ABSTRACT
Auditory evoked response (AER) was recorded before, during and after physiotherapy in 11 paralysed (atracurium 0.56 (SD) 0.13 mg kg-1 h-1), sedated (propofol 2.2 (1.0) mg kg-1 h-1; fentanyl 4.4 (2.3) micrograms kg-1 h-1) and critically ill patients undergoing ventilation in the intensive care unit (ICU). The latency of the negative wave, NB, was reduced by physiotherapy (mean 44.8 (SD) 7.9 ms before, 41.0 (6.8) ms during (P less than 0.01, non-parametric Friedman test) and 45.6 (6.3) ms after physiotherapy); NB amplitude showed no consistent change (-0.81 (1.4) microV, -0.81 (1.5) microV and -0.71 (1.3) microV, respectively). NB latency responded to patient arousal at constant levels of sedation and this requires further evaluation as a means of monitoring sedation in paralysed patients in the ICU.
Subject(s)
Critical Care , Evoked Potentials, Auditory/physiology , Paralysis/physiopathology , Physical Therapy Modalities , Adult , Aged , Arousal/physiology , Atracurium , Evaluation Studies as Topic , Female , Humans , Hypnotics and Sedatives , Male , Middle Aged , Monitoring, Physiologic , Respiration, ArtificialABSTRACT
Two groups of 14 patients were compared after coronary artery bypass surgery where the left internal mammary artery had been used as a conduit. One group received nasal continuous positive airway pressure for 1 h, the other group acted as a control. Mean pulmonary shunt fraction was 16.3% before, 12.6% during and 15.7% after continuous positive airways pressure. In the control group the shunt fraction fell from 17.3% to 16.8%. The reduction in shunt fraction was significantly greater with nasal continuous positive airways pressure than in the control group (p = 0.016). There was a significant reduction (p = 0.025) in respiratory rate from 18.3 to 16.7 breath.min-1 during continuous positive airway pressure. Other measured cardiorespiratory variables did not differ significantly between the groups. Visual analogue scores showed no significant difference in chest pain or mask comfort between the groups. The ease of breathing score was, however, significantly better in the continuous positive airways pressure group, 7.5 (SD 1.8) cm and control 5.6 (SD 2.6) cm.
Subject(s)
Coronary Artery Bypass , Positive-Pressure Respiration , Postoperative Care/instrumentation , Equipment Design , Hemodynamics , Humans , Male , Middle Aged , Oxygen/administration & dosage , Patient Satisfaction , SmokingABSTRACT
The performance characteristics of two transcutaneous combined PO2 (tcPO2) and PCO2 (tcPCO2) sensors were compared with single tcPO2 and tcPCO2 electrodes in critically ill patients. The relationship between arterial blood gases (PaO2, PaCO2) and transcutaneous values was linear. Correlation coefficients (r) varied from 0.79 to 0.87 for tcPO2 and 0.92 to tcPCO2. The tcPO2 readings were always lower than PaO2 values, but the tcPCO2, with modified calibration of the electrodes, did not differ significantly from PaCO2. There was no significant difference of clinical importance in the performance of the three monitoring systems.
Subject(s)
Blood Gas Monitoring, Transcutaneous , Carbon Dioxide/blood , Critical Care , Oxygen/blood , Adult , Blood Gas Monitoring, Transcutaneous/instrumentation , Electrodes , Humans , Partial Pressure , Polarography , Reference ValuesABSTRACT
Values obtained for cardiac output (CO) were compared using thermodilution (TD) with those obtained using bioimpedance (Bi) as measured using the Bomed NCCOM3 (Revision 6) in 28 consecutive patients in the first 24 h after coronary artery bypass surgery (CABS). In 46 paired measurements made in the first 12 h after CABS Bi values for CO were significantly lower than TD values, the limits of agreement between the two methods were also unacceptably large (mean Bi 4.38 (SD 1.40) l/min, mean TD 5.46 (SD 1.19) l/min, limits of agreement -3.05 to +0.89). In 55 paired measurements made after 12 h (all in spontaneously breathing patients) there was no significant difference between the two methods and acceptable limits of agreement, mean Bi 5.69 (SD 1.2) l/min mean TD 5.6 (SD 1.2) l/min, limits of agreement -0.99 to +1.17). The significantly lower BiCO values obtained in the first 12 h after CABS show that BiCO measurement is not consistently reliable in the intensive care setting.
Subject(s)
Cardiac Output , Cardiography, Impedance/standards , Coronary Artery Bypass , Monitoring, Physiologic/methods , Thermodilution/standards , Bias , Cardiography, Impedance/instrumentation , Evaluation Studies as Topic , Humans , Monitoring, Physiologic/instrumentation , Postoperative Period , Reproducibility of ResultsABSTRACT
A patient with obstructive sleep apnoea is described, who required admission to an intensive care unit on two separate occasions within 2 months. The first admission was after anaesthesia for operation on the upper airway. The second occurred after a relative overdose of an opioid analgesic was administered. The diagnosis, treatment and anaesthetic management of patients with this syndrome are discussed.
Subject(s)
Sleep Apnea Syndromes , Airway Obstruction/complications , Airway Obstruction/surgery , Anesthesia , Humans , Lung Diseases, Obstructive/complications , Male , Middle Aged , Nasal Cavity/surgery , Phenazocine/adverse effects , Postoperative Complications , Sleep Apnea Syndromes/therapyABSTRACT
The case is described of a patient with myasthenia gravis who required prolonged controlled ventilation for respiratory failure. Muscular relaxation was obtained with a continuous infusion of atracurium 5 mg h-1 for 45 h. Following cessation of the infusion, paralysis disappeared rapidly.
Subject(s)
Atracurium/administration & dosage , Critical Care , Myasthenia Gravis/complications , Respiration, Artificial , Respiratory Insufficiency/therapy , Adolescent , Female , Humans , Intensive Care Units , Respiratory Insufficiency/etiology , Time FactorsSubject(s)
Exchange Transfusion, Whole Blood , Pancreatitis/therapy , Acute Disease , Alcoholism/complications , Hemorrhage , Humans , Male , Middle Aged , NecrosisABSTRACT
An injector gun of the type developed for vaccinations was used to perform intercostal nerve blocks. Analgesia was achieved in all patients to some degree, but the effectiveness of the technique was limited by the currently available local anaesthestics.