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  • 1
    Electronic Resource
    Electronic Resource
    Mortality during intensive care after orthotopic liver transplantation (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The postoperative course of 335 adult patients who underwent orthotopic liver transplantation from 1968–1987 was reviewed retrospectively to identify patients who died in the intensive care unit and the causes of death. Forty-four percent of all deaths occurred in the intensive care unit. The mortality rate in the intensive care unit peaked in 1984 (48%), but decreased to 11% in 1987. The main causes for death in the intensive care unit were infection (55%) and haemorrhage (19%). The patients who died spent more time in the intensive care unit, had a longer period of tracheal intubation and received a larger intra-operative blood transfusion than patients who died in other locations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb09195.x
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Infusions of analgesics, sedatives and muscle relaxants in patients who require intensive care (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb09137.x
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    The influence of anaesthetic technique on metabolism of oral morphine (1988)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 43 (1988), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The pharmacokinetics of oral controlled release morphine were studied in 10 patients to investigate the effect of two different anaesthetic techniques on its absorption and metabolism. Five patients received general anaesthesia with neuromuscular blockade; the remainder received lumbar epidural analgesia with general anaesthesia but without neuromuscular blocking agents. Blood samples were collected throughout the peri-operative period for estimation of plasma morphine concentration using two radio immunoassay techniques, one specific for morphine, the other less specific and crossreacting with morphine glucuronides. Plasma morphine concentrations with the specific method were similar for the two groups of patients but there was a statistically significant difference between the two groups with the less specific method at 30 and 45 minutes after induction of anaesthesia. This difference was because of the varying concentrations of morphine metabolites and may reflect the change in splanchnic blood flow produced by lumbar epidural analgesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1988.tb05742.x
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Reversal of sedation by prolonged infusion of flumazenil (Anexate, Ro 15–1788) (1988)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 43 (1988), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A 22-year-old male was involved in a road traffic accident and sustained multiple injuries. He received an infusion of midazolam to sedate him during a period of artificial ventilation. His conscious level remained depressed 36 hours after the infusion was discontinued but the sedation was completely reversed with flumazenil. An infusion was started because of the short duration of action of flumazenil, and continued for 8 days. The infusion was slopped seven times during this period and on each occasion except the last, his conscious level deteriorated but returned to normal when flumazenil was administered again. Plasma concentrations of midazolam and α-hydroxymidazolam were measured and found to be low during this period. Possible explanations for this finding are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1988.tb09016.x
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Failure of critically ill patients to metabolise midazolam (1987)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 42 (1987), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The pharmacokinetics of midazolam and its metabolite, 1-OH midazolam, were studied in six critically ill patients during and after a continuous intravenous infusion of midazolam. Four patients had an increased elimination half-life of midazolam; two were associated with a reduction in plasma clearance with low plasma concentrations of the metabolite, and two with normal metabolite levels and increased volume of distribution. The two patients with reduced clearance suffered from septic shock and were studied over a longer period. Their altered clearance was due to a reduced capability to form the 1-OH metabolite. As their condition improved, plasma concentrations of 1-OH midazolam increased and midazolam clearance returned towards normal. The impaired ability of critically ill patients with septic shock to metabolise midazolam, may be due to reduced organ perfusion and may lead to cumulation of midazolam in these patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1987.tb03086.x
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    The prevention of renal impairment in patients undergoing orthotopic liver grafting by infusion of low dose dopamine (1987)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 42 (1987), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Administration of low dose dopamine (2.0 μg/kg/minute) begun before surgery in patients undergoing liver transplantation decreases the incidence of postoperative renal impairment. Thirty-four consecutive patients in the Cambridge/King's College Hospital liver transplantation series were studied. Nineteen patients (21 transplant operations) received prophylactic low dose dopamine throughout the operative and early postoperative period, while 15 patients (15 transplant operations) received dopamine only when clinically indicated for incipient renal failure or as an inotropic agent. In the prophylactic dopamine group, only two transplant operations (9.5%) were complicated by renal impairment, whereas in the other group, 10 patients (67%) developed renal impairment (p = 0.001); of these, four developed acute renal failure (27%). Comparison of seven pairs of patients, matched for age, sex, diagnosis, operative blood loss and operative hypotension (one group receiving dopamine, the other not), revealed a significantly higher urine output in the first 24 hours and creatinine clearance 24—48 hours after surgery (p 〈 0.05) in those treated prophylactically. In view of these findings, we would recommend that consideration be given to the prophylactic use of dopamine in patients undergoing orthotopic liver transplantation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1987.tb02938.x
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    Intensive care in the United Kingdom: Report from the King's Fund Panel (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb09210.x
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    Chlormethiazole sedation for critically ill patients in renal failure (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Chlormethiazole infusions were used successfully to provide night sedation for 10–19 nights in three patients with renal failure managed by continuous veno-venous haemofiltration with dialysis. Fluid overload has accompanied the use of this drug previously because of its low concentration. The ability to remove large amounts of fluid during haemofiltration dialysis proved to be effective in preventing this. All three patients had impaired liver function and showed evidence of chlormethiazole accumulation after 4–6 days. The combination of progressive reduction in dose and daily withdrawal of infusions prevented a major problem. Acceptance of this technique by the patients was high. Chlormethiazole may be a useful addition to the drugs available to provide sedation in well defined clinical circumstances.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb09147.x
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    Paper (German National Licenses)
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  • 9
    Electronic Resource
    Electronic Resource
    Ketamine infusion (1987)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 42 (1987), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A patient with acute lymphatic leukaemia developed a bilateral fulminating Pseudomonas aeruginosa pneumonia and required controlled ventilation of the lungs. Marked agitation, hypotension and bronchospasm unresponsive to conventional bronchodilators presented a therapeutic challenge. A continuous intravenous infusion of midazolam failed to provide adequate sedation. A continuous intravenous infusion of ketamine resulted in better sedation, an increase in arterial pressure and a dimunition of bronchospasm. The clinical improvement was maintained for the 5 days during which ketamine was infused. Plasma concentrations of ketamine and its metabolites are reported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1987.tb05370.x
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    Paper (German National Licenses)
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  • 10
    Electronic Resource
    Electronic Resource
    Reversal of prolonged sedation using flumazenil in critically ill patients (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Thirteen critically ill patients received flumazenil after multiple doses, or an infusion, of midazolam was used as part of a sedation regimen to facilitate intensive care. All patients remained excessively sedated after the midazolam was stopped for 6 hours or longer. An improvement in conscious level occurred in eight patients (61%). In four of these eight patients, the duration of action of flumazenil necessitated its continued administration by an infusion to maintain the improvement in conscious level. The dose of flumazenil required each hour was less than estimated previously; this indicates that it may be subjected to similar alterations of elimination as those described for midazolam. Flumazenil appears to be a useful drug for the reversal of prolonged benzodiazepine sedation but repeated bolus doses or an infusion are needed if significant accumulation of benzodiazepines has occurred.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb11455.x
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