ABSTRACT
BACKGROUND AND OBJECTIVE: Remifentanil has a short duration of action and constant elimination, which allow administration of high doses, without prolonging recovery. Remifentanil has been compared to alfentanil, as part of a total intravenous anaesthetic technique, where remifentanil provided better anaesthetic conditions than alfentanil, without adverse effect on recovery. However, these results were obtained during anaesthesia involving neuromuscular blockade, which may mask both signs of insufficient anaesthesia and side-effects such as muscle rigidity. The aim of this study was to compare remifentanil with alfentanil for anaesthesia without neuromuscular blockade. METHODS: We performed a prospective, randomized, double-blind, four-centre study to compare remifentanil infusion 15 microg kg(-1) h(-1) and alfentanil infusion 60 microg kg(-1) h(-1), using a total intravenous technique for non-paralysed patients, and the laryngeal mask airway for airway management. We enrolled 192 patients, 18-65 yr of age with ASA I-II, undergoing minor surgery. The primary endpoint was the number of patients having pre-defined responses to surgical stimulation. A number of secondary criteria was evaluated to assess undesirable properties of the procedures. RESULTS: In the alfentanil group, 85% of patients responded to surgical stimulation, vs. 35% in the remifentanil group (P < 0.0001). No difference was found in recovery data, or in any other parameter than those related to insufficient anaesthesia. CONCLUSIONS: The remifentanil-based technique provided significantly better anaesthetic conditions than the alfentanil-based technique in the setting of this study, without causing any significant adverse effects.
Subject(s)
Alfentanil , Anesthesia, Intravenous , Anesthetics, Intravenous , Piperidines , Adolescent , Adult , Aged , Alfentanil/administration & dosage , Anesthesia Recovery Period , Anesthetics, Intravenous/administration & dosage , Double-Blind Method , Humans , Laryngeal Masks , Middle Aged , Pain, Postoperative , Piperidines/administration & dosage , Postoperative Nausea and Vomiting , RemifentanilABSTRACT
In five women and two men, profound accidental hypothermia--core temperature on admission 24-28 degrees C--was treated with peritoneal dialysis. In two cases 16 gauge intravenous catheters were used, without difficulty, for the dialysis. Six of the seven patients were intoxicated by hypnotics, and four also by alcohol. Two patients died--one 38 hours after admission due to acute myoglobinuric renal failure arising from gangrene of an arm, and the other after 71 hours, due to cerebral herniation. The remaining five patients recovered without cerebral sequelae. Peritoneal dialysis is a useful procedure for rewarming patients with profound accidental hypothermia.
Subject(s)
Hypothermia/therapy , Peritoneal Dialysis , Adolescent , Adult , Aged , Arrhythmias, Cardiac/prevention & control , Female , Hot Temperature/therapeutic use , Humans , Male , Middle Aged , Peritoneal Dialysis/methods , Suicide, AttemptedABSTRACT
The purpose of this study was to investigate if insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) predispose to the development of acute myocardial infarction (AMI) and modify the prognosis. The study includes 832 AMI patients consecutively hospitalized over a 3-yr period. The prevalence of diabetes mellitus among the AMI patients was 9.7% and is significantly higher than in an age-matched population, where it is 6.1% (P less than 0.001). The prevalence of diabetes was higher for women than for men (14.9% versus 7.6%). The risk of AMI was found to be twice as high among IDDM than among nondiabetic patients (P less than 0.001). Men with NIDDM were not found to have a significantly higher risk of AMI (P greater than 0.1), but the risk of AMI in women with NIDDM was approximately doubled (P less than 0.01). During the first month following AMI the mortality rate for nondiabetic patients was 20.2% compared with 42.0% for diabetic patients (P less than 0.001). Insulin treatment in NIDDM was associated with a reduced mortality rate compared with treatment with oral agents (P less than 0.05). The mortality rate was significantly higher in patients with poor metabolic control compared with patients in good control, whether before AMI or at the time of hospitalization. Diabetic patients had a higher risk of developing cardiogenic shock and conduction disorders than nondiabetic patients. We conclude that diabetes mellitus disposes to AMI and that the mortality rate of AMI is significantly increased among diabetic patients. Poor metabolic regulation of the diabetes may aggravate the prognosis for AMI.
Subject(s)
Diabetes Complications , Myocardial Infarction/etiology , Aged , Blood Glucose/metabolism , Denmark , Diabetes Mellitus/blood , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 2/complications , Epidemiologic Methods , Female , Humans , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/mortality , Prognosis , RiskSubject(s)
Crisis Intervention , Grief , Mothers/psychology , Adult , Child, Preschool , Female , Humans , Mother-Child Relations , Professional-Patient RelationsSubject(s)
Crisis Intervention , Depression/therapy , Grief , Adult , Female , Humans , Psychotherapy , Suicide, AttemptedSubject(s)
Fingers/blood supply , Oximetry , Adult , Aged , Humans , Middle Aged , Oximetry/instrumentation , SpectrophotometryABSTRACT
A case of a recurrent arachnoid cyst in the thoracic region in a 13-year-old boy is reported. At the first operation, complete removal of the cyst proved impossible. At a second operation four years later, it was still impossible to remove the cyst so we performed a shunt procedure with drainage through a Hakim valve to the right atrium. This procedure was successful, resulting in complete disappearance of symptoms. In the presence of recurrent intraspinal cysts the authors recommend this treatment, as it is an easy operation which does not cause undue discomfort to the patient.
