European journal of anaesthesiology. Supplement最新文献_第4页

Clinical testing of CSF circulation. 脑脊液循环的临床检测。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003249

Z Czosnyka, M Czosnyka, A Lavinio, N Keong, J D Pickard

引用次数: 7

Bioethical aspects of end-of-life care. 临终关怀的生物伦理方面。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003456

N Zamperetti, R Bellomo, C Ronco

{"title":"Bioethical aspects of end-of-life care.","authors":"N Zamperetti, R Bellomo, C Ronco","doi":"10.1017/S0265021507003456","DOIUrl":"https://doi.org/10.1017/S0265021507003456","url":null,"abstract":"Managing end-of-life care can be difficult because of the particular nature of intensive care support, which can separate the biological and the biographical aspects of life. Artificial organ support can temporarily delay death but, at the same time, may fail to restore a quality of life that the patient judges acceptable. For this reason, two concepts must be considered: that the mission of the healthcare system should be to care for patients according to their interests and wishes and that quality of care is related above all to the careful commitment of healthcare workers to the patient's best interests. Keeping these concepts in mind, the rule of the five Cs (competence, collegiality, communication, continuity of care and compassion) might be helpful in the management of end-of-life care. Unfortunately, neither the rule of the five Cs nor the careful use of moral principles in order to promote the patients' dignity can assure a universally acceptable decision. A reasonable level of 'moral certainty', however, might be achieved using a deliberative approach, which provides for the inclusion of all the different subjects involved in the decision-making process (patient, family, doctors, nurses and other carers), in order to reach the best possible decision in a specific situation.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003456","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

Long-term psychiatric disorders after traumatic brain injury. 创伤性脑损伤后的长期精神障碍。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003250

S Fleminger

{"title":"Long-term psychiatric disorders after traumatic brain injury.","authors":"S Fleminger","doi":"10.1017/S0265021507003250","DOIUrl":"https://doi.org/10.1017/S0265021507003250","url":null,"abstract":"In the long term after traumatic brain injury, the most disabling problems are generally related to neuropsychiatric sequelae, including personality change and cognitive impairment, rather than neurophysical sequelae. Cognitive impairment after severe injury is likely to include impaired speed of information processing, poor memory and executive problems. Personality change may include poor motivation, and a tendency to be self-centred and less aware of the needs of others. Patients may be described as lazy and thoughtless. Some become disinhibited and rude. Agitation and aggression can be very difficult to manage. Anxiety and depression symptoms are quite frequent and play a role in the development of persistent post-concussion syndrome after milder injury. Depression may be associated with a deterioration in disability over time after injury. Psychosis is not unusual though it has been difficult to confirm that traumatic brain injury is a cause of schizophrenia. Head injury may, many years later, increase the risk of Alzheimer's disease. Good rehabilitation probably minimizes the risk of psychiatric sequelae, but specific psychological and pharmacological treatments may be needed.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 162

The role of hypertonic saline in neurotrauma. 高渗盐水在神经外伤中的作用。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003420

H White, D Cook, B Venkatesh

引用次数: 36

Nerve membrane excitability testing. 神经膜兴奋性测试。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021508003505

W J Z'Graggen, H Bostock

{"title":"Nerve membrane excitability testing.","authors":"W J Z'Graggen, H Bostock","doi":"10.1017/S0265021508003505","DOIUrl":"https://doi.org/10.1017/S0265021508003505","url":null,"abstract":"Routine motor nerve conduction studies measure latencies, conduction velocities and amplitudes of compound action potentials. These measurements can be very useful in defining the pathology, while they provide little insight into the underlying disease mechanisms. Increasingly, the technique of 'threshold tracking' is being used in research and clinical studies on large myelinated axons. Nerve excitability testing is a non-invasive approach in investigating the pathophysiology of peripheral nerve disorders, which determines the electrical properties of the nerve membrane at the site of stimulation. We have found evidence that in patients with critical illness polyneuropathy peripheral nerves are depolarized. The correlations with serum factors suggest that this membrane depolarization is related to endoneurial hyperkalemia and/or hypoxia. While other mechanisms of depolarization may well be involved, the degree to which potential-sensitive nerve excitability indices are related to serum potassium and bicarbonate suggests that other factors, independent of potassium and acid-base balance, are likely to be of relatively minor significance.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021508003505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 11

Critical illness myopathy: sepsis-mediated failure of the peripheral nervous system. 危重性肌病:败血症介导的周围神经系统衰竭。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003262

