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The anaesthesiologist in the intensive care unit

机译：重症监护室的麻醉师

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This review focuses on recent knowledge in areas of anaesthesia expertise which are indispensable to intensive care unit management, including airway management, vascular access, regional analgesia and the treatment of status asthmaticus and status epilepticus.Etomidate as the sole agent for intubation in the intensive care unit has a 90% success rate, while in a prehospital setting, the addition of succinylcholine to etomidate results in a 99% success rate. In determining successful intubation, capnography and laryngoscopic/fibreoptic visualization are superior to auscultation, while auscultation is as effective as the self-inflating bulb or transillumination with the lightwand. The dorsalis pedis artery is an effective alternative to radial artery cannulation, while arterial cannulation itself can result in major adverse effects if complications arise. Ultrasound guidance in the placement of central catheters results in an improved insertion success rate. Internal jugular and subclavian lines have similar risk of haemothorax or pneumothorax, while subclavian lines are associated with the lowest incidence of infection. Midazolam, thiopentone and propofol have all been found to be efficacious in terminating refractory status epilepticus, with thiopentone resulting in a lower incidence of breakthrough seizures or treatment failure but an increased incidence of hypotension. Inhalational anaesthesia using isoflurane or desflurane has also been found to be successful in refractory status epilepticus. In the management of status asthmaticus, limiting minute volume while tolerating hypercapnia and acidosis as well as the use of inhalational anesthesia have proven effective strategies in a number of refractory cases.The anaesthesiologist's unique knowledge and skills are ideally suited to the practical management of patients in a critical care setting as well as in the treatment of the critical phases of many illnesses
机译：这篇综述着重介绍了麻醉专长领域不可缺少的麻醉专业知识，包括气道管理，血管通路，区域镇痛以及哮喘，癫痫持续状态的治疗。依托咪酯是重症监护中唯一插管剂该病房的成功率为90％，而在院前环境中，依托咪酯中加入琥珀胆碱的成功率为99％。在确定成功的插管过程中，二氧化碳图和喉镜/纤维化可视化效果优于听诊，而听诊的效果与自动充气灯泡或用电灯泡进行透照一样有效。足背动脉是radial动脉插管的有效替代方法，而如果发生并发症，动脉插管本身会导致严重的不良反应。中央导管放置中的超声引导可提高插入成功率。颈内和锁骨下线有相似的血胸或气胸风险，而锁骨下线与感染的发生率最低。已发现咪达唑仑，硫代戊酮和丙泊酚都可以有效终止癫痫发作的难治性状态，其中硫喷妥酮导致突破性癫痫发作或治疗失败的发生率降低，但低血压发生率增加。还发现使用异氟烷或地氟醚进行吸入麻醉在难治性癫痫持续状态中是成功的。在控制哮喘状态中，限制微小体积同时耐受高碳酸血症和酸中毒以及使用吸入麻醉已在许多难治性病例中被证明是有效的策略。麻醉师独特的知识和技能非常适合于患者的实际管理重症监护环境以及许多疾病关键阶段的治疗

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