M. Bredgaard Sørensen

Acute carbon monoxide poisoning.

The course and outcome in terms of cerebral morbidity and hospital mortality in 79 severely carbon monoxide poisoned patients admitted to the intensive care unit during a period of 15 years is presented. Treatment consisted of administration of pure oxygen. Ninety–four per cent of the patients were artificially hyperventilated, and the majority of the patients were also treated with moderate hypothermia, steroid hormones and diuretics. Hospital mortality was 30%, and 14% of the patients were discharged after long–term hospital treatment with signs of brain damage. Due to the unpredictable cerebral course after the acute incident long–term follow–up is recommended.

Acute self-poisoning with tricyclic antidepressants in 295 consecutive patients treated in an ICU

Clinical findings on admission to hospital and outcome in 295 consecutive patients with severe tricyclic antidepressant self‐poisoning treated in an ICU are presented. Cerebral depression was observed in 92%, convulsions in 23% and respiratory failure was present in 72%. Cardiovascular function was impaired in 44% and an abnormal ECG was found in 57%. Cardiac arrest was treated in 14 patients (6%) of whom seven were resuscitated. The mortality rate was 2%. All patients were artificially ventilated. A beneficial effect of respiratory alkalosis on cardiac arrhythmias is supported.

Acute salicylate self‐poisoning in 177 consecutive patients treated in ICU

The course of 177 consecutive patients with severe salicylate self‐poisoning treated in an intensive care unit (ICU) during a period of 15 years is presented. On admission, cerebral depression was observed in 61%, respiratory failure was present in 47%, acidosis in 36% and cardiovascular function was impaired in 14%. A mortality rate of 15%, was observed, which was proportionally higher in patients more than 40 years old and in patients with delayed diagnosis. Twenty‐seven patients died and an autopsy was performed on 26 patients. The main autopsy diagnosis was ulcers of the gastrointestinal tract in 46%, pulmonary oedema in 46%, cerebral oedema in 31% and cerebral haemorrhage in 23%.

Acute propoxyphene self-poisoning in 222 consecutive patients

The course of severe propoxyphene self‐poisoning in 222 consecutive patients is presented. On admission, 73% of the patients had neurological symptoms, 10% had convulsions, 45% were in respiratory failure, and impaired circulation was present in 48%. A mortality rate of 8% was observed. Twelve patients arrived in asystole of whom six were resuscitated without sequelae. The overdose was accidental in 13 patients, one of whom died. Early medical intensive care was found mandatory for a good prognosis. Before discharge from the ICU we recommend an observation‐period free of cardiovascular symptoms for 24 h.

Self‐poisoning treated in an ICU: drug pattern, acute mortality and short‐term survival

A total of 1558 admissions to an ICU over 5 years because of severe self‐poisoning with drugs provides the basis for this study. Three drugs accounted for 60% of the admissions: overdose with barbiturates in 28%, with tricyclic antidepressants in 19% and with propoxyphene in 14%. The annual incidence of poisonings with barbiturates and tricyclic antidepressants was the same during the period, whereas the incidence of propoxyphene intoxication increased by 80%. Intensive supportive care was the main principle of treatment. All patients were artificially ventilated. The mortality rate was 6.1%, salicylate, propoxyphene and strong analgesics having the highest mortalities (11%, 9% and 9%, respectively). A mortality rate of 3% was found following overdose with tricyclic antidepressants. By 36 months after the overdose, 235 patients (18%) had died. The expected number of deaths was 39 (3%). The suicide rate in the follow‐up period was 10%, in the majority (75%) of whom death was caused by a new episode of self‐poisoning.

The psychological effects of having a contact‐person from the anesthetic staff

Seventy‐four patients admitted for elective surgery completed identical questionnaires and rating scales pre‐and postoperatively. The course of anxiety was compared between patients who were either routinely informed or had contact with an anesthetic nurse available for support during the 30‐min anesthesia and surgery preparation. Comparing the results with our three other studies, it is concluded that emotional support given by a “contact‐person” is more effective than either detailed information or a tranquillizer.

Cardiovascular effects of pentobarbital in pigs, and the lack of response to naloxone in pentobarbital induced circulatory failure

The hemodynamic effects of pentobarbital were tested in an experimental model used for cardiovascular research. Anesthesia was induced with an i.v. bolus and maintained with a continuous infusion of pentobarbital. The cardiovascular performance was then evaluated at various pentobarbital plasma concentrations ranging from 25 to 100 mg·l‐1. Optimal experimental conditions were found at plasma pentobarbital concentrations within the range 40–60 mg·l‐1, as the animals were well anesthetized with intact hemodynamics or ECG. The method of continuous pentobarbital administration seems advantageous for experimental research. Circulatory impairment following pentobarbital overdose was not affected by naloxone.

Moderate hypotensive anaesthesia for reduction of blood loss during total hip replacement.

Thirty‐two consecutive patients scheduled for total hip replacement were randomly allocated to receive either neurolept anaesthesia or halothane anaesthesia. In the halothane group, systolic blood pressure was reduced to 10.69‐13.33 kPa in normotensive patients, and to 13.33‐16.0 kPa in hypertensive patients by adjusting the inspired halothane concentration and using supplementary fentanyl when necessary. In the neurolept group, no attempt was made to reduce blood pressure below the level achieved with adequate anaesthetic doses of fentanyl and droperidol. The average peroperative blood loss in the halothane group was 809 ml (range 250–1700 ml); this was significantly lower than in the neurolept anaesthesia group in which an average blood loss of 1909 ml (range 600–4900 ml) occurred. Moderate hypotensive halothane anaesthesia is recommended as an anaesthetic technique for total hip replacement.

The Use of Epidural Analgesia for Delivery in a Patient with Pulmonary Hypertension

In a patient with severe pulmonary hypertension, haemodynamic observations, including cardiac output and pressure measurements in the systemic and the pulmonary circulation, were performed during vaginal delivery under selective segmental epidural block from T9 to L1 combined with Idatera1 pudendal blocks. No hypotensive episodes were observed in connection with the epidural block, but a gradual increase in the pulmonary pressures was observed during the stages of delivery. After perineal analgesia was achieved with bilateral pudendal blocks, a 2100 g girl with an Apgar score of 9 at 1 rnin was delivered by vacuuni extraction. The patient died 9 days after the delivery because of intractable cardiac failure.

Severe acute propoxyphene overdose: plasma concentrations of propoxyphene and norpropoxyphene and the effect of dopamine on circulatory failure

Twelve patients with cardiovascular failure because of propoxyphene self‐poisoning were treated with dopamine. The patients responded favourably to dopamine infusion (2–17 μg/kg/min) with a dose‐dependent rise in systolic arterial blood pressure and a fall in central venous pressure and copious urinary output. Side effects during infusion were few, and in periods where dopamine infusion exceeded 10 μg/kg/min no tachyarrhythmias were seen. Eleven of the patients were treated on a respirator. Two patients were discharged from the ICU with signs of hypoxic brain damage, one of whom recovered completely after 2 weeks. Serum propoxyphene and norpropoxyphene were measured in nine patients. All but one patient had either propoxyphene or norpropoxyphene concentrations above 3 μmol/l.