O Friedrich

{"title":"Critical illness myopathy: sepsis-mediated failure of the peripheral nervous system.","authors":"O Friedrich","doi":"10.1017/S0265021507003262","DOIUrl":"https://doi.org/10.1017/S0265021507003262","url":null,"abstract":"With better survival of critically ill patients, 'de novo' arising neuromuscular complications like critical illness myopathy or polyneuropathy have been increasingly observed. Prolonged hospitalization not only imposes risks like pneumonia or thrombosis on patients but also represents a real budget threat to modern intensive-care medicine. Clinical symptoms like muscle weakness and weaning failure are common to critical illness myopathy and critical illness polyneuropathy and do not allow for distinction. Specific therapies are not yet available, and the quest for the pathomechanisms has proved more complicated than anticipated. Especially for critical illness myopathy, multiple sites of disturbances to the excitation-contraction coupling cascade are possible causes of muscle weakness. The present review summarizes the epidemiological, clinical and diagnostic features of critical illness myopathy and then focuses on current concepts of the presumed pathomechanisms of critical illness myopathy. Sepsis was shown to be a major cause of critical illness myopathy and special emphasis will be placed on how sepsis and inflammatory mediators influence (i) the membrane excitability at the level of voltage-gated ion channels and (ii) the intracellular protein signalling that results in selective loss of myosin protein content and muscle wasting. For (i), critical illness myopathy represents a new type of acquired channelopathy affecting the inactivation properties of Na+ channels. For (ii), both protein proteolysis and protein build up at the transcriptional level seem to be involved. Findings from different studies are put into a common context to propose a model for cytokine-mediated failure of muscle in severe sepsis. This can open a series of new possible trials to test specific therapeutic strategies in the future.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003262","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 38

Haemorrhagic stroke during anti-platelet therapy. 抗血小板治疗期间出血性中风。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003213

M Cattaneo

{"title":"Haemorrhagic stroke during anti-platelet therapy.","authors":"M Cattaneo","doi":"10.1017/S0265021507003213","DOIUrl":"https://doi.org/10.1017/S0265021507003213","url":null,"abstract":"Drugs that inhibit platelet function are widely used to decrease the risk of occlusive arterial events in patients with atherosclerosis. There are three families of anti-platelet agents with proven clinical efficacy: (1) cyclo-oxygenase inhibitors, such as aspirin; (2) adenosine diphosphate receptor antagonists, such as the thienopyridine compounds ticlopidine and clopidogrel; and (3) glycoprotein IIb/IIIa antagonists. All these drugs are used during coronary interventions and in the medical management of acute coronary syndromes, while only aspirin and thienopyridine compounds are used in the long-term prevention of cardiovascular and cerebrovascular events in patients at risk. Despite the good risk-to-benefit ratio of anti-platelet agents, the risk of severe bleeding complications, including cerebral haemorrhage, is slightly increased, albeit to a much lesser extent than that associated with the use of other antithrombotic drugs, such as anticoagulants or thromobolytic agents. In addition, it must be noted that the increased incidence of haemorrhagic stroke is usually outweighed by a significant decrease in the incidence of ischaemic strokes. The combination of aspirin and vitamin K antagonists may be associated with the heightened risk of cerebral haemorrhage, compared to treatment with either drug alone.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 13

Effects of catecholamines on cerebral blood vessels in patients with traumatic brain injury. 儿茶酚胺对创伤性脑损伤患者脑血管的影响。

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003407

D Pfister, S P Strebel, L A Steiner

{"title":"Effects of catecholamines on cerebral blood vessels in patients with traumatic brain injury.","authors":"D Pfister, S P Strebel, L A Steiner","doi":"10.1017/S0265021507003407","DOIUrl":"https://doi.org/10.1017/S0265021507003407","url":null,"abstract":"Data on the cerebrovascular effects of catecholamines after head injury are difficult both to interpret and to compare. Diverse parameters with regard to brain trauma animal models, methods of determining the effects on the cerebral blood flow and metabolism and choice of end-points have been used. Many studies investigate the cerebrovascular effects of catecholamines over a range of cerebral perfusion pressures above the range recommended by current guidelines. The relationship between patient outcome and the use of a specific substance to improve cerebral perfusion has not been investigated. Dopamine, norepinephrine and phenylephrine all seem to increase cerebral blood flow in various animal models and in patients. The data suggest that norepinephrine may be the most predictable. It is associated with an improved restoration of global and regional oxygenation when compared to dopamine. Dopamine has been associated with an increase in brain oedema. There is further evidence that dopamine has many disadvantages in critically ill patients due to its ability to suppress circulating concentrations of most anterior pituitary-dependent hormones. Both aspects would further discourage its use. Data on phenylephrine are scarce. It has been associated with increased intracranial pressure and a failure to improve cerebral oxygenation despite markedly improved cerebral perfusion pressure. For all other catecholamines and related substances there are insufficient data on the cerebrovascular effects after head injury. This suggests that norepinephrine may be the catecholamine that is the most suitable substance to maintain or restore adequate cerebral perfusion. The data, however, are insufficient to formulate a guideline.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 39

Postanoxic coma: how (long) should we treat? 缺氧后昏迷:我们应该治疗多久?

