| 1. |
- Edsberg, Lennart, et al.
(författare)
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Volume kinetics of glucose solutions given by intravenous infusion
- 2001
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 87:6, s. 834-843
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Tidskriftsartikel (refereegranskat)abstract
- Glucose solutions given by intravenous (i.v.) infusion exert volume effects that are governed by the amount of fluid administered and also by the metabolism of the glucose. To understand better how the body handles glucose solutions, two volume kinetic models were developed in which consideration was given to the osmotic fluid shifts that accompany the metabolism of glucose. These models were fitted to data obtained when 21 volunteers who were given approximately 1 litre of glucose 2.5 or 5% or Ringer's solution (control) over 45 min. The maximum haemodilution was similar for all three fluids, but it decreased more rapidly when glucose had been infused. The volume of distribution for the infused glucose molecules was larger (similar to 12 litres) than for the infused fluid, which amounted to (mean (SEM)) 3.7 (0.3) (glucose 2.5%). 2.8 (0.2) (glucose 5%), and 2.5 (0.2) litres (Ringer). Fluid accumulated in a remote (cellular) body fluid space when glucose had been administered (similar to0.2 and 0.4 litres, respectively), while expansion of an intermediate fluid space (7.1 (13) litres) could be demonstrated in 33% of the Ringer experiments. In conclusion, kinetic models were developed which consider the relationship between the glucose metabolism and the disposition of intravenous fluid. One of them, in which infused fluid expands two instead of three body fluid spaces, was successfully fitted to data on blood glucose and blood haemoglobin obtained during infusions of 2.5 and 5% glucose.
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| 2. |
- Good, Lars, 1953-, et al.
(författare)
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Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement
- 2003
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 90:5, s. 596-599
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Tidskriftsartikel (refereegranskat)abstract
- Background. Total knee arthroplasty (TKA) is often carried out using a tourniquet and shed blood is collected in drains. Tranexamic acid decreases the external blood loss. Some blood loss may be concealed, and the overall effect of tranexamic acid on the haemoglobin (Hb) balance is not known. Methods. Patients with osteoarthrosis had unilateral cemented TKA using spinal anaesthesia. In a double-blind fashion, they received either placebo (n=24) or tranexamic acid 10 mg kg-1 (n=27) i.v. just before tourniquet release and 3 h later. The decrease in circulating Hb on the fifth day after surgery, after correction for Hb transfused, was used to calculate the loss of Hb in grams. This value was then expressed as ml of blood loss. Results. The groups had similar characteristics. The median volume of drainage fluid after placebo was 845 (interquartile range 523-990) ml and after tranexamic acid was 385 (331-586) ml (P<0.001). Placebo patients received 2 (0-2) units and tranexamic acid patients 0 (0-0) units of packed red cells (P<0.001). The estimated blood loss was 1426 (1135-1977) ml and 1045 (792-1292) ml, respectively (P<0.001). The hidden loss of blood (calculated as loss minus drainage volume) was 618 (330-1347) ml and 524 (330-9620) ml, respectively (P=0.41). Two patients in each group developed deep vein thrombosis. Conclusions. Tranexamic acid decreased total blood loss by nearly 30%, drainage volume by ~50% and drastically reduced transfusion. However, concealed loss was only marginally influenced by tranexamic acid and was at least as large as the drainage volume.
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| 3. |
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| 4. |
- Håkansson, E, et al.
(författare)
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Management of life-threatening haemoptysis
- 2002
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 88, s. 291-295
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Tidskriftsartikel (refereegranskat)abstract
- Massive haemoptysis represents a major medical emergency that is associated with a high mortality. Here we present two cases of life-threatening haemoptysis, the first caused by rupture of an aortic aneurysm into the lung in a 37-yr-old woman with polyarteritis nodosa and the second caused by massive bleeding from an angiectatic vascular malformation in the right main bronchus in a 21-yr-old woman. Fibreoptic bronchoscopy played an essential role in the diagnostic process and management of the respiratory tract. Diagnosis in the first case was obtained by CT scan and the aneurysm was treated surgically. In the second case, bronchial arteriography contributed to both definitive diagnosis and treatment. Initial cardiorespiratory management, diagnostic procedures and definitive therapy are described and reviewed. Adequate early management of the cardiorespiratory system is essential to the outcome. Aggressive measures to elucidate the cause of haemoptysis and prompt therapy are warranted because of the high risk of recurrence.
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| 5. |
- Kimme, Peter, 1961-, et al.
