ABSTRACT
We present the case of a 21-year-old female drug addict with severe accidental hypothermia (core body temperature 27.5 degrees C) and cardiorespiratory arrest. After successful cardiopulmonary resuscitation the patient was actively internally rewarmed without the use of extracorporal circulation. Although at the first clinical presentation the patient appeared to be dead, an excellent neurological outcome was achieved. This case report reviews the epidemiology, pathophysiology, prognostic markers and the therapeutic approaches of severe hypothermia.
Subject(s)
Analgesics, Opioid/poisoning , Cardiopulmonary Resuscitation , Heroin/poisoning , Hypothermia/complications , Adult , Drug Overdose , Female , Heart Arrest/chemically induced , Heart Arrest/therapy , Heroin Dependence/complications , Heroin Dependence/physiopathology , Humans , Prognosis , RewarmingABSTRACT
AIM: The aim of this study was to determine whether P-STIM-verum in patients undergoing laparoscopic nephrectomies resulted in a lower consumption of analgesics and an improvement of pain scores compared with P-STIM-placebo when administered for acute peri- and postperative pain. METHODS: The study was carried out in a double-blind, randomized, controlled manner. Forty-four patients were randomised into 2 groups. The P-STIM device was applied to each patient 30 minutes pro-operatively. The Stimulation was applied over 96 hours. The P-STIM-verum group received subthreshold stimulation. The P-STIM-placebo group received no stimulation. Premedication and anaesthesia were applied in a standardised fashion. The efficacy of treatment was evaluated using a postoperative visual analogue scale (at rest and on exertion) and by dermining postoperative analgesic consumption. RESULTS: The P-STIM-verum group demonstrated better visual analogue at rest and on exertion then the P-STIM-placebo group. The postoperative consumption of morphine-hydrochloride in the first 6 h significantly less in the P-STIM-verum group. The time of first analgesic request was significantly later in the P-STIM-verum group compared with the P-STIM-placebo group. CONCLUSIONS: In this study we were able to demonstrate, that pre- and postoperative P-STIM applied in patients undergoing laparoscopic nephrectomies seems to be an effective, simply applied method with few side-effects for reducing pain and postoperative analgesic consumption.
Subject(s)
Acupuncture Therapy/methods , Ear , Electrochemistry/methods , Nephrectomy , Pain, Postoperative/therapy , Aged , Aged, 80 and over , Analgesics/therapeutic use , Double-Blind Method , Female , Humans , Laparoscopy , Male , Pilot ProjectsABSTRACT
The propofol infusion syndrome is a rare but potentially lethal complication resulting from a prolonged continuous administration of propofol. It was first described in the beginning of the 1990's and in recent years there have been frequent reports of problems in association with the use of propofol sedation. The cardinal signs and symptoms of the propofol infusion syndrome are metabolic acidosis, rhabdomyolysis, renal failure, cardiac arrhythmias and a progressive, often therapy-resistant cardiac failure. The pathophysiology of this syndrome appears to involve a disturbance of mitochondrial metabolism induced by propofol. Our report involves a case of propofol infusion syndrome in a patient having undergone cardiac surgery.
Subject(s)
Acidosis/chemically induced , Acute Kidney Injury/chemically induced , Anesthesia, Intravenous/adverse effects , Anesthetics, Intravenous/adverse effects , Arrhythmias, Cardiac/chemically induced , Intraoperative Complications/chemically induced , Propofol/adverse effects , Rhabdomyolysis/chemically induced , Acidosis/diagnosis , Acute Kidney Injury/diagnosis , Aged , Arrhythmias, Cardiac/diagnosis , Coronary Artery Bypass , Echocardiography , Humans , Infusions, Intravenous , Intraoperative Complications/diagnosis , Male , Potassium/blood , Rhabdomyolysis/diagnosis , SyndromeABSTRACT
The aim of this study was to provide evidence for the peripheral effect of opioids in oromaxillary procedures and to investigate whether postoperative morphine sulfate plus lidocaine administered as a local spray achieve better analgesic efficacy than lidocaine applied alone. The double-blind randomized study included 60 patients. The patients exhibited neither preoperative pain nor inflammation (tooth extractions) and when pain occurred received as alternative medication diclofenac retard 50 mg or tramadol. Side effects were documented. No differences between the two groups were observed in the demographic data, visual and numeric analog scale in the first 24 h, or in the consumption of analgesics. Since the patients presented in a pain-free state at the time of surgery, apparently no activation of the peripheral opioid receptors occurs. Thus, a peripheral effect of opioids could not be demonstrated in this model.
