[Continuous venovenous hemodiafiltration in critically ill patients with acute renal failure]. / Kontinuerlig venovenøs haemodiafiltration til kritisk syge patienter med akut nyresvigt.

The development of computerized machines with a simple user-friendly interface to perform continuous venovenous hemodiafiltration (CVVHDF) has resulted in a break-through of CVVHDF in the treatment of acute renal failure (ARF) in Danish intensive care units. During CVVHDF the blood is submitted to a combination of dialysis and ultrafiltration. In contrast to intermittent haemodialysis (HD), CVVHDF can be used in critically ill patients with unstable circulation. Biocompatible membranes are used. During treatment with CVVHDF, cytokines are removed from the blood partly by ultrafiltration, partly by adsorption to the filter. The clinical importance of this is not yet known. Patients with ARF treated with CVVHDF seem to be more likely to show renal recovery than those treated with HD. There are few prospective investigations of the effect of CVVHDF on mortality, but all comparisons of CVVHDF with HD indicate a trend in favor of CVVHDF.

[Complications after spinal analgesia using three different spinal needles: Sprotee, Spinocan and Atraucan]. / Komplikationer efter spinal analgesi ved anvendelse af tre forskellige spinalkanyler: Sprotte, Spinocan og Atraucan.

In this prospective, randomised study 197 patients aged below 40 years received spinal analgesia using one of the following needles: Sprotte G24, Spinocan G27 or Atraucan G26. The incidence of insufficient or failed analgesia and difficulties handling the needles were noted. Patients were interviewed within three weeks after anaesthesia so as to establish the incidence of postoperative complications including post-dural puncture headache (PDPH). Headache was noted in 63 patients of which 33 (16.8%) were of PDPH type. The Sprotte needle caused significantly fewer cases of PDPH (Sprotte: 8.1%; Spinocan: 19.7; Atraucan: 21.7%. p < 0.05). Furthermore a significantly lower incidence of insufficient analgesia was observed with the Sprotte needle (0% versus 12.1% with the Spinocan and 11.6% with the Atraucan, p < 0.05). In conclusion, the Sprotte needle had the best profile with respect to PDPH and successful analgesia. This confirms the importance of the needle tip design.

The effect of ketanserin upon postoperative blood pressure, cerebral blood flow and oxygen metabolism in patients subjected to craniotomy for cerebral tumours.

Hypertension and cerebral hyperperfusion are often seen in the immediate postoperative period after craniotomy for supratentorial tumours. This study was performed to evaluate the effect of ketanserin, given at the end of the peroperative period, upon cerebral blood flow (CBF), and cerebral metabolic rate of oxygen (CMRO2) before extubation. Mean arterial blood pressure (MABP), cerebral arterio-venous oxygen content difference (AVDO2), PaO2, and PaCO2 were repeatedly measured during the operation, and 180 minutes after extubation. Ten patients were included in this study. The results were compared to those from a recent study in which ten patients served as control. All patients were anaesthetized with thiopentone, fentanyl, nitrous oxide 67%, halothane 0.5% anesthesia. Ten patients were given ketanserin 10-20 mg (mean 18.5 mg) before extubation. There was no significant difference in CBF- and CMRO2 values between the two groups. During the period between closure of the dura and 5 minutes after extubation, an increase in MABP was observed in the control group (P < 0.05) but not in the ketanserin group. During the same period, a decrease in AVDO2 was observed in both groups (P < 0.05) and during the next 10 minutes an increase was observed. However, no difference in AVDO2 values between the two groups was found. These findings suggest that peroperative treatment with ketanserin reduces postoperative hypertension without influencing the cerebral blood flow or metabolism.

The effect of metoprolol upon blood pressure, cerebral blood flow and oxygen consumption in patients subjected to craniotomy for cerebral tumours.

Hypertension and cerebral hyperperfusion are often seen in the immediate postoperative period after craniotomy for supratentorial tumours. Metoprolol is known to attenuate the postoperative hypertensive response after hypotensive anaesthesia and this study was carried out to evaluate the effect of metoprolol on cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) before extubation and cerebral arteriovenous oxygen content difference (AVDO2), mean arterial blood pressure (MABP), PaO2 and PaCO2 in a 180-min period after extubation. Twenty patients anaesthetized with thiopentone, fentanyl, nitrous oxide 67%, and halothane 0.5% were randomized to receive intravenous metoprolol or placebo at the end of the peroperative period. There were no significant differences in CBF- and CMRO2 values between the two groups. In the period between closure of the dura and 5 min after extubation, an increase in MABP was observed in the control group (P < 0.05), but not in the metoprolol group. During the same period a decrease in AVDO2 was observed in both groups (P < 0.05); during the next 10 min an increase was observed, but with no difference in AVDO2 values between the groups. A higher level of PaO2 in the metoprolol group was observed in the postoperative period. These findings suggest that peroperative treatment with metoprolol reduces postoperative MABP but does not influence the cerebral blood flow and metabolism.