Intensive care

Insomnia is a related psychiatric illness having potentially serious consequences. In any given year up to one-third of the general population may experience insomnia and consequently considerable impact on quaUty of life. Potentially serious psychosocial, health, and socioeconomic consequences may foUow. Many sedative—hypnotics additionally have a firmly estabUshed position within the field of anesthesiology as premedication, inducing agents, and/or for maintenance in intensive care medicine. 

Combinations of barbiturates and benzodiazepine tranquilizers or even antihistaminergics having sedative properties are sometimes used. Furthermore, infusion of anesthetics can be used to provide long-term anesthesia for intensive care medicine. The antagonist flumazenil (18) is available to reverse the effects of anesthetics of the benzodiazepine class. 

NSAIDs are used as the first-line treatment of rheumatoid arthritis, osteoarthritis, systemic lupus erythematosis and other inflammatory diseases, and are thus amongst the most widely used dtugs in the developed world. This widespread use inevitably entailed a considerable associated morbidity, in particular a high incidence of gastric toxicity. In the USA alone, perforations, ulcers and bleeds lead to the hospitalisation of 100,000 patients per year, and about 15% of these die while under intensive care. 

Propofol (Diprivan) is used for induction and maintenance of anesthesia. It also may be used for sedation during diagnostic procedures and procedures that use a local anestiietic. This drug also is used for continuous sedation of intubated or respiratory-controlled patients in intensive care units. 

Dantrolene should be repeated after 5—8 hr. Bicarbonate, procaine amide, and other drugs should be repeated as needed. Treatment of disseminated intravascular coagulation is symptomatic. Early diagnosis and treatment ofMH is essential. After effective treatment, the patient should be watched closely in the intensive care unit for recurrence of MH, myoglobinuric renal failure, disseminated intravascular coagulation, muscle weakness, and electrolyte imbalance. 

Tobias JD Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Crit Care Med 28 2122-2132, 2000... 

Fisher MMD Clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse. Anesth Intensive Care 1986 17 17-21. Galli S (ed) Anaphylaxis. Novartis Foundation Symposium 157. Chichester, Wiley, 2004. Gronemeyer W Noradrenalin statt Adrenalin beim anaphylaktischen Schock. Dtsch Med Wochenschr 1980 102 101. 

Department of Internal Medicine, Clinical Immunology and Allergology and Department of Anesthesia and Intensive Care, University Hospital, Nancy, France... 

Fisher MM, Bowey CJ Alleged allergy to local anaesthetics. Anaesth Intensive Care 1997 25 611-614. 19... 

Fisher MM, Graham R Adverse responses to local 24 anaesthetics. Anaesth Intensive Care 1984 12 325-327. 25... 

Bellomo R. Chapman M, Finfer S, Hickhng K, Myburth J Low-dose dopamine in patients with early renal dysfunction a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Chnical Trials Group. Lancet 2000 356 2139-2143. 

INTENSIVE CARE MANAGEMENT OF ACUTE ISCHEMIC STROKE... 

Rordorf G, Koroshetz W, Efird JT, Cramer SC. Predictors of mortality in stroke patients admitted to an intensive care unit. Crit Care Med 2000 28(5) 1301-1305. 

Santoli F, De Johghe B, Hayon J, Tran B, Piperaud M, Merrer J, Outin H. Mechanical ventilation in patients with acute ischemic stroke survival and outcome at one year. Intensive Care Med 2001 27(7) 1141-1146. 

Georgiadis D, Schwarz S, Kollmar R, Baumgartner RW, Schwab S. Influence of inspiration expiration ratio on intracranial and cerebral perfusion pressure in acute stroke patients. Intensive Care Med 2002 28(8) 1089-1093. 

Salam A, Tilluckdharry L, Amoateng-Adjepong Y, Manthous CA. Neurological status, cough, secretions and extubation outcomes. Intensive Care Med 2004 30(7) 1334 1339. 

Diringer MN, Reaven NL, Funk SE, Uman GC. Elevated body temperature independently contributes to increased length of stay in neurological intensive care unit patients. Crit Care Med 2004 32(7) 1489-1495. 

Stocchetti N, Rossi S, Zanier ER, Colombo A, Beretta L, Citerio G. Pyrexia in head-injured patients admitted to intensive care. Int Care Med 2002 28(11) 1555-1562. 

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