Subject(s)
Analgesics, Opioid/administration & dosage , Anesthetics, Local/administration & dosage , Lidocaine/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/drug therapy , Tooth Extraction , Administration, Topical , Adult , Aged , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Pain Measurement , Treatment OutcomeABSTRACT
AIM: Lornoxicam is a non opioid analgesic belonging to the oxicam group. The aim of this study was to determine whether lornoxicam has a preemptive analgesic effect. METHODS: This study was carried out in a randomized, double-blind fashion with 66 patients divided into three groups undergoing gynecological operations. Group I was administered 8 mg of lornoxicam i.v. preoperatively followed by an 8-mg bolus every 8 h for a total dose of 24 mg in the first 24 h. Group II was administered 8 mg of lornoxicam i.v. bolus before the end of the operation followed by 8 mg every 8 h for a total dose of 24 mg in the first 24 h. Group III was administered placebo before and after the operation and for the first 24 h. The effectiveness was assessed postoperatively using the visual analogue scale (at rest, on exertion) and by calculating the total analgesic consumption of morphine hydrochloride in the first 24 h following operation. Vital signs and side effects were documented. RESULTS: Groups I and II demonstrated significantly reduced pain scores compared to group III at various points in time. Group I also demonstrated a weakly significant reduction in analgesic consumption of morphine hydrochloride postoperatively compared to groups II and III. CONCLUSION: Lornoxicam administered preemptively appears to improve the quality of postoperative analgesia and lead to reduced consumption of opioid analgesics postoperatively in patients undergoing gynecological operations.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Genital Diseases, Female/surgery , Genital Neoplasms, Female/surgery , Pain, Postoperative/prevention & control , Piroxicam/analogs & derivatives , Piroxicam/therapeutic use , Adult , Analgesics, Opioid/therapeutic use , Double-Blind Method , Drug Administration Schedule , Female , Humans , Injections, Intravenous , Middle Aged , Morphine/therapeutic use , Pain Measurement , Piroxicam/administration & dosage , Postoperative Period , Preoperative Care , Time FactorsABSTRACT
We report a case of near drowning of a 3-year-old girl, who was admitted to our emergency room with a core temperature of 18.4 degrees C. After rewarming on cardiopulmonary bypass and restitution of her circulation, respiratory failure resistant to conventional respiratory therapy prohibited weaning from cardiopulmonary bypass. Therefore, we instituted extracorporeal membrane oxygenation (ECMO). Fifteen hours later, she could be weaned from ECMO but required assisted ventilation for another 12 days. Twenty months later there are no neurologic deficits.
Subject(s)
Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Near Drowning/therapy , Respiratory Insufficiency/therapy , Cardiopulmonary Bypass , Child, Preschool , Female , Follow-Up Studies , Humans , Hypothermia/therapy , RewarmingABSTRACT
BACKGROUND: Cardiac operations using extracorporeal circulation bear a risk of cerebral complications. The aim of our study was to investigate if off-pump operations without heart-lung machines can reduce cerebral injury. METHODS: S100, a protein specific for cerebral tissue, was used as a marker for cerebral impairment in 108 randomized patients undergoing coronary bypass operation: 67 patients (group A) were operated on with extracorporeal circulation and cardioplegic cardiac arrest, and 41 patients (group B) underwent off-pump beating heart revascularization. Both groups were similar regarding age, sex, ejection fraction, and number of anastomoses. S100 levels were measured from induction of anesthesia until 24 hours after the operation. RESULTS: Data collection was 100% complete. There was no in-hospital death. Nonfatal myocardial infarctions occurred in 2 patients in group A, and 1 patient in group B required resternotomy for bleeding. There was no neurologic deficit in either group. S100 levels increased only slightly in the off-pump patients (group B), whereas in group A there was a sharp rise in S100 concentration during extracorporeal circulation, only returning to baseline 6 hours after the end of the operation. Peak S100 levels were four times higher in group A than in group B (2.1 microg/L versus 0.5 microg/L; p < 001). CONCLUSIONS: The results of our study suggest that perioperative cerebral impairment is reduced in cardiac operations without the use of extracorporeal circulation. Further large-scale studies are needed to show whether this result is reflected by fewer neurologic deficits.
Subject(s)
Biomarkers/blood , Cardiopulmonary Bypass , Cerebrovascular Disorders/etiology , Coronary Artery Bypass/methods , S100 Proteins/blood , Aged , Aged, 80 and over , Cardiopulmonary Bypass/adverse effects , Cerebrovascular Disorders/diagnosis , Female , Humans , Male , Middle Aged , Reoperation , Stroke VolumeABSTRACT
This is a case report involving a 71 year old man with generalized tetanus. The patient was initially treated conservatively with sedatives and muscle relaxants, which necessitated intubation and mechanical ventilation. After intrathecal administration of baclofen all cramps and spasms subsided and the patient could be weaned from the respirator and subsequently discharged from the intensive care unit.
