Anestezjologia intensywna terapia
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Anestezjol Intens Ter · Oct 2008
[Fractal dimension--a new EEG-based method of assessing the depth of anaesthesia].
It has been suggested that analysis of the EEG signal using the fractal dimension method may be useful for assessment of depth of anaesthesia. ⋯ The fractal dimension method can be regarded as equal to BIS for assessment of depth of anaesthesia.
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Propofol is probably the most popular intravenous anaesthetic in daily practice. Its use is known to be associated with dose-dependent cardiovascular compromise. We have assessed the effect of a single dose of propofol on cardiovascular function. ⋯ The results indicated that 1 mg kg(-1) propofol moderately compromised cardiac contractility and increased afterload on the right ventricle, without significant effect on coronary perfusion pressure. The cardiovascular compromise was clinically insignificant, but caution is required when propofol is administered in larger doses.
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Anestezjol Intens Ter · Oct 2008
Review[Intralipid for treatment of local anaesthetic-induced toxicity].
Regional anaesthesia can be associated with severe complications, which may be due to overdose or accidental intravascular injection of local anaesthetics. The clinical picture varies and depends on the pharmacodynamics of specific drugs, the total dose used, and the route of injection. Among the most common side effects are: excitation, seizures, loss of consciousness, cardiac dysrhythmias, severe shock and cardiac arrest. ⋯ Recently, intravenous fat emulsion (Intralipid) has been used during resuscitation. This review focuses on the role of intravenous fat emulsions in the treatment of toxicity due to local anaesthetics. The possible antidotal mechanisms are discussed.
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A growing number of very sick and hospital-dependent patients in an ageing population, together with a chronic lack of intensive care beds, has resulted in a significant impairment in hospital care. Acute, life-threatening symptoms are frequently missed, leading to increased mortality and morbidity. Many projects have been introduced to improve the situation; among them, the creation of early warning scoring and trigger systems, and organisation of in-hospital medical response and critical care teams. ⋯ Organisational aspects as well as the main differences between medical emergency teams and intensive care outreach services, are presented. During the development and organisation phase, all plans have to be assessed against specific local needs and requirements. The effects of the introduction of outreach systems and medical emergency teams on hospital morbidity, mortality and treatment outcome, are briefly analyzed.
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Anestezjol Intens Ter · Oct 2008
Randomized Controlled Trial Comparative Study[Comparison of two methods of pre-emptive infiltration anaesthesia for inguinal hernia repair].
Intraarticular injection of neostigmine has been reported to create long-lasting analgesia due to the blockade of muscarinic receptors and neuronociceptive transmitters. The aim of the study was to determine if similar effects could be achieved after adding neostigmine to bupivacaine during infiltration of the surgical area before inguinal hernia surgery. ⋯ Neostigmine added to bupivacaine had no effect on analgesia after pre-emptive local wound infiltration.