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  • 1
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 10 (1995), S. 0 
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: In this article, we examine 14 studies conducted from 1974 to 1994 on “early” endotracheal extubation (0 to 12 hours postoperatively) in adult cardiac surgery patients. Aspects reviewed include: criteria for patient selection; criteria for extubation; analyses of feasibility and safety; effects of anesthetic technique; and patient morbidity. Advantages and disadvantages of early or “fast-track” extubation are discussed as are directions for future research. Selection criteria varied among studies; patients were most commonly excluded because of severe, preexisting pulmonary disease or ventricular dysfunction. Based on the studies examined, however, at least 70% to 80% of adult patients would meet selection criteria. Three universal criteria were applied in all studies: (1) patient is awake and responsive; (2) adequate gas exchange while breathing spontaneously; and (3) cardiovascular stability. To facilitate early extubation in appropriately selected patients, the choice of anesthetic technique and postoperative sedation technique appears to be important. Anesthetic techniques based on inhalational anesthetic agents, supplemented by moderate doses of narcotics, are more appropriate than high-dose narcotic anesthesia for early extubation protocols. Postoperative sedation with propofol, which has a rapid offset of action, may be particularly advantageous. Every published investigation has concluded that early extubation is safe, feasible, and desirable. Morbidity and mortality have not been shown to be affected by early extubation. Anesthetic technique and the patient's medical condition are the two major factors to consider in accomplishing early extubation.
    Materialart: Digitale Medien
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Journal of cardiac surgery 10 (1995), S. 0 
    ISSN: 1540-8191
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Several factors have pointed to a potential link between ATP sensitive potassium channel activation in ventricular myocytes and the phenomenon of myocardial preconditioning. Preconditioning can be blocked by adenosine antagonists, and is mimicked by adenosine A1-receptor agonists. A portion of the physiological action of adenosine is, however attributable to adenosine actions on Katpchannels. The adenosine A1 receptor is reported to be linked to the Katpchannel in rat ventricular myocytes by a G-protein mechanism. This article will review the current status of work regarding the role of Katpchannels in myocardial preconditioning and will highlight recent work addressing the role of anesthetic effects in these studies. Recent reports and work from our laboratory reveal that several commonly used anesthetic drugs either have direct effects on Katpchannels (barbiturates) or have prominent physiological effects that are modulated in large part by Katpchannels (volatile anesthetics halothane and isoflurane).
    Materialart: Digitale Medien
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 3
    ISSN: 1432-1238
    Schlagwort(e): Key words Propofol ; Disodium edetate ; Critical illness ; Calcium ; Magnesium ; Homeostasis
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective: To compare propofol with disodium edetate (EDTA) and propofol without EDTA when used for the sedation of critically ill surgical intensive care unit (ICU) patients. Design: Prospective, randomised, multicentre trial. Patients: A total of 122 surgical ICU patients who required intubation and mechanical ventilation. Interventions: Patients were randomised to receive either propofol or propofol plus EDTA (propofol EDTA) by continuous infusion for sedation. Measurements and Results: The addition of EDTA to propofol had no effect on calcium or magnesium homeostasis, renal function, haemodynamic function, or efficacy when used for the sedation of surgical patients in the ICU. The most common adverse events were hypotension, atrial fibrillation, and hypocalcaemia. In this trial, a greater number of serious adverse events and adverse events leading to withdrawal occurred in the propofol group relative to the propofol EDTA group. There was a significantly lower crude mortality rate at 7 and 28 days for the propofol EDTA group compared with the propofol group. There were no statistically significant differences between groups with respect to depth of sedation. Conclusion: The propofol EDTA formulation had no effect on calcium or magnesium homeostasis, renal function, or sedation efficacy compared with propofol alone when used for sedation in critically ill surgical ICU patients. There was a significant decrease in mortality in the propofol EDTA group compared with the propofol group. Further investigations are needed to validate this survival benefit and elucidate a possible mechanism.
    Materialart: Digitale Medien
    Standort Signatur Einschränkungen Verfügbarkeit
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