Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2003
Meta AnalysisUse of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis.
Total hip or knee arthroplasty is associated with significant blood loss. Techniques such as the use of antifibrinolytics or desmopressin, or normovolaemic haemodilution have been used to reduce the need for allogeneic blood transfusion. Tranexamic acid has been used to reduce blood loss and transfusion requirement for total hip and knee arthroplasty, with variable results. ⋯ Tranexamic acid reduces the proportion of patients requiring allogeneic blood transfusion (OR 0.16, 95% CI: 0.09-0.26), total amount of blood loss (WMD 460 ml, 95% CI: 274-626 ml), and the total number of units of allogeneic blood transfused (WMD 0.85 unit, 95% CI: 0.36-1.33). Tranexamic acid does not increase the risk of thromboembolic complications such as deep vein thrombosis, pulmonary embolism, thrombotic cerebral vascular accident, or myocardial infarction (OR 0.98, 95% CI: 0.45-2.12). Intravenous tranexamic acid appears effective and safe in reducing allogeneic blood transfusion and blood loss in total hip and knee arthroplasty.
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Anaesth Intensive Care · Oct 2003
Randomized Controlled Trial Clinical TrialCorrelation and linear regression between blood pressure decreases after a test dose injection of propofol and that following anaesthesia induction.
Propofol reduces systemic vascular resistance and suppresses cardiac function when injected rapidly. In this study we investigated whether blood pressure decrease after a minimal dose (test-dose) injection of propofol correlates with that after an induction-dose injection. Patients were randomly divided into two groups; anaesthesia was induced in group A (n = 60) using 1.5 mg/kg propofol and in group B (n = 61) using 2.0 mg/kg. ⋯ In both groups, blood pressure after induction was significantly lower than the control value (P < 0.05). In both groups, a positive correlation was observed between blood pressure reduction after the minimal dose injection and that after the induction-dose injection [P < 0.01, R value for systolic blood pressure correlation in group A 0.712 (P < 0.01) and in group B 0.758 (P < 0.01)]. We concluded there was a positive correlation between blood pressure reduction after a minimal (test-dose) injection and that after an induction-dose injection.
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Anaesth Intensive Care · Oct 2003
Incident reporting in anaesthesia: a survey of practice in New Zealand.
A postal survey of anaesthetists practising in New Zealand assessed their practice and attitudes to anaesthetic incident reporting. 136 replies were received (57% response rate). Respondents indicated a high awareness of the Anaesthetic Incident Monitoring Study (AIMS) based incident monitoring yet individual utilization may be declining due to a perception that this system is ineffective. Seventy-five per cent of respondents used AIMS forms in their current institute, whilst 87% had at some time completed an AIMS form. ⋯ Almost half the anaesthetists felt that the AIMS reporting system had changed their practice. Common concerns with the system included a need to simplify the reporting process and to ensure that information is managed to provide a useful outcome. This study suggests that incident reporting in its present form needs to be re-evaluated in light of changing priorities in anaesthesia quality improvement activities.
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Anaesth Intensive Care · Oct 2003
Case ReportsInadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent.
Although cervical epidural steroid injection with local anaesthetic is considered a safe technique and widely practiced, complications may occur. We report a patient experiencing unexpected delayed high block, moderate hypotension and unconsciousness eight to ten minutes after an apparently normal cervical epidural steroid injection. ⋯ Anatomical peculiarities of the epidural and subdural space in the cervical region increase the risk of subdural spread during cervical epidural injection. Fluoroscopic guidance is important during cervical epidural injection to increase certainty of correct needle placement, thus minimizing the risk of complications.
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Anaesth Intensive Care · Oct 2003
Randomized Controlled Trial Comparative Study Clinical TrialParaesthesiae during needle-through-needle combined spinal epidural versus single-shot spinal for elective caesarean section.
The aim of this study was to compare the incidence of paraesthesiae during spinal needle insertion in a needle-through-needle combined spinal-epidural (CSE) versus a single-shot spinal (SSS) technique. Eighty-nine women presenting for elective caesarean section at a tertiary referral obstetric unit were randomized to receive either needle-through-needle CSE or SSS. Equipment used was a 16 gauge/26 gauge combined spinal-epidural kit and a 26 gauge pencil-point spinal needle with introducer (both Sims Portex, Australia) The presence and distribution of paraesthesiae was recorded by an observer at spinal needle insertion and again on day one postoperatively. ⋯ Seventeen of forty-six (37%) women in the needle-through-needle CSE group and four of forty-three (9%) in the SSS group had paraesthesiae upon spinal needle insertion (P < 0.05, Chi-squared test). No patient had persistent neurological symptoms at postoperative day one. We postulate that the higher incidence of paraesthesiae with needle-through-needle CSE may be related to deeper penetration of the subarachnoid space with this technique.