Acta anaesthesiologica Scandinavica. Supplementum最新文献

{"title":"How to practice and teach evidence-based medicine: role of the Cochrane Collaboration.","authors":"J Kleijnen, I Chalmers","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"111 ","pages":"231-3"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20349916","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}

{"title":"Transesophageal echocardiography in anesthesia and intensive care: current situation--indications--future trends.","authors":"H Andel, G Huemer, C Wolrab, H Tschernich, T Weber, M Zimpfer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"111 ","pages":"267-9"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20349930","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}

{"title":"Extracorporeal membrane oxygenation in neonates.","authors":"G Trittenwein,&nbsp;G Fürst,&nbsp;J Golej,&nbsp;G Burda,&nbsp;M Hermon,&nbsp;G Wollenek,&nbsp;A Pollak","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal membrane oxygenation (ECMO), originally developed as an artificial replacement for respiratory assistance, is decreasingly used in neonates with respiratory failure. Nevertheless, there is a constant need for this invasive and expensive neonatal treatment modality.</p><p><strong>Intervention: </strong>Review of our experience (80 recent ECMO performances because of circulatory failure) and the literature.</p><p><strong>Results: </strong>In contrary to reduced ECMO performances out of respiratory insufficiency in neonates, ECMO as circulatory support is increasingly used. Neonatal sepsis, pre- and postoperative cardiac failure, combined circulatory and respiratory failure after resuscitation and with congenital diaphragmatic hernia result in a permanent need for ECMO, whenever there are fewer ECMO treatments per year. Nonocclusive pumps, portable devices, small priming volumes and tapered anticoagulation protocols enable survival through ECMO even in virtually hopeless hemodynamic conditions. Special efforts in investigation and prevention of permanent neurological impairment, especially after severe pre-ECMO hypoxia seem to be mandatory.</p><p><strong>Conclusion: </strong>ECMO remains an important tool in neonatal and pediatric intensive care. However, the number of ECMO therapies was reduced due to respiratory therapeutic progress, but indications and ECMO technology have changed.</p>","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"111 ","pages":"143-4"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20349973","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}

{"title":"Sevoflurane in paediatric anaesthesia.","authors":"C M Müller,&nbsp;C G Krenn,&nbsp;G Urak,&nbsp;M Zimpfer,&nbsp;M Semsroth","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sevoflurane is a potent inhalational agent, combining several advantages of specific interest in paediatric anaesthesia. Rapid and smooth induction, a safe cardiovascular profile, rapid emergence and a short postoperative recovery with minimal side effects are ideal characteristics of this agent for the use in paediatric anaesthesiology. The apparent improvement in management should not obscure the fact that sevoflurane in higher MAC should be used with caution in renal impairment. For the future world of our children, the lack of chlorine in the structure makes sevoflurane theoretically less ozone-depleting than halothane and isoflurane, a substance contributing to environmental protection.</p>","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"111 ","pages":"150-1"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20349977","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}

{"title":"Pain management with spinal and epidural analgesia.","authors":"P Lierz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"111 ","pages":"186-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20349991","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}

{"title":"Aspects on the cerebral perfusion pressure during therapy of a traumatic head injury.","authors":"P O Grände,&nbsp;B Asgeirsson,&nbsp;C Nordström","doi":"10.1111/j.1399-6576.1997.tb05493.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05493.x","url":null,"abstract":"<p><p>An actively raised cerebral perfusion pressure by vasopressors is nowadays often advocated during therapy of a post traumatic brain oedema to improve oxygenation of the brain. In this paper we argue that the arterial pressure not uncritically can be raised as the subsequent increase in hydrostatic capillary pressure may favour transcapillary filtration if the blood-brain barrier is opened for solutes. Further, the use of vasoconstrictor drugs to increase the perfusion pressure may in fact impair oxygenation to the penumbra zones around brain contusions but also to other tissues of the body, like the intestinal mucosa and the kidney. An alternative therapeutical concept which both ensures an adequate oxygenation of the brain and controls the intracranial pressure (ICP) is given. In short, it implies active antistress and sedative treatment, adequate fluid therapy with blood and colloids to normal haemoglobine and albumin values, artificial ventilation to normal PaCO2 and PaO2, and this in combination with antihypertensive and catecholamine reducing treatment with alpha 2-agonist and beta 1-antagonist.</p>","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05493.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20191619","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}

