Acute care
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I have reviewed the identifiable hemodynamic effects of selected inotropic and vasoactive agents in the context of several clinical patient subsets. Knowledge of relative hemodynamic effects of various agents permits the selection of those that are best in specific clinical circumstances. Combining drugs may only occasionally be advisable to supplement a desired effect or to attenuate an unwanted one.
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Recent studies showed that the patient work of breathing may be unexpectedly high during mechanical ventilation. During assisted mechanical ventilation and synchronous intermittent mechanical ventilation particularly, attention must be paid to the patient work if the respiratory muscles are to be rested. Clinicians should observe chest wall movements to recognize inspiratory efforts and incoordination. Monitoring the profile of inspiratory airway pressure over time is also helpful, with irregular and only partially positive pressures indicating inspiratory effort by patients.
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Patient-controlled analgesia (PCA) has been studied extensively for the treatment of postoperative pain using narcotic analgesics. Butorphanol, a nonnarcotic injectable analgesic, has not previously been investigated using this drug delivery mechanism. ⋯ Most patients (84%) were able to obtain excellent postoperative pain relief. The role of butorphanol in the management of postoperative pain should be expanded to include patient-controlled drug delivery.