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Εταιρεία Αναισθησιολογίας και Εντατικής Ιατρικής Βορείου Ελλάδας (ΕΑΕΙΒΕ)
HSA
Ελληνική Αναισθησιολογική Εταιρεία

A majority of current pharmacokinetic and pharmacodynamic data are generated from studies in healthy volunteers and stable patients with single organ dysfunction. However, critically ill patients differ from other patients because of the complex and unstable nature of their illness. Critical illness results in multiple changes that alter drug disposition in the body. As organs fail, so the pharmacokinetic processes of absorption, distribution, and elimination are affected.

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Transcranial Doppler (TCD) is increasingly utilized in patients with lifethreatening neurologic injury and has several practical applications in neurocritical care. It holds promise for the diagnosis and monitoring of vasospasm (VSP) in patients with subarachnoid hemorrhage (SAH) and the detection of increased intracranial hypertension.

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Cell protection against hypoxia can be mediated by brief periods of sublethal ischemia, a phenomenon called ‘preconditioning’. The molecular mechanisms that are responsible for cell protection are extremely complicated; however, extensive research in molecular biology and cellular physiology has uncovered many different signaling pathways, especially in cardiac tissues.

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General anaesthesia is associated with a reduction in heart rate variability (HRV) compared to awake situation. In this study the hypothesis of reduction in HRV was tested in two different levels of anaesthesia depth. Forty six patients were randomly allocated in two groups, where anaesthesia was maintained with sevoflurane (n=23) or propofol (n=23). Administration of both anaesthetics was regulated in order to achieve a BIS value 25±5, followed by an increase to 55±5, both being stable for 5 min.

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As general anaesthesia administered during the first two trimesters of pregnancy for gynaecological procedures was associated with a high incidence of mis-carriage and exposes the fetus to teratogenic effects of drugs, a case of successful breast tumour extraction under thoracic paravertebral block is reported with review of the literature.

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Perturbations of the clotting system frequently accompany systemic inflammatory states. Coagulation abnormalities, specifically an imbalance between coagulant and anticoagulant mechanisms, are a frequent occurrence in patients with septic shock and trauma and have been associated with an increased mortality.

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Acute and prolonged illness seems to result in a variety of different neuroendocrine alterations. During the acute phase of critical illness there is an actively secreting anterior pituitary gland and a peripheral resistance to anabolic hormones. In the chronic phase of critical illness there is a uniformly reduced secretion of anterior pituitary hormones, with the notable exception of cortisol.

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