Human exposures to immobilising agents: results of an online survey.

Cases of human exposure to veterinary injectable anaesthetics were reviewed following a literature search and completion of an online questionnaire in an attempt to provide an objective approach to the problem. The modified Glasgow Coma Scale was used to rank cases according to their severity. From the cases examined, results showed that intoxication with potent opioids, such as etorphine, carfentanil and thiafentanil, need to be treated with antagonists such as naloxone, nalmefene or naltrexone, and not with antagonists with agonistic properties, such as diprenorphine. With regard to the alpha(2)-agonists xylazine, detomidine, medetomidine and romifidine, no antagonist is currently accredited for human use. Atipamezole, a specific alpha(2)-antagonist, is widely used in veterinary medicine and has been used experimentally to reverse dexmetomidine in a study in human medicine. The high concentrations of alpha(2)-agonists being used in zoo and wildlife medicine warrant the accreditation of atipamezole for use in cases of human exposure. Knowledge and availability of the appropriate antagonist are essential in cases of human intoxication with injectable anaesthetics. Preventive measures, such as wearing gloves and eye protection, need to be used more regularly to reduce the risk of exposure.

Bilateral stenting of symptomatic and asymptomatic internal carotid artery stenosis due to fibromuscular dysplasia.

Stent grafting of internal carotid artery (ICA) stenoses due to fibromuscular dysplasia has been rarely and only unilaterally carried so far. Bilateral carotid stent grafting of ICA stenoses due to fibromuscular dysplasia has not been reported previously. In a 37 year old woman with recurrent right hemispheric transitory ischaemic attacks, a non-disabling minor stroke, and recurrent right amaurosis fugax despite antithrombotic therapy, cerebral angiography disclosed a long segment narrowing, distal, high grade (95%) stenosis of the right ICA and a long narrowing, distal high grade (70%) stenosis of the left ICA. Morphological features of both stenoses were indicative of fibromuscular dysplasia. The right sided stenosis was stented with a PTFE-HEMOBAHN endoprosthesis; this was followed by a brief, postprocedural left sided hemiparesis. The left sided ICA stenosis was successfully stented by the same procedure. Nine months later, both stents were still patent and the patient was symptom free. Bilateral carotid stenting may remain an alternative to endarterectomy in bilateral ICA stenosis due to fibromuscular dysplasia when ischaemic events persist despite full antithrombotic therapy.

[Limitations of life support in patients with anoxic encephalopathy after CPR. Results of a questionnaire to Austrian intensive care units]. / Befragung von österreichischen Intensivstationen zum Vorgehen bei anoxischer Enzephalopathie nach primär erfolgreicher Reanimation.

A questionnaire was sent to 97 Austrian intensive care units to define the current practises of predicting neurologic outcome in patients with anoxic encephalopathy after cardio-pulmonary resuscitation. All relevant prognostic predictors, such as clinical scales, electrophysiological techniques and laboratory tests were included to examine if these procedures influence the decision to withdraw life support. The answers of 68 (70%) units were collected and analysed. The results show that tests such as somatosensory evoked potential of the determination of brain cell-specific cytosolic enzymes are without any practical importance in Austria. In addition, the methods of reducing life support were evaluated. According to the controversial discussion in the literature, there is no common approach to this problem, especially in the question of withdrawing controlled mechanical ventilation. The result of our survey show, that there is a need for general guidelines to determine the prognosis and the methods of withdrawing life support which could be used in all intensive care units regardless of their size and technical infrastructure.