{"title":"Pathophysiology of aortic cross-clamping.","authors":"S Gelman","doi":"10.1111/j.1399-6576.1997.tb05494.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05494.x","url":null,"abstract":"Arterial hypertension is the most dramatic and consistent component of the hernodynamic response to aortic cross-clamping. Most texts attribute this sign to a sudden increase in impedance to aortic flow and an increase in afterload. Increases in left ventricle endsystolic wall stress and systemic arterial pressure’ are consistent with this notion. However, Caldini, et a12 provided theoretical ground for the following speculations; clamping of the thoracic aorta increases cardiac output by diverting blood away from the longtime constant area, presumably the splanchnic vasculature. In other words, the splanchnic venous vasculature collapses when intramural venous pressure decreases; the latter results from a decrease in blood flow from the arterial to the venous vasculature with a subsequent decrease in venous capacitance, secondary to an elastic recoil. Splanchnic venous collapse, in turn, results in an increase in venous return and cardiac output. There is some experimental sup port for this theory: Occlusion of the inferior caval vein prevented increases in arterial pressure and in enddiastolic myocardial segment length, whereas occlusion of other, smaller veins modified the increases to different degrees, presumably reflecting different amounts of blood volume translocated from various veins, thereby affecting venous return, preload and the degree of arterial hypertension. The authors concluded that blood volume shift from the nonsplanchnic region maintains cardiac output during infraceliac aortic occlusion whereas during occlusion of the thoracic aorta, drainage from the splanchnic area accounts for about 70% of the increase in enddiastolic myocardial segment length.’ Cross-clamping of the thoracic aorta is associated with almost a twofold increase in blood flow through the upper part of the body,‘” and more than a three-fold increase in blood flow though the muscle proximal to the clamp’. These observations are consistent with (but do not prove) the hypothesis of blood volume redistribution. using whole-body scintigraphy with Tc“ -labeled plasma albumin we demonstrated that aortic crossclamping at the diaphragmatic level is associated with a significant increase in blood volume in the organs and tissues proximal to the level of occl~sion.~ Thus, the data presented provide evidence that blood volume shifts from the lower to the upper part of the body during aortic cross-clamping. Variation in the blood volume status of splanchnic vascular tone, resulting from differences in fluid load, depth of anesthesia, pharmacodynamics of an anesthetic, and other factors might affect the degree and pattern of blood volume redistribution. For example, during infrasplanchnic aortic occlusion, the blood volume redistributed from the vasculature below the occlusion might travel to the heart, increasing preload and inducing central hypervolemia, or it might travel to the compliant splanchnic venous vasculature. The distribution of volume between the heart and t","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"41-2"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05494.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20191620","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}

{"title":"General or regional anaesthesia--pro general.","authors":"M Wattwil","doi":"10.1111/j.1399-6576.1997.tb05499.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05499.x","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"54-5"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05499.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20191625","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}

