Läkartidningen
-
This review discusses the treatment of impaired gas exchange in acute respiratory distress syndrome (ARDS) using conventional ventilation, the open lung approach, prone position, nitric oxide (NO) inhalation and extracorporeal membrane oxygenation (ECMO). It is concluded that ventilation with high inspiratory pressures or volumes should be avoided, and that the open lung approach should be used as the first step. If this does not lead to satisfactory results, prone positioning is recommended, and if life-threatening hypoxemia persists, ECMO could be considered. NO inhalation is not recommended.
-
In a Swedish nationwide case-control study, gastroesophageal reflux and obesity were identified as strong and independent risk factors for esophageal adenocarcinoma. A moderately strong association was found with adenocarcinoma of the gastric cardia. No significant association was found with squamous cell carcinoma of the esophagus. ⋯ Our calculations revealed that even in the group with the highest risk, endoscopic surveillance is not readily recommended. Possible reasons for the increasing incidence of adenocarcinoma of the esophagus include 1) a suspected increase in the prevalence of reflux disease; 2) the increasing prevalence of obesity reported in western populations; and 3) the widespread use of medications that relax the lower esophageal sphincter and might cause reflux. All of these hypotheses suffer from inconsistencies that need to be solved before any firm conclusions can be drawn concerning the reasons for the increasing incidence of esophageal adenocarcinoma.
-
Nitrous oxide may cause neurological and haematological signs and symptoms, as a result of its tendency to form complex with cobalt(I) in methylcobalamin, the cofactor for methionine synthase (EC 2.1.1.13), resulting in irreversible oxidation of the cofactor and inactivation of the enzyme protein. Formation of active enzyme requires new protein synthesis, as well as cobalamin supply (vitamin B12). Patients with low or marginal cobalamin depots (commonly found in the elderly) are at risk. The risk may be avoided by giving vitamin B12 to patients with confirmed or suspected cobalamin deficiency in good time before surgery involving nitrous oxide anaesthesia.
-
During the first decade of the new millennium the intense reorganisation of hospitals and of medical care will be replaced by stability and long-term goals. An anaesthesiologist is now as active outside as within the operating theatre, being a predominant resource in intensive care, pain management, and emergency and prehospital care. The anaesthesiologist will also have a key part to play in risk analysis of patients scheduled for various kinds of advanced treatment. Anaesthesiologists are now also more involved in primary home care where, together with other physicians and categories of health care providers, they offer qualified treatment of various diseases at home--the environment preferred by the patient.