Hypotension and vasoconstrictors
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Successful treatment of traumatic spinal epidural haematoma with fluoroscopically-guided percutaneous drainage: a report of two cases
We report two cases of spinal epidural haematoma that were successfully treated with percutaneous drainage. The patients initially presented with severe backache and progressive neurological symptoms due to traumatic epidural haematoma. After fluoroscopically-guided percutaneous drainage and irrigation, rapid physical decompression and full recovery was observed in both patients. To the best of our knowledge, this is the first report indicating that traumatic spinal epidural haematoma can be successfully treated with fluoroscopically-guided percutaneous drainage. Because percutaneous puncture under fluoroscopy is less inva...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Comparison of bioreactance non-invasive cardiac output measurements with cardiac magnetic resonance imaging
Impedance cardiography measurement of cardiac output gained wide interest due to its ease of use and non-invasiveness. However, validation studies of different algorithms yielded diverging results. Bioreactance (BR) as a recent adaption differs fundamentally as the flow signal is derived from phase shifts. Our aim was to assess the accuracy and reproducibility of BR, as compared to the non-invasive gold standard —cardiac magnetic resonance imaging (CMR). We prospectively included 32 stable patients. BR was performed twice in the supine position and averaged over 30 seconds. Mean bias was 0.2 ± 1.8 l/minute (1 ± 28%, ...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Sequencing of genes involved in the movement of calcium across human skeletal muscle sarcoplasmic reticulum: continuing the search for genes associated with malignant hyperthermia
The genetic basis of malignant hyperthermia (MH) is not fully characterised and likely involves more than just the currently classified mutations in the gene encoding the skeletal muscle ryanodine receptor (RYR1) and the gene encoding the α1 subunit of the dihydropyridine receptor (CACNA1S). In this paper we sequence other genes involved in calcium trafficking within skeletal muscle in patients with positive in vitro contracture tests, searching for alternative genes associated with MH. We identified four rare variants in four different genes (CACNB1, CASQ1, SERCA1 andCASQ2) encoding proteins involved in calcium handling ...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Safety of nicotine replacement therapy in critically ill smokers: a retrospective cohort study
The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT. The groups were case-matched for sex, age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was administration of antipsychotic medication. Secondary outcomes included use of physical restraints, 30-day mortality, and ventilation r...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Defining a reference range for vital signs in healthy term pregnant women undergoing caesarean section
This study defined a reference range for vital signs in healthy term pregnant women undergoing CS. Study findings suggest that currently used criteria for EWS triggers, based on non-pregnant values, may be too extreme for timely detection of deteriorating p regnant patients. Further research examining the modified HR triggers of ≤50 and ≥110 /minute in pregnant women and their relationship to clinical outcomes is required. (Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Comparison of kinemyography and electromyography during spontaneous recovery from non-depolarising neuromuscular blockade
This study compared two commercially available quantitative neuromuscular function monitoring techniques, kinemyography (KMG) and electromyography (EMG), to assess whether KMG could be used interchangeably with EMG to exclude residual neuromuscular blockade (RNMB). Train-of-four (TOF) ratios were recorded every 20 seconds using KMG at the adductor pollicis and EMG at the first dorsal interosseous of the same hand during spontaneous recovery from shallow neuromuscular blockade. TOF ratios were compared using Bland –Altman analysis for repeated measurements. The precision of each device was assessed by the repeatability co...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Accuracy of dispersing tramadol capsules for oral administration in young children
Tramadol is used in children aged (Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Improved hospital mortality with a low MET dose: the importance of a modified early warning score and communication tool
Rapid response systems have been mandated for the recognition and management of the deteriorating patient. Increasing medical emergency team (MET) dose may be associated with improved outcomes. Large numbers of MET calls may divert resources from the program providing the service unless additional personnel are provided. To describe the implementation and outcomes of a multifaceted rapid response system (RRS) in a teaching hospital, we conducted an observational study. The RRS consisted of the introduction of a MET together with 1) redesign of the ward observation chart with the vital sign variables colour-coded to identif...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
