ABSTRACT
Etomidate is an anaesthetic induction agent which may be favoured in critically ill patients because of its cardiovascular stability. However, etomidate causes adrenocortical suppression which may be particularly harmful in these patients. This article reviews current evidence and debates the use of etomidate in critical illness.
Subject(s)
Anesthetics, Intravenous , Critical Illness , Etomidate , Anesthetics, Intravenous/administration & dosage , Anesthetics, Intravenous/chemistry , Anesthetics, Intravenous/pharmacology , Etomidate/administration & dosage , Etomidate/chemistry , Etomidate/pharmacology , Humans , Hypothalamo-Hypophyseal System/physiology , Molecular StructureSubject(s)
Analgesics/therapeutic use , Ketamine/therapeutic use , Neuralgia/drug therapy , Pain, Postoperative/drug therapy , Analgesia, Patient-Controlled , Analgesics/administration & dosage , Analgesics/adverse effects , Analgesics, Opioid/administration & dosage , Drug Therapy, Combination , Humans , Ketamine/administration & dosage , Ketamine/adverse effectsABSTRACT
Angiotensin-converting enzyme (ACE) inhibitors inhibit the enzyme that cleaves angiotensin I to form angiotensin II. They are potent vasodilators as they decrease concentrations of angiotensin II and noradrenaline and increase concentrations of bradykinin and nitric oxide. They reduce secretion of aldosterone and antidiuretic hormone, thus reducing salt and water reabsorption by the kidney (Groban and Butterworth, 2006).
Subject(s)
Angiotensin-Converting Enzyme Inhibitors/adverse effects , Hypotension/chemically induced , Intraoperative Complications/chemically induced , Perioperative Period , Anesthesia, General/adverse effects , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Humans , Renin-Angiotensin System/drug effects , Safety-Based Drug WithdrawalsABSTRACT
Pulmonary aspiration of gastric contents has been recognized as a cause of significant morbidity and mortality during anaesthesia since the classic publication by Mendelson in 1946. The introduction of suxamethonium 5 years later allowed tracheal intubation to be achieved under complete muscle relaxation within 1 minute of induction of anaesthesia. In 1961 Sellick described the use of cricoid pressure to prevent gastric regurgitation.
Subject(s)
Anesthesia, General/methods , Gastroesophageal Reflux/prevention & control , Respiration, Artificial/methods , Humans , Unnecessary ProceduresSubject(s)
Methemoglobinemia/diagnosis , Aged , Diagnostic Errors , Humans , Male , Methemoglobin/analysis , Methemoglobinemia/blood , Oximetry , Oxygen/blood , Partial Pressure , SpectrophotometryABSTRACT
BACKGROUND: Cigarette smoking often starts in teenage years. It is not known whether teenagers are aware of the association of smoking with eye disease and blindness. AIM: To explore the knowledge of the link between smoking, and eye diseases and blindness, and the likely impact of this knowledge among teenagers in UK. METHODS: A cross-sectional survey, using a structured interview of teenagers attending four organised social events, was conducted. Awareness and fear of blindness, and of three smoking-related diseases (lung cancer, heart disease and stroke) and a distractor condition (deafness) was investigated. The likelihood of smokers quitting on developing early signs of each condition was determined. RESULTS: A 92% "opt in" response rate was achieved. Out of 260 teenagers (16-18 years), 15%, 27% and 81% believed that smoking caused stroke, heart disease and lung cancer, respectively. Only 5% believed smoking caused blindness. Subjects ranked their fear of each of the five conditions, scoring five for the most feared and one for the least feared. Subjects were significantly (p<0.01) more fearful (mean scores in brackets) of blindness (4.2) than of lung cancer (3.4), heart disease (2.3) and deafness (1.2). More teenagers (p<0.01) said they would stop smoking on developing early signs of blindness compared with early signs of lung or heart disease. CONCLUSIONS: Awareness of the risk of blindness from smoking is low among teenagers, but fear of blindness may be more likely to motivate teenagers to stop smoking than fear of lung or heart disease. Teenagers should be made more aware of the ocular risks of cigarette smoking as a novel public health measure.
