Anestezjologia intensywna terapia
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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.