The effect of dabigatran on the kaolin-activated whole blood thromboelastogram
This study examines whether there is a consistent effect of dabigatran on the thromboelastogram (TEG) and whether this correlates with the effects of dabigatran on traditional coagulation parameters. Twenty patients taking dabigatran had blood sampled for kaolin-activated whole blood TEG analysis and routine coagulation testing. There was a statistically significant correlation between thrombin clotting time (TCT) and R-time (R=0.77,P=0.0001) and between activated partial thromboplastin time (APTT) and R-time (R=0.68,P=0.0013), but not between TCT and alpha-angle (R= -0.4232,P=0.071). Despite the moderate to high correlati...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Balancing the risks and benefits of using emergency diagnostic radiocontrast studies to diagnose life-threatening illness in critically ill patients: a decision analysis
Diagnosis of many life-threatening illnesses, including acute pulmonary embolism, aortic dissection, and ischaemic bowel disease, requires confirmatory radiological imaging with radiocontrast. It is well established that radiocontrast can induce acute kidney injury, especially in patients with pre-existing renal impairment. The decision to proceed with a radiological study with radiocontrast to confirm or exclude a life-threatening, but potentially reversible, illness in patients with renal impairment is difficult. Theoretically, a radiocontrast study will be justifiable provided its benefits outweigh its harms. Using publ...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
A comparative study of tracheal diameter in Caucasian and Chinese patients
Ethnicity may be considered a factor when considering what size endotracheal tube to insert. In particular it has been suggested that Chinese patients have a smaller tracheal diameter, justifying the selection of smaller endotracheal tubes. We systematically evaluated transverse tracheal diameters in Chinese and Caucasian patients, utilising archived computer tomography images. A convenience sample of 100 Caucasian patients from Australia was compared with 100 Chinese patients from Hong Kong. Patients over 18 years of age who had undergone a computerised tomography scan of the neck and thorax, and also had accurate body he...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Bow-tie diagrams for risk management in anaesthesia
Bow-tie analysis is a risk analysis and management tool that has been readily adopted into routine practice in many high reliability industries such as engineering, aviation and emergency services. However, it has received little exposure so far in healthcare. Nevertheless, its simplicity, versatility, and pictorial display may have benefits for the analysis of a range of healthcare risks, including complex and multiple risks and their interactions. Bow-tie diagrams are a combination of a fault tree and an event tree, which when combined take the shape of a bow tie. Central to bow-tie methodology is the concept of an undes...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Can femoral venous pressure be used as an estimate for standard vesical intra-abdominal pressure measurement?
Intra-abdominal hypertension (IAH) is highly prevalent in critically ill patients admitted to the intensive care unit and is associated with an increased morbidity and mortality. The present study investigated whether femoral venous pressure (FVP) can be used as a surrogate parameter for intra-abdominal pressure (IAP) measured via the bladder in IAH grade II (IAP20 mmHg with new onset organ failure) in two (18%) with all-cause study mortality of 18%. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21 ± 5, Simplified Acute Physiology (SAPS 2) score 49 ± 8, and Sequential Organ Failure Assessm...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
Driving impairment due to propofol at effect-site concentrations relevant after short propofol-only sedation
Australian guidelines state “Following brief surgery or procedures with short acting anaesthetic drugs, the patient may be fit to drive after a normal night’s sleep. After long surgery or procedures requiring longer lasting anaesthesia, it may not be safe to drive for 24 hours or more”. The increasing use of the short-ac ting anaesthetic drug propofol as a solitary sedative medication for simple endoscopy procedures suggests a need to review this blanket policy. Thirty patients presenting for elective day surgery were recruited as volunteers for a pre-procedure driving simulation study and randomised to propofol or p...
Source: Anaesthesia and Intensive Care - November 10, 2016 Category: Anesthesiology Source Type: research