European journal of anaesthesiology. Supplement Pub Date : 2008-01-01 DOI: 10.1017/S0265021507003468

E G J Zandbergen

{"title":"Postanoxic coma: how (long) should we treat?","authors":"E G J Zandbergen","doi":"10.1017/S0265021507003468","DOIUrl":"https://doi.org/10.1017/S0265021507003468","url":null,"abstract":"Postanoxic coma is a state of unconsciousness caused by global anoxia of the brain, most commonly due to cardiac arrest. Outcome after postanoxic coma lasting more than several hours is generally, but not invariably, poor. Recovery of consciousness reported in the literature varies from 8% to 72% of patients, but is mostly thought to be around 20-30% in patients surviving in coma for at least 24 h. Research is directed at defining factors that reliably predict poor outcome in these patients. Favourable outcome proves impossible to predict. Studies on outcome prediction have focussed mostly on neurological examination, clinical neurophysiological tests and biochemical parameters. The most recent and extensive study in this respect was the PROPAC study in The Netherlands (407 patients). This study confirmed earlier findings that bilaterally absent early cortical response after median nerve somatosensory potentials (absent somatosensory evoked potentials) is the most reliable predictor of poor outcome (no recovery of consciousness). A serum neuron-specific-enolase level >33 microg L(-1) seemed equally reliable. In 2006, the American Practice Parameter on anoxic-ischaemic coma was published, summarizing the findings from the different studies. Poor outcome was defined as death, coma or severe disability after 6 months. The following factors were found to reliably predict this outcome: myoclonic status epilepticus within the first 24 h, absent pupillary responses after 24 h, absent corneal reflexes after 48 h, motor response to pain absent or extensor after 72 h and absent somatosensory evoked potentials (as defined above) after 1-3 days. Results for biochemical parameters (such as neuron-specific enolase) and neuroimaging are inconclusive.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2008-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507003468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27277682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Abstracts of the Annual Meeting of the European Society of Anaesthesiology. Munich, Germany. June 9-12, 2007. 欧洲麻醉学学会年会摘要。德国慕尼黑。2007年6月9日至12日。

European journal of anaesthesiology. Supplement Pub Date : 2007-01-01 DOI: 10.1017/S0265021507000798

{"title":"Abstracts of the Annual Meeting of the European Society of Anaesthesiology. Munich, Germany. June 9-12, 2007.","authors":"","doi":"10.1017/S0265021507000798","DOIUrl":"https://doi.org/10.1017/S0265021507000798","url":null,"abstract":"Background and Goal of the Study : This pilot study aims to examine the effect of goal directed therapy using fluid alone on postoperative morbidity score (PMS) in patients following emergency abdominal surgery [1]. \u0000 \u0000 Materials and Methods : This prospective randomized study included patients over the age of 50 undergoing emergency abdominal surgery. Patients presenting following trauma, undergoing vascular surgery or who were on lithium therapy were excluded from the study. Research ethic committee approval and informed consent was obtained. In the intervention group the Lidco monitor (Lidco plus system, Lidco Ltd., UK) was used to guide fluid boluses of 250ml of 6% Hydroxyethylstarch 130/0.4 (Voluven, Fresenius Ltd., UK) based on pulse pressure variation measurement (bolus given if >10%). The control group received standard care. PMS were measured postoperatively on days 5 and 15 and 30. Data are median (range) and were analyzed using chisquare test or Mann Whitney test as appropriate. \u0000 \u0000 Results : 30 patients were recruited. Their age was 65 yrs (51-76), 23 patients were male, ASA = 3 (1-4), Lee risk score = 3 (2-4). One patient died prior to surgery and was excluded from the analysis.10 patients had upper and 19 lower abdominal surgery. Duration of surgery was 110 min (40-295). There were no demographic differences between the groups. The intervention group received a median of 750ml of hydroxyethylstarch. On day 5 and 30 there were no differences in PMS scores. Day 15 data as displayed in table. \u0000 \u0000 Conclusions : Goal directed therapy using fluid alone may be associated with an increased incidence of in hospital stay at 15 days.","PeriodicalId":11873,"journal":{"name":"European journal of anaesthesiology. Supplement","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1017/S0265021507000798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27055156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0