(författare)
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Moderate hypothermia for 359 operations to clip cerebral aneurysms
- 2004
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 93:3, s. 343-347
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Tidskriftsartikel (refereegranskat)abstract
- Background. Experimental data have suggested that hypothermia (32–34°C) may improve outcome after cerebral ischaemia, but its efficacy has not yet been established conclusively in humans. In this study we examined the feasibility and safety of deliberate moderate perioperative hypothermia during operations for subarachnoid aneurysms.Methods. A total of 359 operations for intracranial cerebral aneurysms were included in this prospective study. By using cold intravenous infusions (4°C) and convective cooling our aim was to reduce the patient's core temperature to more than 34°C within 1 h before operation. The protocol assessed postoperative complications such as infections, prolonged mechanical ventilation, pulmonary complications and coagulopathies.Results. During surgery, the body temperature was reduced to a mean of 32.5 (sd 0.4) °C. Cooling was accomplished at a rate of 4.0 (sd 0.4) °C h−1. All patients were normothermic at 5 (sd 2) h postoperatively. Peri/postoperative complications included circulatory instability (n=36, 10%), arrhythmias (n=17, 5%) coagulation abnormalities and blood transfusion (n=169, 47%), infections (n=29, 8%) and pulmonary complications (infiltrate or oedema while on ventilatory support) (n=97, 27%). Eighteen patients died within 30 days (5%). There was no significant correlation between the extent of hypothermia and any of the complications. However, there was a strong correlation between the occurrence of complications and the severity of the underlying neurological disease as assessed by the Hunt and Hess score.Conclusion. Moderate hypothermia accomplished within 1 h of induction of anaesthesia and maintained during surgery for subarachnoid aneurysms appears to be a safe method as far as the risks of peri/postoperative complications such as circulatory instability, coagulation abnormalities and infections are concerned.
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| 6. |
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| 7. |
- Larsson, Jan, et al.
(författare)
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Trainee anaesthetists understand their work in different ways : implications for specialist education
- 2004
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 92:3, s. 381-387
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Tidskriftsartikel (refereegranskat)abstract
- Background. Traditionally, programmes for specialist educationin anaesthesia and intensive care have been based on lists ofattributes such as skills and knowledge. However, modern researchin the science of teaching has shown that competence developmentis linked to changes in the way professionals understand theirwork. The aim of this study was to define the different waysin which trainee anaesthetists understand their work.Methods. Nineteen Swedish trainee anaesthetists were interviewed.The interviews sought the answers to three open-ended questions.(i) When do you feel you have been successful in your work?(ii) What is difficult or what hinders you in your work? (iii)What is the core of your anaesthesia work? Transcripts of theinterviews were analysed by a phenomenographic approach, a researchmethod aiming to determine the various ways a group of peopleunderstand a phenomenon.Results. Six ways of understanding their work were defined:giving anaesthesia according to a standard plan; taking responsibilityfor the patient’s vital functions; minimizing the patient’ssuffering and making them feel safe; giving service to specialistdoctors to facilitate their care of patients; organizing andleading the operating theatre and team; and developing one’sown competence, using the experience gained from every new patientfor learning.Conclusions. Trainee anaesthetists understand their work indifferent ways. The trainee’s understanding affects bothhis/her way of performing work tasks and how he/she developsnew competences. A major task for teachers of anaesthesia isto create learning situations whereby trainees can focus onnew aspects of their professional work and thus develop newways of understanding it.
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| 8. |
- Lichtwarck-Aschoff, Michael, et al.
(författare)
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Static versus dynamic respiratory mechanics for setting the ventilator.
- 2000
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Ingår i: British Journal of Anaesthesia. - 0007-0912 .- 1471-6771. ; 85:4, s. 577-86
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Tidskriftsartikel (refereegranskat)abstract
- The lower inflection point (LIP) of the inspiratory limb of a static pressure-volume (PV) loop is assumed to indicate the pressure at which most lung units are recruited. The LIP is determined by a static manoeuvre with a PV-history that is different from the PV-history of the actual ventilation. In nine surfactant-deficient piglets, information to allow setting PEEP and VT was obtained, both from the PV-curve and also during ongoing ventilation from the dynamic compliance relationship. According to LIP, PEEP was set at 20 (95% confidence interval 17-22) cm H2O. Volume-dependent dynamic compliance suggested a PEEP reduction (to 15 (13-18) cm H2O). Pulmonary gas exchange remained satisfactory and this change resulted in reduced mechanical stress on the respiratory system, indirectly indicated by volume-dependent compliance being consistently great during the entire inspiration.
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| 9. |
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| 10. |
- Szabó, Zoltán, 1957-
(författare)
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A simple method to pass a pulmonary artery flotation catheter rapidly into the pulmonary artery anaesthetized patients
- 2003
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Ingår i: British Journal of Anaesthesia. - : Elsevier BV. - 0007-0912 .- 1471-6771. ; 90:6, s. 794-796
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Tidskriftsartikel (refereegranskat)abstract
- Background. In some patients passage of a pulmonary artery flotation catheter (PAFC) into the pulmonary artery may be difficult and time consuming and the prolonged manipulation can cause ventricular arrhythmias. A simple clinical method used during general anaesthesia is presented to allow rapid passage of a PAFC into the pulmonary artery. Methods. The operating table is positioned head up and slightly right side down to position the pulmonary valve at the highest level possible. When the balloon catheter is in the right ventricular outflow tract (indicated by premature ventricular contractions) the ventilator is paused in inspiration and the balloon catheter simultaneously passed into the pulmonary artery. Results. The manoeuvre shortens the time necessary to pass the catheter into the pulmonary artery and may reduce ventricular arrhythmias. Over 5 yr, 105 PAFCs were inserted with this method without major complications. Conclusion. This method may reduce the risk of ventricular arrhythmias, and could be particularly useful in high-risk critically ill patients.
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