthesia, and the efficacy of postoperative continuous spinal analgesia in 48 elderly high risk patients undergoing major abdominal, vascular or orthopaedic surgery is reported. Intraoperative anaesthetic technique proved to be safe and provided satisfactory results in the immediate postoperative period. Furthermore, the postoperative analgesic regimen which involved intrathecal fentanyl and bupivacaine, and intravenous tenoxicam, provided effective analgesia for all patients. ⋯ The mean doses of fentanyl and bupivacaine infused intrathecally for the first 24 h postoperatively were 14.5 +/- 1.5 microg h(-1) (mean +/- SD) and 0.72 +/- 0.08 mg h(-1) (mean +/- SD), respectively, while the requirements for analgesia decreased progressively overtime but lasted for 118 h. The technique provided effective analgesia with low pain scores that was reflected by the ease in performing physical exercises and the pleasant co-operation with the physiotherapist. Only minor complications related to anaesthesia/analgesia were encountered.
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Case Reports
Successful epidural blood patch in a patient with headache for 6 months after lumbar root decompression.
Prolonged headache following dural puncture is an uncommon problem that may occur after a spinal tap, often as a complication of epidural anaesthesia. This problem has also been described after long-term epidural or spinal anaesthesia, myelography or spinal surgery. ⋯ No other cause could be found either clinically or with the aid of scanning by computerized tomography or magnetic resonance imaging techniques at the spinal level involved. The symptoms were successfully treated with an epidural blood patch performed seven months following the original surgical operation.
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We present a case of a patient submitted for extirpation of a neoplasm of the larynx, by means of carbon dioxide laser surgery. High frequency jet ventilation was applied by means of orotracheal intubation with two Teflon catheters, 2 mm in external diameter and 30 cm in length, attached with three equally placed strips of adhesive paper tape. One catheter was used to inject the jet volume and the other used to measure the airway pressure. ⋯ Ventilation was interrupted and the catheters were removed. The patient was reintubated with an endotracheal tube of 6 mm ID and the surgical procedure was continued until the tumour was removed. Two factors contributed to the airway fire: the ignition of the lowest adhesive strip that had dried and the use of the laser in the mode of continuous pulsation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative nausea and vomiting after breast surgery: efficacy of prophylactic ondansetron and droperidol in a randomized placebo-controlled study.
Postoperative nausea and vomiting (PONV) is a common adverse phenomenon following breast surgery. The efficacy of ondansetron and droperidol in preventing post-operative nausea and vomiting in women undergoing breast surgery was compared in this randomized, double-blind, placebo-controlled study. Altogether 207 women were randomly assigned to receive either a single intravenous dose of droperidol (1.25 mg) (n = 69), ondansetron (8 mg) (n = 67) or saline (n = 71) immediately after induction of general anaesthesia with thiopental, fentanyl, atracurium, nitrous oxide in oxygen and isoflurane. ⋯ The incidence of post-operative nausea and vomiting during the first 24 h was 61%, 48% and 45% in the placebo, droperidol and ondansetron treatment groups, respectively (NS). Postoperative analgesic requirements and the length of stay in the post-anaesthesia care unit were equal in all three treatment groups. It is concluded that the intravenous pretreatment with single doses of ondansetron or droperidol did not substantially prevent postoperative nausea and vomiting after breast surgery.