Anestezjologia intensywna terapia
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Nowadays, simple survival from a life threatening condition requiring treatment in an ICU, cannot be regarded as a sole indicator of the medical success. Patients expect to return to a more or less normal life, and to resume their daily activities. The aim of the study was to evaluate the health related quality of life (HRQOL) as a long-term indicator of successful outcome. ⋯ Compared to the healthy population, the quality of life of patients treated in an ICU was significantly lower in all areas. The lowest results were noted in the physical and physiological aspects of patients who survived cardiac arrest and surgical procedures. There was no correlation found between quality of life and duration of ICU treatment. The HRQOL index correlated negatively with high APACHE II scores on admission. The HRQOL was also related to the pre-ICU health status and co-existing diseases.
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Patients with upper airway obstruction during sleep are at constant risk of hypoxic and hypercarbic episodes and are especially vulnerable during anaesthesia and sedation as the abnormal anatomy is compounded by drug-related respiratory depression. Elective procedures in patients with the obstructive sleep apnoea (OSA) should be usually delayed, allowing for the preoperative home treatment (diet, alcohol abstinence, nasal CPAP/BiPAP during night). Respiratory supportive techniques, started at home, should be continued in the hospital, both in preoperative and postoperative periods. ⋯ In selected cases, prolonged intubation and/or ventilation are recommended. Regional anaesthesia are usually safe in these patients, however, opioids should be used carefully. When sedation is required, ketamine or dexmedetomidine may be used.
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Anestezjol Intens Ter · Jul 2008
Review[The priming technique in neuromuscular blockade --should we use it?].
The priming technique is one of the methods used to shorten the time between administering non-depolarizing neuromuscular blocking agents and endotracheal intubation. There are differing opinions concerning the priming technique. Its efficiency depends on which muscle relaxant is used, the priming dose, and the interval between the administration of the prime dose and the intubating dose. The paper presents advantages and disadvantages of the technique and compares its usefulness in rapid sequence induction.
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Anestezjol Intens Ter · Jul 2008
Biography Historical Article[Pioneers of anaesthesiology--Arthur Ernest Guedel (1883-1956)].
Arthur Ernest Guedel was a US born anaesthetist, whose name found its place among key persons in our specialty. Commonly known as a developer of the oropharyngeal airway, he did much more. Possibly, his major achievements were the detailed description of nitrous oxide and diethyl ether anaesthesia. ⋯ So called Guedel charts, describing the relationship between the level of anaesthesia and pupillary reactions, allowed many non-anaesthesiologists to administer diethyl ether relatively safely. Together with Waters, he was among pioneers of cuffed endotracheal tubes. At the end of his career, in 1937, he produced a manual "Inhalational Anaesthesia--A Fundamental Guide, which served at least three generations of medical professionals.