British journal of anaesthesia
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Whilst dopexamine appears to increase overall splanchnic blood flow in postoperative and septic patients, the effects on gastric mucosal perfusion are controversial and based on concomitantly increasing mucosal to arterial PCO(2) gradients (PdCO(2)). We hypothesized that dopexamine alters splanchnic blood flow distribution and metabolism during experimental endotoxin shock and modifies the inflammatory response induced by endotoxin. ⋯ Dopexamine protects colonic, but not gastric mucosal epithelium in experimental endotoxin shock. This may be related to redistribution of blood flow within the splanchnic circulation.
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The present case report describes the observed sequelae following an inadvertent intrathecal injection of tramadol in a patient with metastatic malignancy. The contributing circumstances before the injection are discussed, as is the potential aetiology of the observed sequelae.
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Inorganic fluoride is released by the metabolism of enflurane and the increased serum fluoride concentrations may impair renal function. Tobacco smoke consists of numerous reactive compounds that can either induce or inhibit drug metabolism. Studies on the interaction of smoking with anaesthetic drug metabolism and possible toxicity are warranted. ⋯ Regular smoking is associated with an increase in serum inorganic fluoride concentration after anaesthesia with enflurane, but there are no signs of renal damage.
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Witnessed resuscitation is widely accepted in paediatric practice and is becoming more common in adult emergency departments, but information on this topic is sparse. ⋯ Intensive care staff support witnessed resuscitation. Many intensive care personnel have experienced witnessed resuscitation and the majority felt that relatives gained benefit. Almost all agree that the views of both patient and relatives should be sought formally before admission to intensive care.
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Target-controlled infusions (TCI) are used to simplify administration and increase precision of i.v. drugs during general anaesthesia. However, there is a limited relationship between preset targets and measured concentrations of drugs and between measured concentrations and measures of brain function, such as the bispectral index (BIS). ⋯ TCI devices for remifentanil and propofol result in large variation in measured serum concentrations. The lack of correlation between BIS and serum concentrations of propofol adds to the debate about whether BIS measures hypnosis as a graded state during surgery. This study confirms that women wake up faster than men, but provides no explanation for this repeatedly shown difference.