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  • 1
    Electronic Resource
    Electronic Resource
    Changes in cardiac output during air ambulance repatriation (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1396-1399 
    Details
    ISSN: 1432-1238
    Keywords: Air ambulance ; Cardiac ouput ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To measure, with the use of suprasternal Dopler ultrasound, the hemodynamic changes in patients and volunteers during air ambulance repatriation. Design Unblinded prospective observational study. Setting Chartered air ambulances for the international repatriation of patients. Patients and participants Six medical crew members and seven patients transported back to hospitals in the UK. Interventions The measurement of non-invasive blood pressure, ECG, heart rate, oxygen saturation and hemodynamic variables with suprasternal Doppler. Measurements and results There was a drop in systolic and mean arterial blood pressure in the patient's group once in the air. Oxygen saturation dropped in both groups once at cruising altitude. Heart rate remained unchanged. Stroke distance and minute distance increased significantly in the patient's group and non-significantly in the volunteers. Peak velocity increased significantly in the patient's group. There was an overall reduction of systemic vascular resistance during take off and once at cruising altitude. Conclusions Hemodynamic changes happen during air ambulance transportation in fit and healthy volunteers and patients alike. These may be due to a combination of hypobaric hypoxia and gravitational forces. It is necessary to establish if these changes have short-or long-term effects in the critically ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709557
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    A cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients (1997)
    Springer
    Intensive care medicine 23 (1997), S. 85-90 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiac output ; Complications ; Cost ; Dopexamine ; High risk patients ; Intensive care ; Morbidity ; Mortality ; Oxygen delivery ; Resource use ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate the cost implications of a treatment policy of a deliberate perioperative increase of oxygen delivery in high risk surgical patients. Design: A cost-effectiveness analysis comparing ‘protocol’ high risk surgical patients in whom oxygen delivery was specifically targeted towards 600 ml/min/m2 with ‘control’ patients. Interventions: In a randomised, controlled clinical trial we previously demonstrated a significant reduction in mortality (5.7% vs 22.2%, p=0.015) and morbidity (0.68±0.16 complications vs 1.35±0.20, p=0.008) in ‘protocol’ high risk surgical patients in whom oxygen delivery was specifically targeted towards 600 ml/min per m2 compared with ‘control’ patients. This current study retrospectively analysed the medical care and National Health Service resource use of each patient in the trial. Departmental purchasing records and business managers were consulted to identify M28.9nthe unit cost of these resources, and thereby the cost of treating each patient was calculated. Results: The median cost of treating a protocol patient was lower than for a control patient (£6,525 vs £7,784) and this reduction was due mainly to a decrease in the cost of treating postoperative complications (median £213 vs £668). The cost of obtaining a survivor was 31% lower in the protocol group. Conclusion: Perioperative increase of oxygen delivery in high risk surgical patients not only improves survival, but also provides an actual and relative cost saving. This may have important implications for the management of these patients and the funding of intensive care.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050295
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Changes in cardiac output during air ambulance repatriation (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1396-1399 
    Details
    ISSN: 1432-1238
    Keywords: Key words Air ambulance ; Cardiac output ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To measure, with the use of suprasternal Doppler ultrasound, the hemodynamic changes in patients and volunteers during air ambulance repatriation. Design: Unblinded prospective observational study. Setting: Chartered air ambulances for the international repatriation of patients. Patients and participants: Six medical crew members and seven patients transported back to hospitals in the UK. Interventions: The measurement of non-invasive blood pressure, ECG, heart rate, oxygen saturation and hemodynamic variables with suprasternal Doppler. Measurements and results: There was a drop in systolic and mean arterial blood pressure in the patient’s group once in the air. Oxygen saturation dropped in both groups once at cruising altitude. Heart rate remained unchanged. Stroke distance and minute distance increased significantly in the patient’s group and non-significantly in the volunteers. Peak velocity increased significantly in the patient’s group. There was an overall reduction of systemic vascular resistance during take off and once at cruising altitude. Conclusions: Hemodynamic changes happen during air ambulance transportation in fit and healthy volunteers and patients alike. These may be due to a combination of hypobaric hypoxia and gravitational forces. It is necessary to establish if these changes have short- or long-term effects in the critically ill.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709557
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Esmolol aids extubation in intensive care patient with ischaemic pulmonary oedema (1996)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 51 (1996), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A 49-year-old man with a history of ischaemic heart disease failed successful tracheal extubation on four consecutive occasions following emergency surgery because of the development of acute pulmonary oedema. Attenuation of the cardiovascular responses to tracheal tube removal by pretreatment with an intravenous infusion of esmolol hydrochloride allowed successful extubation of the patient to be achieved.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1996.tb07794.x
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Effects of thiopentone, etomidate and propofol on the haemodynamic response to tracheal intubation (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 haemodynamic response to tracheal intubation was compared in 303 patients in whom anaesthesia was induced with either thiopentone 4 mg/kg, etomidate 0.3 mg/kg or propofol 2.5 mg/kg, with and without fentanyl 2 μg/kg. There was after propofol alone a significant decrease in arterial blood pressure, which did not increase above control values after intubation. Significant increases in arterial pressure followed intubation in patients induced with thiopentone or etomidate alone. Increases in heart rate occurred with all agents after laryngoscopy. The use of fentanyl resulted in arterial pressures lower than those after the induction agent alone, and in an attentuation, but not abolition of the responses to largyngoscopy and intubation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1988.tb09065.x
