Reversible cardiogenic shock complicating subarachnoid haemorrhage.
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Aneurysm, Ruptured↗
Biomedical subjects
S R Finfer
Publications and source records attributed to S R Finfer.
Inhaled nitric oxide in acute respiratory failure in adults.
We have assessed the acute effects of inhaled nitric oxide 8, 32 and 128 volumes per million (vpm) on pulmonary haemodynamics and arterial oxygenation in patients with severe acute respiratory failure. Fourteen patients requiring artificial ventilation with mean pulmonary artery pressures greater than 30 mm Hg were given inhaled nitric oxide; haemodynamic values and blood-gas tensions were measured before and after 10 min of inhalation of nitric oxide. Nitric oxide inhaled at 8, 32 and 128 vpm decreased mean pulmonary artery pressure by 1.7 (SD 2.2), 3.2 (2.6) and 3.3 (3.3) mm Hg, pulmonary vascular resistance by 20 (64), 53 (57) and 66 (54) dyn s cm-5 and increased arterial oxygen tension by 2.5 (3.6), 3.0 (5.1) and 2.9 (3.9) kPa, respectively. All changes were significant (P < 0.05 or less) except for changes in pulmonary vascular resistance at 8 vpm. The improvement in arterial oxygenation with 128 vpm was related to pulmonary vascular resistance before commencing nitric oxide. The major beneficial effect of nitric oxide in acute respiratory failure would appear to be improvement in oxygenation rather than reduction in pulmonary artery pressure. The degree of improvement in arterial oxygenation with nitric oxide was related directly to pulmonary vascular resistance before treatment.
Acute Disease↗
Advanced trauma life support.
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Anesthesiology↗
Pacemaker failure on induction of anaesthesia.
A patient with a permanent pacemaker presented for repair of a strangulated hernia. During induction of anaesthesia, the pacemaker generator stopped discharging, thus causing cardiac arrest. The likely cause of the generator failure was inhibition by suxamethonium-induced muscle fasciculations. Following defibrillation, and increase in stimulation threshold necessitated urgent insertion of a transvenous pacing system. It is suggested that, when suxamethonium is to be used in a patient with a permanent pacemaker, consideration should be given to reprogramming the pacemaker to asynchronous mode before induction of anaesthesia. If a patient with a pacemaker requires defibrillation, an acute increase in stimulation threshold may result and cause loss of capture. Rapid insertion of a transvenous pacing system may be necessary.
Aged↗
Management of labour and delivery in patients with intracranial neoplasms.
The presence of an intracranial neoplasm (ICN) during pregnancy has serious implications for the anaesthetic management of labour and delivery. The physiological changes of pregnancy and labour are potentially hazardous to women with ICN, but the provision of adequate pain relief during labour reduces the risk to the mother. Extradural anaesthesia is the only technique that provides pain-free labour reliably, but it carries added risks. Three patients are reported who were managed with extradural anaesthesia: two delivered per vaginam and one by Caesarean section. None suffered any complication related to the anaesthetic technique. At present, there are no published data on the influence of anaesthetic management on outcome of labour and delivery in patients with ICN. Anaesthetists should report such cases so that the relative risks of different management strategies may be assessed.
Adult↗
Cardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fibreoptic intubation.
The cardiovascular responses to tracheal intubation using a fibreoptic bronchoscope or Macintosh laryngoscope were compared in twenty in-patients and twenty day-stay patients. Within these groups patients were randomly allocated to direct laryngoscopic or fibreoptic bronchoscopic intubation. Arterial blood pressure, heart rate and arterial oxygen saturation were recorded before induction and at one-minute intervals until four minutes after intubation. In both groups both laryngoscopic and bronchoscopic intubation resulted in a significant rise in blood pressure and heart rate. At no stage was there a significant difference in mean blood pressure in either group, or in heart rate in the day-stay patients, between the different methods of intubation. In the in-patients mean heart rate was significantly higher in those patients intubated with the bronchoscope at three and four minutes after intubation. Time taken for intubation was significantly longer in those patients intubated with the bronchoscope. In no patient did the arterial oxygen saturation fall below 98%.
Adult↗
Ventilatory support in asthma.
Mechanical ventilation in acute asthma is associated with significant morbidity and mortality, and maximal medical therapy should prevent it being used inappropriately. We review current standards of medical therapy in acute asthma, the indications for mechanical ventilation and its management.
Acute Disease↗