European journal of anaesthesiology
-
Subarachnoid haemorrhage (SAH) following cerebral aneurysm rupture or trauma can result in the induction of secondary ischaemic brain damage via a decrease in microvascular perfusion, a disruption of the blood-brain barrier and consequent vasogenic oedema, and the delayed spasm of the major cerebral arteries (i.e. vasospasm). It is increasingly apparent that oxygen radical-induced, iron-catalyzed lipid peroxidation (LP) within the subarachnoid blood and vascular wall plays a key role in the occurrence of these secondary events. ⋯ Much of its action is mediated by an effect on the vascular endothelium, although it also appears to exert some direct neuroprotection and to inhibit LP in the subarachnoid blood. These actions of tirilazad in experimental SAH are reviewed.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Timing of tracheal intubation: monitoring the orbicularis oculi, the adductor pollicis or use a stopwatch?
The most suitable time for tracheal intubation, following vecuronium 0.1 mg kg-1, was estimated in 120 patients. The trachea was intubated at cessation of the visually observed response of the orbicularis oculi muscle to facial nerve stimulation (group 1; n = 30), or of the manually detected response of the adductor pollicis to ulnar nerve stimulation (group 2; n = 30), or after waiting 3 min (group 3; n = 30), or 4 min (group 4; n = 30). There were no significant differences in intubation scores between the four groups of patients. ⋯ However, intubating conditions were poor in four patients (14%) in group 1, compared with none in group 2 and one in groups 3 and 4, respectively. Thus, contrary to expectations, the cessation of the response of the orbicularis oculi muscle did not guarantee good or even satisfactory intubating conditions. The results suggest that in fit adult patients it is as good to wait 3 min after injection of vecuronium 0.1 mg kg-1 before tracheal intubation, as to use a nerve stimulator.
-
From a family tragedy 20 years ago, ATLS has truly become an international trauma care program. Its success is demonstrated not only in the large number of physicians that have been trained, but also in the appearance of a number of affiliated courses with a similar structure, aimed at training medical, nursing, civilian and military personnel in how to deal with trauma in a variety of settings. ⋯ We are now faced with the next major stage in the development of ATLS, namely to provide the evidence for the efficacy of this in an acceptable scientific manner. It is a challenge we should accept with the same enthusiasm that originally embraced ATLS, and where better to meet this challenge than within the countries of Europe?
-
Comparative Study Clinical Trial
A comparison of the use of transoesophageal Doppler and thermodilution techniques for cardiac output determination.
Doppler cardiac output (CO) determination is discussed as a non-invasive alternative to CO estimation by thermodilution. This study was designed to compare the accuracy of a new transoesophageal Doppler device with the thermodilution technique. In 24 patients undergoing coronary artery bypass surgery, CO was determined simultaneously by the oesophageal Doppler (OD) and thermodilution (TD) method in triplicate for three sample episodes: after induction of anaesthesia during clinical steady-state conditions (A), after start of surgery (B), and after sternotomy (C). ⋯ Bias analysis of the log-transformed data revealed that 95% of the ODCO values differed from TDCO values by 43% below to 50% above for sample episode A, by 39% below to 95% above for sample episode B, and by 32% below to 96% above for sample episode C. Analysis of the changes in CO from sample episode A to B and from sample episode B to C, expressed as percentage values, showed a non-significant bias between the methods, but the 2 SD limits were +/-44% and +/-36% respectively. Our findings suggest that CO estimation by OD cannot replace estimation by the TD method.