Since the outbreak of the novel influenza H1N1 in Mexico in April 2009, more than half a million cases have been recorded with close to 6000 deaths. In contrast to seasonal flu, this virus appears to have a predilection for the young, obese and pregnant. It's most important and almost fatal complication is Acute Respiratory Distress Syndrome (ARDS). ICUs around the world have scrambled to upgrade various treatment modalities including high frequency oscillation ventilation, inotropes, antivirals and antibiotics in an effort to reduce the mortality arising out of this complication. More importantly, this complication appears reversible if adequate and early therapy is instituted. In particular, rescue therapies that allow the lung to rest appear to have brought success in some clinical settings. This article describes the experiences of six centres that have used Extracorporeal Membrane Oxygenation (ECMO) as rescue therapy in patients having ARDS. ECMO has been instituted in many of these cases not only as a bridge to therapy but also to reduce further barotrauma in these patients. ECMO experiences regarding 2 patients at the
Objectives:To compare the effect of induction position (sitting versus lateral) for spinal anaesthesia in the elderly patient on hemodynamic, sensory block and motor block characteristics and patient satisfaction.
Material and methods:Randomized controlled trial of patients undergoing spinal anaesthesia for lower abdominal, pelvic, lower limb and urological surgeries aged more than 60 years. Hyperbaric Bupivacain (0.05%) was injected into the spinal space while the patients were either in sitting or lateral position. Effects on hemodynamic parameters, sensory block and motor block characteristics and patient satisfaction were analysed.
Results:Induction position for spinal anaesthesia does not affect the hemodynamic parameters and incidence of adverse effects when adequate preloading is done. There was no statistically significant difference in the sensory level and motor level achieved. However lateral position appears to be more comfortable for elderly patients (P= 0.03).Conclusions: Induction position for administration of spinal anaesthesia has no effect on hemodynamic parameters or block characteristics except that patients feel more comfortable in lateral position.
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