Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of forced air warming on postoperative oxygen consumption and temperature in elective orthopaedic surgery.
Actively warming patients during surgery is considered the best method of preventing inadvertent hypothermia. In order to investigate the effect of forced air warming on postoperative oxygen consumption, we studied 26 patients undergoing orthopaedic surgery using a prospective, randomized trial design. ⋯ This study demonstrated the gradual heat gain and also the potential for hyperthermia from pre- and intraoperative forced air warming. We conclude that forced air warming is not necessary for moderate duration non-body-cavity surgery if effective preinduction covering of patients and minimal surgical exposure is achieved.
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Anaesth Intensive Care · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of intraoperative ventilation strategies on perioperative atelectasis.
Several methods of ventilation have previously been shown to reduce intraoperative atelectasis and alveolar to arterial oxygen gradient (A-a DO2) in healthy patients. This study was designed to show firstly the relative intra-operative benefit and secondly if any method had an effect on atelectasis postoperatively. Using a factorial design we randomized 24 patients to each of the four ventilatory interventions (manual inflations, large tidal volumes, PEEP, and pressure control inverse ratio ventilation (IRV)). ⋯ This study demonstrated that PEEP and IRV were most effective in reducing intraoperative A-a DO2 (P < 0.05 ANCOVA). Using more than one intervention did not improve the A-a DO2. No method had any effect on postoperative A-a DO2.
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Anaesth Intensive Care · Jun 1998
Case ReportsRhabdomyolysis following severe physical exercise in a patient with predisposition to malignant hyperthermia.
A 21-year-old man suffered from exertional heat stroke with impaired consciousness and rhabdomyolysis after strenuous physical exercise. Within two weeks the patient recovered completely without any specific therapy. ⋯ An in vitro contracture test was performed and a predisposition to malignant hyperthermia was diagnosed; other muscular diseases were excluded by histological examination. At present, the in vitro contracture test is the only method used to determine susceptibility to malignant hyperthermia and should be performed when the diagnosis is suggested on clinical grounds.
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Anaesth Intensive Care · Jun 1998
Case ReportsRecurrent acute upper airway obstruction after anterior cervical fusion.
A 67-year-old man presented with cervical myelopathy for which a C3/4 discectomy and anterior fusion was performed. Recurrent episodes of acute upper airway obstruction necessitated laryngoscopy and endotracheal intubation. Drainage of a prevertebral collection of CSF and surgical repair of a dural tear corrected the obstructive symptoms. Management of the difficult airway is discussed.