[The critical care patient in the operating room].
ICU patients can undergo elective or emergency surgery. Optimising the patient and arranging for the necessary blood components is as important as the fully monitored transport to the OR. Monitoring usually includes radial artery and vena cava access routes, pulmonary artery catheters help to check on oxygen transport parameters and cardiac output. Echocardiography is a new feature to determine cardiac volumes and left ventricular function as well as possible regional ischaemia. Anaesthesia induction can be performed using thiopentone along with diazepam and opioids. In shocked patients ketamine helps to prevent further drop of blood pressure. Propofol can also be employed for maintenance of anaesthesia. For muscle relaxation succinylcholine is the agent of choice if crush intubation is necessary. Atracurium and vecuronium should be used according to their specific route of elimination, although there can be interaction with antibiotics or adrenergic blockers. To ventilate the patient a mixture of oxygen in air might be useful, since nitrous oxide might be determined to blood cell formation and may distend gas-containing cavities. With the aid of positive end expiratory pressure FiO2 should be kept at a minimum, respiratory rate and inspiratory-expiratory ratio can keep ventilation pressures within an acceptable range and ensure CO2 excretion. Volume losses will be replaced mainly with Ringer's lactate, of which it takes four times the amount of colloidal replacement solutions which have the side effects of blood-borne infection and anaphylaxis. Fresh frozen plasma, platelets and erythrocytes might be necessary if coagulation parameters or oxygen transportation warrant it.(ABSTRACT TRUNCATED AT 250 WORDS)
Lackner
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Universitätsklinik für Anästhesie und allgemeine Intensivmedizin, Universität Wien.
D000768:Anesthesia, General / Q000379:methods*; D003422:Critical Care / Q000379:methods*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods*; D011229:Preanesthetic Medication / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012307:Risk Factors; D013514:Surgical Procedures, Operative
Der Intensivpatient im Operationssaal.