Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2003
Clinical TrialRocuronium and cisatracurium-positive skin tests in non-allergic volunteers: determination of drug concentration thresholds using a dilution titration technique.
Muscle relaxants are believed to be responsible for 2/3 of the cases of anaphylactic reactions during anesthesia. This assumption is based mainly on positive skin tests obtained in individuals that have experienced anesthesia-related anaphylaxis. A positive skin test is supposed to be associated with mast cell degranulation of vasoactive amines. In the present study we tested the frequency of positive skin tests with two commonly used muscle relaxants, rocuronium and cisatracurium, in a selected group of volunteers with low potential for allergic reactions. ⋯ Non-mast-cell-mediated positive intradermal skin reactions are frequently occurring with rocuronium and cisatracurium, even at vial dilution 1 : 1000. A clinically applicable test technique is needed that is able to separate positive skin tests associated with mast cell degranulation from non-mast-cell-mediated reactions.
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Acta Anaesthesiol Scand · May 2003
Withdrawal of medical treatment in the ICU. A cohort study of 318 cases during 1994-2000.
Many deaths in intensive care occur after life support has been withdrawn or withheld. In Sweden there are no guidelines for the withholding or withdrawal of life-sustaining treatments, and information on the frequency of such decisions is scarce. Open and conscious accounts of crucial standpoints in theses decisions are important. The aim of this study was to determine the incidence of decisions to withdraw medical therapy in a Swedish, general intensive care unit (ICU), the underlying reasons and outcomes. ⋯ Medical therapy was withdrawn in the ICU in 8.1% of patients and the chief reasons were failure to respond to therapy or poor prognosis of the acute disease. Four patients were still alive five years later. The time interval from admission to a withdrawal decision was short.
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Acta Anaesthesiol Scand · May 2003
Case ReportsBronchial rupture with a left-sided polyvinylchloride double-lumen tube.
Bronchial rupture after intubation with a double-lumen endobronchial tube has been infrequently reported. Overinflation of the bronchial cuff was speculated to be a frequent cause of the bronchial damage. We report the case of a 78-year-old woman with non-small cell carcinoma of the right upper lobe. ⋯ Subsequent course of the patient was uneventful: she developed neither bronchial leak nor mediastinitis. Ten days later the patients was discharged home in a satisfactory condition. Factors that seem to increase the risk of injury by a double-lumen tube are discussed.
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Lactic acidosis is a common cause of metabolic acidosis and is usually connected with high mortality. However, changes in the level of lactate and pH can also be seen after generalized epileptic attacks, due to local muscle hypoxia during the seizures. Although these changes can be quite marked, the condition is self-limiting and usually does not call for any specific treatment. We report five cases of lactic acidosis following convulsions from our centre.
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Acta Anaesthesiol Scand · May 2003
Case ReportsA fatal case of malignant hyperthermia complicated by generalized compartment syndrome and rhabdomyolysis.
A healthy 21-year-old male who had previously been anaesthetized without complications underwent a laparotomy following a skiing accident. He developed severe malignant hyperthermia. ⋯ The patient died of hyperkalaemia in spite of continuous dialysis. We present a detailed description of the case and also discuss the role of propofol and rhabdomyolysis.