RESUMO
In a prospective study of the complications of cardiac resuscitation, 705 cases were autopsied to identify the cause of death and the pathologic findings attributable to cardiac resuscitation. Thoracic complications were observed in 42.7 percent of the cases. A total of 31.6 percent had rib fractures, 21.1 percent had sternal fractures, and 18.3 percent were reported as having anterior mediastinal hemorrhage; 20.4 percent of the cases had an upper airway complication. Abdominal visceral complications were noted in 30.8 percent of the cases, and pulmonary complications occurred in 13 percent of the resuscitation population. Life-threatening complications, such as heart and great vessel injuries, occurred in less than .5 percent of the cases.
Assuntos
Ressuscitação/efeitos adversos , Traumatismos Abdominais/etiologia , Feminino , Fraturas Ósseas/etiologia , Traumatismos Cardíacos/etiologia , Hemorragia/etiologia , Humanos , Laringe/lesões , Masculino , Doenças do Mediastino/etiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Edema Pulmonar/etiologia , Fraturas das Costelas/etiologia , Esterno/lesõesRESUMO
Characteristics of neuromuscular block produced by polymyxin B (PXB) were examined in 12 anesthetized cats, using sciatic nervetibialis anticus muscle preparations. The ED50 was 6.7 (+/- 1.4, SD) PXB base/kg body weight. The ED95 was 10.8 (+/- 2.4) mg/kg. Spontaneous recovery from 25 percent of control to 75 percent of control required 72 (+/- 16) minutes. During a 50 percent block, train-of-four twitches elicited at 2 Hz faded with a train-of-four ratio of 0.42 (+/- 0.13), but the tetanus did not fade. Edrophonium Cl, neostigmine methylsulfate, and pyridostigmine Br at sub-clinical dosages weakly antagonized the block but enhanced the block at anti-curare dosages. All 3 cholinesterase inhibitors were short acting, lasting 10 to 15 minutes, and noncumulative on repeated injection. The potency ratio was approximately 20:10:1 in the order of edrophonium, neostigmine, and pyridostigmine on a weight-for-weight basis. Calcium partially antagonized the block. The authors conclude that neuromuscular blocks produced by various antibiotics differ from each other and from that produced by other groups of neuromuscular blocking agents, including curare.
Assuntos
Bloqueadores Neuromusculares , Polimixinas/farmacologia , Animais , Pressão Sanguínea/efeitos dos fármacos , Cálcio/farmacologia , Gatos , Edrofônio/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Contração Muscular/efeitos dos fármacos , Neostigmina/farmacologia , Bloqueadores Neuromusculares/antagonistas & inibidores , Junção Neuromuscular/fisiologia , Brometo de Piridostigmina/farmacologiaRESUMO
Pronation of anesthetized patients may result in complications. Neuromuscular block increases the risk. To minimize the risk, the authors devised a technic of "awake pronation," evaluating its feasibility, in 11 consecutive patients in a 1-year period for 12 operations; all attempts were successful and without complicatons. Neuroleptanalgesia is achieved with droperidol and fentanyl, topical anesthesia of the upper airway is induced with lidocaine, awake intubation is performed orotracheally under direct vision, and pronation is accomplished with patient cooperation.
