Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Modern anaesthesia is still associated with a risk of serious complications. This article focuses on frequency, causes, and prevention of the most important anaesthetic complications. ⋯ Optimization of the patient's preoperative health is important to improve safety. The focus of the anaesthesiology department should be education and guidelines. Systems and routines for improved safety must also take into account that human and organizational factors may cause anaesthetic accidents.
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All types of anaesthesia should ensure absence of pain, inhibit autonomic responses and provide optimal conditions for surgery. Choice of anaesthetic approach (local, regional or general anaesthesia or a combination of methods) depends on type of surgery and the patients' health and preferences. ⋯ An appropriate anaesthetic approach, taking into account patient characteristics and type of surgery, is important for safety and potential complications. In some situations, the anaesthetic approach and anaesthetic drugs may have an impact on outcome.
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Local anaesthetics may alleviate pain more effectively than any other anaesthetic method. In regional anaesthesia/analgesia, rare but serious complications make it necessary to always consider the risk-benefit ratio. The article discusses these issues and gives advice on effective and safe conduct. ⋯ Optimal regional anaesthesia/analgesia may improve the postoperative result.
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Tidsskr. Nor. Laegeforen. · Jan 2010
Review[Acute respiratory failure concomitant with serious disease or injury].
Acute respiratory failure has an annual incidence of 20-75/100,000 and is the most common reason for admittance to an intensive care unit. A common cause is acute inflammatory changes in lung tissue. The article reviews clinical, etiological, pathophysiological and therapeutic aspects of acute respiratory failure, with an emphasis on failure secondary to proinflammatory processes. ⋯ No specific treatment is available for secondary tissue inflammation; it usually resolves when the precipitating injuries or disease processes are healed. Positive pressure ventilation can prevent serious hypoxemia from causing additional damage to affected tissue. With modern treatment in an intensive care unit only 10-15 % of the deaths are caused by the respiratory failure per se, most deaths are caused by failure of several additional organs (multiorgan failure).
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Intensive care is medical care for critically ill patients. Over the last 20 years more attention has been drawn to studying long-term outcome after intensive care. ⋯ Many ICU patients have rehabilitation potential despite critical illness and comorbidity and most of the long-term survivors achieve acceptable quality of life. ICU patients are a heterogeneous group with great variation in short and long-term outcome. Organization of intensive care should include follow-up after hospital discharge.