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  • 6
    Electronic Resource
    Electronic Resource
    The peri-operative management of surgical insertion and removal of the intravenous oxygenator device (IVOX) (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 48 (1993), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Intravenous oxygenation (IVOX) is a new technique for augmentation of gas exchange in patients who require near maximal conventional ventilatory support. Patients who require IVOX are, by definition, critically ill with a high expected mortality. At present, these high risk patients must be transferred to the operating theatre for the IVOX device to be inserted. This report describes the anaesthetic problems associated with nine patients in whom an IVOX device was inserted and removed in our institution. The mortality was six out of nine patients; all deaths occurred with the IVOX device in situ. Three patients died within 6 h of insertion. Four patients were female. The patients' ages ranged from 14 to 76 years. There were few immediate ventilation changes in the first 4 h after IVOX insertion. Inspired oxygenation concentration was reduced in only one patient. Positive end-expiratory pressure was not reduced. Peak inspiratory pressure decreased in four patients. Arterial oxygen tension increased in four patients (range 0.1–2.5 kPa) and decreased in five (range 0.1–3.4 kPa). Arterial carbon dioxide tension increased in one patient (0.3 kPa) and decreased in eight (range 0.1–2.7 kPa). Inotropic support with adrenaline, dobutamine and nor adrenaline needed to be initiated or increased in eight patients. Eight patients required 2–4 units of blood to be transfused during IVOX insertion or in the following 2 h. One patient suffered an asystolic cardiac arrest during the operation, but was resuscitated successfully. Three patients survived to have the IVOX removed. There were no cardiorespiratory problems associated with its removal and although all three required a vein patch to repair the venotomy site, no patient required blood transfusion. We conclude that IVOX insertion (including transfer to and from the operating theatre) represents a significant cardiorespiratory insult to these critically ill patients. Anaesthetic staff need to be aware of the potential problems to enable them to minimise the risk of serious complications during the insertion of this novel device.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1993.tb07411.x
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    Isoflurane and propofol for long-term sedation in the intensive care unit (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Propofol and isoflurane have been reported recently to offer better sedation than alternative agents in patients who require long-term ventilation in the Intensive Care Unit. This is the first report of a direct comparison between propofol and isoflurane. Twenty-four patients predicted to require artificial ventilation for at least 48 h were entered into a randomised crossover study to monitor sedation quality and time to recovery from sedation. There were no significant differences between the two agents in either end-point, with over 95% optimal sedation achieved by the use of each drug. Few adverse events were noted. Technological advances in the administration of volatile agents as long-term sedatives in the Intensive Care Unit may facilitate their more widespread use.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb03254.x
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  • 8
    Electronic Resource
    Electronic Resource
    Calibration of three capnographs for use with helium and oxygen gas mixtures (2003)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 58 (2003), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Capnography is considered essential in the management of mechanically-ventilated patients. Helium, as an adjunct to mechanical ventilation, is the subject of renewed interest and used increasingly. However, helium affects the performance of infrared capnometry. We constructed a simple device to generate variable mixtures of helium, oxygen and carbon dioxide within the normal physiological range, and tested the performance of two side-stream and one in-line capnographs. We found that addition of helium to the gas mixture caused all three capnographs to underestimate the concentration of carbon dioxide. The underestimation increased as the proportion of helium increased. The maximum underestimation (30%) occurred in a 79:21 helium/oxygen mixture.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2003.02963.x
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  • 9
    Electronic Resource
    Electronic Resource
    Circulating fluoride changes and hepatorenal function following sevoflurane anaesthesia (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 49 (1994), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sevoflurane, a new volatile inhalational agent, undergoes biotransformation to fluoride which is potentially nephrotoxic. We compared the effects of sevoflurane or isoflurane anaesthesia on hepatorenal function and serum fluoride concentrations in 50 ASA 1-3patients undergoing major intra-abdominal surgery. No patient developed renal or hepatic dysfunction. Mean (SEM) peak fluoride concentrations were 23.1 (1.5) μmol.l-1for sevoflurane and 5.4 (0.4) μmol.l-1 for isoflurane (p 〈 0.001). There was a significant correlation in the sevoflurane group between the total dose of agent (MAC h), the total fluoride production (r = 0 78, p = 0.0001) and peak fluoride concentration (r = 0.57, p = 0.003). There was no correlation between these variables in the isoflurane group.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1994.tb04307.x
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  • 10
    Electronic Resource
    Electronic Resource
    Propofol for long-term sedation in the intensive care unit A comparison with papaveretum and midazolam (1990)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 45 (1990), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Thirty-seven patients with a wide range of illnesses were studied during mechanical ventilation of the lungs in an intensive care unit. Fifteen were sedated with a continuous propofol infusion, with analgesia provided by bolus doses of papaveretum. Twelve received a continuous infusion of papaveretum, supplemented by bolus doses of midazolam. The level of sedation was assessed every four hours and measurements were made of haemodynamic and respiratory variables. Levels of sedation were generally satisfactory in both groups. Six patients who received propofol required the use of muscle relaxants, because of their strong respiratory drives, to achieve synchronisation with the ventilator. There was no significant difference in respiratory or haemodynamic variables between the groups, but several patients required inotropic support because of their disease. There was no evidence of inhibition of adrenal steroidogenesis in the propofol group. Propofol can be a useful sedative agent in the intensive care unit, but sedative regimens should be tailored to individual patient requirements.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1990.tb14777.x
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