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.
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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.
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Anestezjol Intens Ter · Jul 2008
Randomized Controlled Trial Comparative Study[Continuous epidural anaesthesia vs paravertebral block for lung surgery--a comparative study].
This prospective randomized study compared the effects of two techniques--thoracic epidural analgesia (TEA), and thoracic paravertebral analgesia (TPVA), on pain control and haemodynamics after thoracotomy. ⋯ (1) Thoracic paravertebral anaesthesia can be regarded as a satisfactory alternative to epidural anaesthesia for control of post-thoracotomy pain. (2) The effect of paravertebral anaesthesia on blood pressure and heart rate is minimal, therefore this technique may be recommended for patients with coexisting circulatory disease. (3) The frequency of use of the PCA system cannot be regarded as an objective method of pain assessment.
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Anestezjol Intens Ter · Jul 2008
Clinical Trial[The use of heart rate variability analysis to determine changes in autonomic nervous system activity induced by laryngoscopy and endotracheal intubation].
Laryngoscopy and intubation are associated with marked autonomic system activation that can be assessed by heart rate variability analysis (HRV)--a new method, comparing R-R intervals in 12-lead continuous ECG recording. ⋯ Because of the large incidence of cardiac rhythm disturbances, the HRV proved to be useless for assessment of autonomic system changes.