Subject(s)
Anesthetics/adverse effects , Cardiovascular Physiological Phenomena/drug effects , Cotinine/adverse effects , Drug Synergism , Humans , Nicotine/adverse effects , Nicotinic Agonists/adverse effects , Preoperative Care/methods , Respiratory Physiological Phenomena/drug effects , Smoking/adverse effects , Smoking Cessation , Time FactorsABSTRACT
A low preoperative hemoglobin (Hb) concentration creates a dilemma for the anesthetist to proceed or not. The authors prospectively studied the perioperative morbidity of 200 healthy infants and children (age range 3 mon-5 years) with preoperative Hb values > or = 7 g/dl, undergoing cleft lip and palate surgery under general anesthesia. The patients were later categorized according to preoperative Hb level group A: Hb 7-10 g/dl and group B: Hb > 10 g/dl and the results were compared. One or more episodes of hypoxemia (SpO2 < 91%) were recorded in 8 patients in group A and 6 in group B during airway management. All patients had stable cardiovascular parameters except for transient bradycardia during desaturations. Recovery was similar and rapid. There were no differences in perioperative morbidity between the two groups. However, the safety of general anesthesia in infants and children with difficult airways is questionable when the oxygen reserve is reduced in anemia.
Subject(s)
Anemia/blood , Anesthesia, General , Blood Loss, Surgical , Child, Preschool , Cleft Lip/complications , Cleft Palate/complications , Hemoglobins/analysis , Humans , Infant , Oxygen/blood , Postoperative Complications/epidemiology , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: To evaluate intensive care utilisation following attempted suicide through self-poisoning. DESIGN: Retrospective analysis of clinical records. SETTING: Intensive Care Unit, Teaching Hospital, Peradeniya. PATIENTS: All patients admitted over the period 1991-1995. RESULTS: 292 patients were admitted after a suicide attempt by ingestion of a poisonous substance or drug in overdose. 52% were mechanically ventilated. The mean stay was 6 days. Daily intensive care cost averaged Rs. 8000 for a ventilated patient. Fifty three patients died. The 292 patients constituted 10.2% of the total admissions to the unit. CONCLUSIONS: Suicide as a medical emergency imposes pressure on the limited resources and facilities available in intensive care units. Concrete preventive measures are mandatory to prevent loss of life and health care resources.
Subject(s)
Adolescent , Adult , Child , Female , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Poisoning , Respiration, Artificial , Retrospective Studies , Sri Lanka/epidemiology , Suicide, AttemptedSubject(s)
Adult , Ambulatory Surgical Procedures , Dilatation and Curettage , Feasibility Studies , Female , Humans , Middle Aged , Prospective Studies , Sri LankaABSTRACT
In a retrospective study of 34 patients with acute Guillain-Barre syndrome admitted to an intensive care unit (ICU) during a six year period from January 1984 to December 1989, for bulbar paresis or impending respiratory failure, 4 required endotracheal intubation to protect the airway, and 27 required mechanical ventilation. A high incidence of respiratory complications was noted. Two patients died of cardiovascular instability. Close monitoring of respiratory and cardiovascular status is essential to ensure survival.
Subject(s)
Adolescent , Adult , Child , Combined Modality Therapy , Female , Humans , Critical Care , Intubation, Intratracheal , Male , Middle Aged , Polyradiculoneuropathy/complications , Respiration, Artificial , Retrospective Studies , TracheostomyABSTRACT
The arterial oxygen saturation, heart rate and systolic blood pressure were measured in 100 patients undergoing electroconvulsive therapy under general anaesthesia. All patients were anaesthetised using thiopentone and suxamethonium. In spite of ventilation with oxygen during the procedure a marked degree of hypoxaemia occurred during the convulsion in 80% of the patients. This was associated with a highly significant rise in heart rate and blood pressure (p less than 0.001). During electroconvulsive therapy there is an imbalance between myocardial oxygen supply and consumption.