{"title":"Efficacy of hypertonic saline dextran (HSD) in patients with traumatic hypotension: meta-analysis of individual patient data.","authors":"C Wade,&nbsp;J Grady,&nbsp;G Kramer","doi":"10.1111/j.1399-6576.1997.tb05509.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05509.x","url":null,"abstract":"Small volume resuscitation, using hypertonic saline/hyperoncotic colloid solutions, effectively restores blood volume and cardiovascular function after hemorrhagic shock in experimental models (I). Clinical evaluation of trauma resuscitation using 7.5% saline/6% Dextran 70 (HSD), as to over all mortality, has been inconclusive (2-9). This inconclusiveness appears to be primarily a result of limited statistical power. However, efficacy has been demonstrated in subpopulations such as patients who subsequently require surgery. What was unique about these clinical trials was they were prospective randomized controlled double-blind studies (RCTs) of trauma patients treated with HSD (2-9). Using verified data collected from previous RCTs, we prospectively designed an individual patient data meta-analysis to assess the efficacy of HSD. Metaanalysis using individual patient data from multiple studies ranks high in the hierarchy of evidence. These methods also allow for assessment of the efficacy of HSD in improving survival in subpopula tions. We utilized rigorous experimental methods, including development of and adherence to a prospectively defined protocol for data acquisition and analysis, with blinding as to treatment assignments to avoid bias to the extent possible. Our objective was to evaluate the efficacy of HSD for initial treatment of trauma versus standard-of-care (SOC) treatment. Specifically, we evaluated the efficacy of a 250 ml infusion of HSD versus an equivalent infusion of isotonic solution for initial management of traumatic hypovolemia and improvement of survival rates.","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"77-9"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05509.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20191635","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}

{"title":"Tissue oxygenation--circulatory aspects.","authors":"J Takala","doi":"10.1111/j.1399-6576.1997.tb05513.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05513.x","url":null,"abstract":"Maintenance of adequate tissue perfusion and oxygenation is one of the major goals of intensive care. Imminent or manifest acute circulatory and respiratory failure are the most common causes of emergency admission to intensive care. Tissue hypoxia due to insufficient blood flow and low arterial oxygen content is common in these patients. The presence and pathogenesis of tissue hypoxia during circulatory shock has been well documented and the importance of tissue oxygenation at this phase of intensive care is not controversial. The presence and relevance of tissue hypoxia in patients without shock is a controversial issue; whether tissue hypoxia is of any importance in patients with stabile haemodynamics remains to be confirmed. Since oxygen delivery to the tissues is the product of blood flow and arterial oxygen content, it is evident that blood flow is a major component of the overall adequacy of tissue oxygen supply. For any given blood flow, the adequacy of the flow depends on the metabolic demands of the tissues and the capability of the tissues to extract the available oxygen. At unchanged blood flow, local and regional blood flow redistribution and changes in local or regional metabolic demand have a considerable impact on the adequacy of tissue perfusion and oxygen supply 11 I. In most clinical disorders of tissue oxygenation, blood volume, cardiac output, and arterial oxygen content are of primary concern. The effects of any therapeutic interventions, such as administration of Vasoadive drugs and mechanical ventilation, will be markedly modified by the volume status of the patient. Two different scenarios of impaired tissue oxygenation due to inadequate perfusion can be distinguished [l]. In low flow states (cardiogenic and hypovolemic shock) both the whole body blood flow and the Various regional blood flows are decreased and the metabolic demands are normal. Under these conditions, various regional circulations are gradually compromised in order to maintain sufficient perfusion of the heart and the brain. In this respect, the splanchnic region has a special role, since splanchnic Vasoconstriction is the first line mechanism in the defense of blood volume and flow [21. Splanchnic vasoconstriction, once established, is maintained even after restoration of the circulating blood volume. This is the most likely explanation for the commonly observed prolonged visceral hypoperfusion after severe hypodynamic shock. The second scenario, which is especially common in sepsis and severe systemic inflammation, includes increased metabolic demand despite normal or even increased blood flow [l]. The main threat for the adequacy of tissue oxygenation here is the substantially increased oxygen demand [3,41. Also in these settings, the splanchnic region appears to have a central role, since the hypermetabolism associated with inflammation is primarily a reflection of splanchnic hypermetabolism. As the result of the regional or local hypermetabolism, spl","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"85-6"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05513.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20191639","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}