Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2001
Clinical TrialLong-term outcome after neurosurgically treated spinal epidural abscess following epidural analgesia.
A recent investigation demonstrated a high incidence of epidural abscess secondary to epidural catheterization and a 50% frequency of neurologic deficits. We studied short- and long-term neurologic outcome in patients operated for spinal epidural abscess after epidural analgesia. ⋯ Overall recovery rate for patients with paresis/plegia after epidural abscess was 20%. No patients with paresis/plegia following a thoracic abscess recovered in contrast to a 50% recovery rate for patients with lumbar epidural abscess. The majority of long-term survivors had severe neurologic deficits. Abscess formation contributed to one death.
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Acta Anaesthesiol Scand · Feb 2001
Case ReportsCesarean section under epidural ropivacaine 0.75% in a parturient with severe pulmonary hypertension.
Pregnancy and delivery are a potentially lethal combination in a patient with primary pulmonary hypertension. There are controversies regarding mode of delivery. Cesarean section is considered to be associated with extensive perioperative risks. ⋯ Vaginal delivery was excluded since her cervix was too immature for succesful induction. This is the first reported case of its kind to receive an epidural anesthesia with ropivacaine with its potential advantage of a low cardiac toxicity. The epidural was slowly and carefully titrated to give a stable anesthesia with good quality.
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Acta Anaesthesiol Scand · Feb 2001
Comparative StudyEffects of different preparations of propofol, diazepam, and etomidate on human neutrophils in vitro.
Intravenous anaesthetics and sedatives can influence polymorphonuclear cell (PMN) functions. Some of the drugs for sedation and anaesthesia have been alternatively dissolved in lipid solutions containing medium (MCT) and/or long chain (LCT) triglycerides. The in vitro effects of two different diazepam (benzyl-alcohol, LCT/MCT), etomidate (propylene-glycol, LCT/MCT), and propofol (LCT, LCT/MCT) preparations on respiratory burst (RB) and phagocytosis of human PMNs were studied. ⋯ The in vitro effects of diazepam, etomidate, and propofol are dependent on the solvent applied. The tested LCT/MCT preparations reduce the inhibitory effects on the bacterial killing capacity of PMNs found after incubation with propyleneglycol, benzyl-alcohol, or LCT preparations, respectively.
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Acta Anaesthesiol Scand · Feb 2001
Clinical TrialMonitoring of end-tidal carbon dioxide partial pressure changes during infrarenal aortic cross-clamping: a non-invasive method to predict unclamping hypotension.
To assess the variations in end-tidal CO2 in response to aortic cross-clamping and the relationship with systolic arterial pressure (SAP) changes induced by unclamping. ⋯ End-tidal CO2 variation monitoring during aortic cross-clamping may provide a reliable and non-invasive method to predict unclamping hypotension. When the aortic clamp was released, systolic hypotension (>20%) occurred in those subjects who had a decrease in end-tidal CO2 greater than 15% during aortic cross-clamping.
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Acta Anaesthesiol Scand · Feb 2001
Warning! Suctioning. A lung model evaluation of closed suctioning systems.
Closed system suctioning, CSS, has been advocated to avoid alveolar collapse. However, ventilator manufacturers indicate that extreme negative pressure levels can be obtained during closed system suctioning, impeding the performance of the ventilator. ⋯ CSS should not be used in volume control ventilation due to risk of high intrinsic PEEP levels at insertion of the catheter and extreme negative pressures during suctioning. Pressure control ventilation produces less intrinsic PEEP effect. The continuous positive airway pressure (CPAP) mode offers the least intrinsic PEEP during insertion of the catheter and least sub-atmospheric pressure during suctioning.