Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Aug 2007
The kinetics of Ringer's solution in young and elderly patients during induction of general anesthesia with propofol and epidural anesthesia with ropivacaine.
Different fluid regimens are often adopted for elderly patients, but it is not known whether they handle infused fluids differently during the induction of anesthesia than young patients. ⋯ Induction of anesthesia greatly increases fluid-induced hemodilution, the magnitude of which can be expressed as an acute reduction of the distribution rate constant for infused fluid. The post-induction value of this parameter was closely associated with MAP but not with the patient's age.
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Acta Anaesthesiol Scand · Aug 2007
Low antibiotic resistance rates in Staphylococcus aureus, Escherichia coli and Klebsiella spp but not in Enterobacter spp and Pseudomonas aeruginosa: a prospective observational study in 14 Swedish ICUs over a 5-year period.
Intensive care units (ICUs) are hot zones for emergence and spread of antibiotic resistance because of frequent invasive procedures, antibiotic usage and transmission of bacteria. We report prospective data on antibiotic use and bacterial resistance from 14 academic and non-academic ICUs, participating in the ICU-STRAMA programme 1999-2003. ⋯ MRSA and cefotaxime-resistant E. coli and Klebsiella spp strains were few despite high total antibiotic consumption. This may be the result of a slow introduction of resistant strains into the ICUs, and good infection control. The cause of imipenem and ciprofloxacin resistance in P. aeruginosa could reflect the increased consumption of these agents plus spread of resistant clones.
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Acta Anaesthesiol Scand · Aug 2007
Divergent effects of ephedrine and phenylephrine on cardiovascular hemodynamics of near-term fetal sheep exposed to hypoxemia and maternal hypotension.
We hypothesized that the administration of ephedrine and phenylephrine for maternal hypotension modifies cardiovascular hemodynamics in near-term sheep fetuses. ⋯ After exposure to hypoxemia and maternal hypotension, ephedrine restored all fetal cardiovascular hemodynamic parameters to baseline. Phenylephrine did not reverse fetal pulmonary vasoconstriction or the relative decrease in the net forward flow through the aortic isthmus observed in fetuses with increased placental vascular resistance. Moreover, fetal left ventricular function was impaired during phenylephrine administration.
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Acta Anaesthesiol Scand · Aug 2007
Therapeutic hypothermia after cardiac arrest: implementation and outcome in Finnish intensive care units.
Therapeutic hypothermia (TH) has been shown to increase survival after out-of-hospital resuscitation. The aim of our study was to find out nationwide implementation and the actual utilization of TH after cardiac arrest in Finnish intensive care units (ICUs). We also determined the outcomes and describe demographic variables of the patients treated with TH. ⋯ In Finland, TH is implemented in almost all ICUs but it is applied only to a selected group of patients. Six months after cardiac arrest, more than half of the patients treated with TH were alive. Among patients treated with TH, younger patients had lower in-hospital mortality.
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Acta Anaesthesiol Scand · Aug 2007
Confusion assessment method for the intensive care unit (CAM-ICU): translation, retranslation and validation into Swedish intensive care settings.
Becoming critical ill or severely injured leads to a process of worry, anxiety and pain. Patients in intensive care sometimes have strange and frightening experiences and may show symptoms of acute confusion or delirium. CAM-ICU, the confusion assessment method for the intensive care unit, was based on the DSM IV, the Diagnostic and Statistic Manual of Mental Disorders IV, and today, healthcare professionals and researchers are increasingly accepting this concept of diagnosing ICU delirium. In Sweden, there is no commonly used, single instrument or method to test the development of ICU delirium. The aim of this study was to translate, retranslate and validate CAM-ICU for use in Swedish ICU settings. ⋯ The translation of the instrument CAM-ICU showed good correlation with the original version and could therefore be applicable in a Swedish ICU setting. In the 40 paired observations, interrater reliability was very good. Although there are limitations in using CAM-ICU, previous studies reveal a need for a homogeneous screening instrument making it possible to detect and determine ICU delirium; and from this basis are able to implement and make the necessary decisions required in medical and nursing care practice preventing ICU delirium.