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#31
08.09.2005, 00:53
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Пища для размышлений
Я тоже небольшой сторонник запоминания хитрых фамилий.Привожу для Вашего внимания один абстракт с похожими непрятностями,которые случились у нашего коллеги.
Anesth Analg 2005;100:1728-1730 © 2005 International Anesthesia Research Society doi: 10.1213/01.ANE.0000149895.99151.20 TECHNOLOGY, COMPUTING, AND SIMULATION Endobronchial Blocker Dislodgement Leading to Pulseless Electrical Activity Warren S. Sandberg, MD, PhD Department of Anesthesia & Critical Care, Massachusetts General Hospital, Boston, Massachusetts Address correspondence and reprint requests to Warren S. Sandberg, MD, PhD, Department of Anesthesia & Critical Care, Massachusetts General Hospital, 55 Fruit St, Clinics 3, Boston, MA 02114. Address e-mail to [Ссылки доступны только зарегистрированным пользователям ]. This is a report of a case in which an endobronchial blocker was dislodged, leading to severe air trapping and a brief episode of pulseless electrical activity. Bronchial blockade for lung deflation was successfully instituted during emergency repair of a ruptured descending aortic aneurysm. During a period not involving manipulation of aortic cross-clamps, end-tidal CO2 decreased precipitously to zero and airway pressures increased markedly, followed by equalization of intracardiac pressures. Prompt deflation of the endobronchial blocker balloon reversed the problem. We hypothesize that when surgical manipulation dislodged the bronchial blocker into the tracheal position, leading to profound air trapping as successive, stacked tidal volumes were forced distal to the blocker 
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#32
10.09.2005, 13:59
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Большое спасибо, papadoctor. Если не трудно, отправте, плс, мне на lancet[собака]pisem.net статью целиком. На носу разборки - вначале внутрибольничная конференция с привлечением главных специалистов области, профессора, затем, если дойдет, суд.
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#33
13.09.2005, 04:39
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Цитата:
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#34
11.10.2005, 07:02
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Which statement(s) about patients receiving oral morphine for the management of cancer pain over a 30-day period is/are true?
A. 1, 2, 3 only B. 1, 3 only C. 2, 4 only D. 4 only E. All are correct. 1)The addition of oral ketamine (0.5 mg/kg bid) can maintain the same level of comfort without increasing the oral morphine dose. 2)The addition of oral dipyrone (a nonsteroidal antiinflammatory drug; 500 mg q6h) can maintain the same level of comfort without increasing the oral morphine dose. 3)The addition of transdermal nitroglycerin (5 mg qd) can maintain the same level of comfort without increasing the oral morphine dose. 4)The addition of oral ketamine (0.5 mg/kg bid) produces side effects in a large percentage of patients.
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#36
12.10.2005, 19:04
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Цитата:
Correct answer is B A recent controlled study (n = 60) evaluated the analgesic efficacy, morphine-sparing effect, and tolerability of a 30-day trial of either oral ketamine (an N-methyl-D-aspartate receptor antagonist; 0.5 mg/kg oral bid), transdermal nitroglycerin (a nitric oxide donor; 5 mg patch qd), or dipyrone (a nonsteroidal antiinflammatory drug; 500 mg q6h) in the early phase of cancer pain management, defined as patients taking 80-90 mg of oral morphine daily. All subjects started at the same level of oral morphine consumption and at the same level of pain (VAS > 4). After 30 days, in contrast to patients in the control and dipyrone groups, patients receiving ketamine or nitroglycerin did not need to increase their oral morphine intake to maintain the same level of comfort they had at the beginning of the study period. The morphine requirement became stable after 15 days of ketamine administration and 20 days of nitroglycerin patch use. Some side effects developed in patients in all groups. Patients in the control and dipyrone groups were more likely to develop somnolence and constipation due to their increased intake of morphine. In both the ketamine and nitroglycerin groups one of 15 patients developed side effects that resulted in a dose reduction. In the patient receiving ketamine, it was due to hallucinations; for the patient receiving nitroglycerin, it was because of headaches. While oral ketamine and transdermal nitroglycerin may not be effective as sole analgesic agents, they appear to offer some efficacy as adjuvants to opiates in the management of cancer pain. REFERENCES Lauretti GR, Lima IC, Reis MP, et al. Oral ketamine and transdermal nitroglycerin as analgesic adjuvants to oral morphine therapy for cancer pain management. Anesthesiology. 1999; 90:1528-1533. Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001:1450-1451
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#38
13.10.2005, 14:32
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Цитата:
Уточните, пожалуйста, про данные в Barash PG, Cullen BF, Stoelting RK. Clinical Anesthesia. 4th ed, 2001. Смотрел только 3th, переведённое на русский, но ничего помогающее ответить не нашёл. Если сочтёте возможным, ответьте, насколько отличается оригинальная . Clinical Anesthesia Barash PG от перевода. С уважением.
