Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Sep 2014
Observational StudyTidal ventilation distribution during pressure-controlled ventilation and pressure support ventilation in post-cardiac surgery patients.
Inhomogeneous ventilation is an important contributor to ventilator-induced lung injury. Therefore, this study examines homogeneity of lung ventilation by means of electrical impedance tomography (EIT) measurements during pressure-controlled ventilation (PCV) and pressure support ventilation (PSV) using the same ventilation pressures. ⋯ In post-cardiac surgery patients, PSV showed improved ventilation of the dependent lung region due to the contribution of the diaphragm activity, which is even more pronounced during lower assist levels.
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Acta Anaesthesiol Scand · Sep 2014
Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery.
To reduce blood loss during liver surgery, a low central venous pressure (CVP) is recommended. Nitroglycerine (NG) with its rapid onset and offset can be used to reduce CVP. In this study, the effect of NG on portal and hepatic venous pressures (PVP and HVP) in different body positions was assessed. ⋯ NG infusion leads to parallel reductions in CVP, HVP and PVP at horizontal body position. Thus, CVP can be used to guide NG dosage and fluid administration at horizontal position. NG infusion can be used to reduce HVP. Head-down tilt can be used during NG infusion to improve both blood pressure and CO without substantial increase in liver venous pressure. In head-down tilt, CVP dissociates from HVP and PVP.
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Acta Anaesthesiol Scand · Sep 2014
Comparative StudyVentilation/perfusion ratios measured by multiple inert gas elimination during experimental cardiopulmonary resuscitation.
During cardiopulmonary resuscitation (CPR) the ventilation/perfusion distribution (VA /Q) within the lung is difficult to assess. This experimental study examines the capability of multiple inert gas elimination (MIGET) to determine VA /Q under CPR conditions in a pig model. ⋯ VA /Q assessment by MIGET is feasible during CPR and provides a novel tool for experimental purposes. Changes in VA /Q caused by different oxygen fractions are traceable during CPR. Beyond pulmonary perfusion deficits, these data imply an influence of the inspired oxygen level on VA /Q. Higher oxygen levels significantly increase shunt fractions and impair the normal VA /Q ratio.
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Acta Anaesthesiol Scand · Sep 2014
Case ReportsUse of neuromuscular monitoring to detect prolonged effect of succinylcholine or mivacurium: three case reports.
Mutations in the butyrylcholinesterase gene can lead to a prolonged effect of the neuromuscular blocking agents, succinylcholine and mivacurium. If the anaesthesiologist is not aware of this condition, it may result in insufficient respiration after tracheal extubation. However, this can be avoided with the use of objective neuromuscular monitoring if used adequately. ⋯ Both patients had insufficient respiration. They were therefore re-sedated, transferred to the intensive care unit and the tracheas were extubated after full recovery from neuromuscular blockade. We recommend the use of monitoring every time these agents are used, even with short-acting drugs like succinylcholine and mivacurium.