Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2003
Randomized Controlled Trial Comparative Study Clinical TrialThe prevention of pain from injection of rocuronium by magnesium sulphate, lignocaine, sodium bicarbonate and alfentanil.
We compared the efficacy of magnesium sulphate, lignocaine, sodium bicarbonate or alfentanil in minimizing pain due to injection of rocuronium in 250 patients. After tourniquet application on the forearm, the patients were given saline, magnesium sulphate, lignocaine, sodium bicarbonate 8.4% or alfentanil, diluted into a 3 ml solution. The occlusion was released after 20 seconds, and rocuronium was injected over 10 to 15 seconds. ⋯ Reactions such as discomfort and pain, withdrawal of the hand and screaming after the administering of the rocuronium were recorded as side-effects and patients were reassessed at 24 hours postoperatively. We concluded that magnesium sulphate, lignocaine, sodium bicarbonate or alfentanil decreased the level of rocuronium injection pain. Of these drugs, magnesium sulphate, lignocaine and sodium bicarbonate were the most effective while alfentanil was the least effective.
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Anaesth Intensive Care · Jun 2003
Randomized Controlled Trial Clinical TrialLack of effect of prophylactic N-acetylcysteine on postoperative organ dysfunction following major abdominal tumour surgery: a randomized, placebo-controlled, double-blinded clinical trial.
Sepsis and respiratory dysfunction leading to multiple system organ failure remains the leading cause of postoperative morbidity and mortality following major surgical procedures. It has been suggested the oxygen free radicals might play a pivotal role in this process. The aim of this study was to investigate whether short-term infusion of N-acetylcysteine (N-acetylcysteine), a potent antioxidant, administered before and during extensive abdominal surgery, could ameliorate the progression of early postoperative organ dysfunction and improve oxygenation. ⋯ For statistical analysis Mann-Whitney U and Chi-squared tests were used. There was no significant difference between the two groups in any of the six organ dysfunction parameters, length of intensive care stay, days of mechanical ventilation and mortality. Our results do not support the routine use of N-acetylcysteine as a prophylactic measure during surgery, and reinforce previous evidence which challenges the indication of N-acetylcysteine in the critically ill.
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Anaesth Intensive Care · Jun 2003
Comparative StudyA comparison of the ProSeal and classic laryngeal mask airways for airway management by inexperienced personnel after manikin-only training.
We compared the ProSeal (PLMA) and Classic (LMA) laryngeal mask airway for airway management by inexperienced personnel. Nine nurses from the post-anaesthesia care unit, with no prior experience of LMA or PLMA insertion, were observed inserting the LMA and PLMA in 60 ASA 1 to 2 anaesthetized, paralyzed adults following manikin-only training. The time to achieve an effective airway (2 consecutive expired tidal volumes (6 ml/kg; maximum 2 minutes allowed), the number of insertion attempts and the reasons for failure (inability to insert into pharynx or inadequate ventilation) were determined by analysis of digital video recordings. ⋯ Failure of both devices occurred in four patients. We conclude that airway management in anaesthetized, paralyzed adults is equally successful for the LMA and PLMA by inexperienced personnel following manikin-only training. The PLMA is worthy of consideration as a tool for emergency airway management by inexperienced personnel.
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Anaesth Intensive Care · Jun 2003
The role of anaesthetists in the Darwin response to the Bali bombing.
The bombing of nightclubs in Bali on the night of October 12, 2002 was one of the worst peacetime disasters affecting Australians. This paper examines the unique role of anaesthetists in helping manage the victims, with the main emphasis on events in Darwin. Anaesthetists were involved in the multiple stages of patient care; from the hospital in Bali, evacuation to Darwin, resuscitation and onward evacuation to burns units around Australia as well as definitive surgical management. We discuss the role of anaesthetists in disaster management.
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Anaesth Intensive Care · Jun 2003
The incidence and immediate respiratory consequences of pulmonary aspiration of enteral feed as detected using a modified glucose oxidase test.
Pulmonary micro-aspiration of enteral feed in intubated critically ill patients has been reported to occur commonly. In this prospective observational study the incidence of micro-aspiration, diagnosed by a modified glucose oxidase test, is reported in 25 enterally fed critically ill and tracheally intubated patients on a general intensive care unit. Episodes of microaspiration were correlated with changes in PaO2/FiO2 ratio as an index of changes in degree of lung injury. ⋯ Aspiration was associated with a mean fall in the PaO2/FiO2 ratio of 5.6 kPa from 27.1 kPa to 21.5 kPa (P = 0.002). Aspiration of enteral feed is common and causes a demonstrable morbidity. Detection using this simple bedside test may alert the clinician to institute measures to minimize further aspiration.