Halothane treatment in life-threatening asthma.

We analysed the case histories of 22 patients with life threatening asthma retrospectively. Fifteen patients needed mechanical ventilation. Three patients, all of them in cardiac arrest before or at the moment of admission, died. In five patients, halothane therapy was successfully used as a last resort. No major complications occurred. Two case-reports are presented.

Scopolamine intoxications.

Pure scopolamine intoxications are extremely rare. We treated a series of severe intoxications exclusively caused by scopolamine and due to the intentional mixing of pure scopolamine into drinks. The clinical course and therapy are reported. On the basis of our experience and a survey of literature, we found physostigmine to be an excellent antidote. The symptomatology of the patients confirms that scopolamine has a dose-related stimulant effect on the central nervous system.

A retrospective study of 130 consecutive multiple trauma patients in an intensive care unit.

A retrospective study of 130 multiple trauma patients admitted to an intensive care unit is presented. Overall mortality was 33% for a mean ISS of 39.4. Craniocerebral trauma, multiple organ failure, sepsis and ARDS are the main causes of death, although there is no statistical difference for these between survivors and non-survivors. There is a good correlation between ISS and mortality (r = 0.86). Patients developing MOF, sepsis and ARDS have significantly higher ISS. Mortality from complications such as sepsis, MOF, ARDS and aspiration pneumonia seems more related to age.

A hemodynamic study of epidural versus intravenous anesthesia for aortofemoral bypass surgery.

The hemodynamic effects of two types of anesthesia on aortofemoral bypass surgery were studied in a randomised prospective trial. Epidural anesthesia supplemented with nitrous oxide (group I) and total intravenous anesthesia combining fentanyl and a continuous infusion of etomidate (group II) were compared. A high incidence of preoperative disease was found and all 18 patients were classified in ASA classes III-IV. It is concluded that epidural anesthesia provides excellent anesthetic and hemodynamic stability provided that an optimal filling pressure is maintained. Total intravenous anesthesia resulted in significant hypertensive reactions during surgery, which were not specifically related to crossclamping. Decreasing the high SVRI with vasodilatory treatment was necessary to treat hypertension in all those patients with preoperative hypertensive disease. No problems were seen in the intravenous group patients without preoperative hypertension. Cardiac work was higher in the intravenous group due to the high impedance of the cardiovascular system provoked by the absence of vasodilatory properties with this type of intravenous anesthesia. Monitoring of PWP and CI by Swan-Ganz catheter is shown to be very useful for optimalization of hemodynamics and fluid management especially during crossclamping, when normal Frank-Starling relationships might not be valid anymore. The effect of vasodilatory treatment, crossclamping and declamping could be carefully evaluated.

Prognostic value of gastric intramural pH in surgical intensive care patients.

Gastric intramural pH (pHi), which has been shown to reflect the adequacy of oxygenation in peripheral tissue beds, was measured in acutely ill surgical patients in order to evaluate its value as a prognostic factor and its relation to the sepsis score. Fifty-nine surgical patients were studied on ICU admission. The stomach wall pH was calculated from the PCO2 in gastric juice and arterial bicarbonate concentration using the Henderson-Hasselbalch equation. A fall in tissue pH less than 7.32 was taken as an indication of inadequate tissue oxygenation. Patients with sepsis scores greater than 10 were considered septic. Hospital and short-term (within 72 h of admission) mortality rates were determined. A significantly higher short-term mortality rate was observed in patients having a pHi less than 7.32 (37% vs. 0%, p less than .005). Most (90%) of the septic patients had a pHi less than 7.32. The short-term mortality rate was the highest (50%) in the septic group. In this group also, a linear correlation was found between pHi and the sepsis score (r = -.43, p less than .01). Gastric pHi, however, offered no prediction for the long-term outcome.

Oral antimony intoxications in man.

Four cases of acute oral antimony intoxication are reported. Three patients survived without sequelae. One patient, a 93-yr-old male, died from multiple organ failure. Toxicological analysis of blood, urine, and tissues revealed a severe intoxication.