Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Feb 2003
Death after injury in rural Norway: high rate of mortality and prehospital death.
Finnmark is a rural and remote area in Norway with a sparse population and long distances. Trauma-related mortality has been consistently above the Norwegian national average for the last 20 years. Although the causes of death are well established, very little is known about the time and place of death. This information has implications for the organization of emergency services in rural areas. We examined all trauma deaths over a five-year period in order to inform the debate on how best to reduce our above-average mortality rate. ⋯ When planning interventions to reduce the mortality rate from trauma in rural areas, a high proportion of prehospital deaths should be expected. The high number of patients who are found dead (which can only be reduced by injury prevention) must be taken into account. Measures to reduce 'preventable' causes of death by bystanders should be evaluated. Further knowledge of exact mechanisms of death in the prehospital phase is required.
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Acta Anaesthesiol Scand · Apr 2003
Case ReportsResponse to the prone position in spontaneously breathing patients with hypoxemic respiratory failure.
The prone position is used for intubated patients with adult respiratory distress syndrome (ARDS) and acute lung injury (ALI). The physiological changes associated with the prone position in nonintubated patients may be even more favorable than in intubated patients. We examined the effect of the prone position on arterial blood gases and patient compliance in four awake, nonintubated patients with hypoxemic respiratory failure. ⋯ The prone position may prove beneficial in some cases of hypoxemic respiratory failure, even in awake patients, by avoiding mechanical ventilation and ventilator-associated complications.
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Acta Anaesthesiol Scand · Apr 2003
High-dose glucose-insulin-potassium after cardiac surgery: a retrospective analysis of clinical safety issues.
Metabolic treatment with insulin or glucose-insulin-potassium (GIK) has received attention in association with myocardial infarction, cardiac surgery and critical care. As a result of insulin resistance during neuroendocrine stress, doses of insulin up to 1 IU kg-1 b.w.*h are required to achieve maximal metabolic effects after cardiac surgery. The clinical experience with regard to safety issues of such a high-dose GIK regime in critically ill patients after cardiac surgery is reported. ⋯ The high-dose GIK regime allowed substantial amounts of glucose to be infused both in diabetic and critically ill patients with maintenance of acceptable blood glucose control. Provided careful monitoring, this regime can be safely used in clinical practice and deserves further evaluation for treatment of critically ill patients following cardiac surgery.
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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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Acta Anaesthesiol Scand · Mar 2003
Case ReportsAnesthetic management of a patient with Weill-Marchesani syndrome.
Weill-Marchesani syndrome is characterized by short stature, brachydactylyl, myopia, microspherophakia, lens dislocation, glaucoma, joint stiffness, restricted articular movements and facial features. The anesthetic management of an 11-year-old-male patient with diagnosis of this syndrome is reported.