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#39
13.10.2005, 18:45
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Which of the following herbal medications is MOST likely to cause perioperative coagulation disturbances?
A. Echinacea B. Garlic C. Kava D. Valerian
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#40
13.10.2005, 20:57
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Цитата:
 Не читал не 3, ни 4 редакцию, ни на русском, ни на английском. Я прочитал только то, что дал pandoc в своём посте.Предлагаю просто продолжить отвечать на его вопросы 
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#41
16.10.2005, 05:29
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Как спрашивал pandoc
Цитата:
Цитата:
[Ссылки доступны только зарегистрированным пользователям ] [Ссылки доступны только зарегистрированным пользователям ] , и кое что о "4 Gs" [Ссылки доступны только зарегистрированным пользователям ] . С уважением.
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#42
16.10.2005, 05:53
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Цитата:
SEE Program Electronic Edition 7. Which of the following herbal medications is MOST likely to cause perioperative coagulation disturbances? A. Echinacea B. Garlic C. Kava D. Valerian Comments on the incorrect answers Correct answer is B (чеснок) Herbal medications, remedies, and supplements are very popular in the United States with as many as 20% to 25% of surgical patients taking them regularly. At least one study has shown that as many as 60% of patients fail to disclose use of these medications to their physicians. A variety of reasons are given for this, including failure on the part of the physician to ask about herbal use. Unfortunately, a number of adverse effects can occur with some of these medications. These side effects may result from the clinical effects of these medications and/or as a result of detrimental drug-drug interactions with conventional medications. Coagulation defects can occur in association with taking garlic or ginkgo. Garlic is taken to treat hypertension, hyperlipidemia, and atherosclerosis, and ginkgo is taken to treat cognitive deficits associated with multi-infarct dementia and Alzheimer disease. Garlic can decrease platelet aggregation and cause bleeding, and it can interact with warfarin to increase the international normalized ratio. Ginkgo is an antagonist for platelet-aggregating factor and also has been reported to cause bleeding in association with warfarin. Kava and valerian are used as anxiolytics and sleep aids. They function to enhance gamma-amino butyric acid (GABA)-mediated inhibitory neurotransmission. They therefore have the potential to interact with other drugs that act on GABA transmission, such as benzodiazepines or barbiturates, to cause prolonged sedation. In addition, kava has been reported to have an associated withdrawal syndrome that may complicate the perioperative period. Finally, echinacea is used as a nonspecific immunostimulant. Its use has been reported to decrease the duration and severity of upper respiratory infections. Unfortunately, long-term use has been associated with immunosuppression, which may increase the risk of postoperative infections and poor wound healing. REFERENCES Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. 2002; 57:889-899. Dennehy CE, Tsourounis C. Botanicals ("herbal medications") and nutritional supplements. In: Katzung BG, ed. Basic & Clinical Pharmacology. New York: Lange Medical Books/McGraw-Hill; 2004:1076-1090.
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#43
16.10.2005, 07:00
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А также вопрос по использованию БАДов в интенсивной терапии: Which statement about nutrition supplements with immune-enhancing nutrients (immunonutrition) is MOST likely true?
A. Immunonutrition has been found to decrease the rate of infectious complications after elective surgical procedures. B. Immunonutrition decreases mortality in critically ill patients. C. Immunonutrition shortens hospital length of stay. D. Immunonutrition decreases the duration of mechanical ventilation in critically ill patients.
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#44
16.10.2005, 17:32
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Уважаемый pandoc!
Прочитал тему «Is this crazy?» анестезиологического форума [Ссылки доступны только зарегистрированным пользователям ] . [Ссылки доступны только зарегистрированным пользователям ] Мнение участников, по поводу анестезиологического пособия для репозиции лучевой кости ребёнку, склонилось от внутривенной седации кетамин/мидозолам к GOTA(GETA), с вариациями на время начало анестезии после приёма пищи. Но, сообщение № 38, от sleepeze, о применении в/в блокады по Биру, с небольшим системным количеством фентанила у двухлетних детей несколько диссонирует, однако подкупает её практическая реализация. Ваш взгляд, если сочтёте возможным ответить, на подобную тактику, как специалиста в педиатрической анестезиологии. С уважением.
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#45
16.10.2005, 20:24
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Цитата:
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Линейный вид
