Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · May 2003
Randomized Controlled Trial Comparative Study Clinical TrialRocuronium combined with i.v. lidocaine for rapid tracheal intubation.
Rocuronium (ORG 9426) has been shown to have an onset of action more rapid than other nondepolarizing neuromuscular blocking agents and to provide intubating conditions similar to those of succinylcholine 60-90 s after administration. We compared the intubating conditions and hemodynamic changes after the administration of rocuronium 0.6 mg kg(-1) and lidocaine 1.5 mg kg(-1) with rocuronium alone and succinylcholine 60 and 90 s after administration. ⋯ The combination of lidocaine (1.5 mg kg(-1)) and low-dose rocuronium (0.6 mg kg(-1)) along with propofol is clinically equivalent to succinylcholine, improves intubating conditions in 60 s and effectively blocks increases in heart rate after intubation.
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Acta Anaesthesiol Scand · May 2003
Randomized Controlled Trial Clinical TrialCombined effects of prone positioning and airway pressure release ventilation on gas exchange in patients with acute lung injury.
Prone positioning has been shown to improve oxygenation in 60-70% of patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Another way to improve matching of ventilation to perfusion is the use of partial ventilatory support. Preserving spontaneous breathing during mechanical ventilation has been shown to improve oxygenation in comparison with controlled mechanical ventilation. However, no randomized studies are available exploring the effects of preserved spontaneous breathing on gas exchange in combination with prone positioning. Our aim was to determine whether the response of oxygenation to the prone position differs between pressure-controlled synchronized intermittent mandatory ventilation with pressure support (SIMV-PC/PS) and airway pressure release ventilation with unsupported spontaneous breathing (APRV). ⋯ APRV during prone positioning is feasible in the treatment of ALI patients. APRV after 24 h appears to enhance improvement in oxygenation in response to prone positioning.
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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.