Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialEarly and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children.
This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. ⋯ Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.
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Anaesth Intensive Care · Oct 2004
Review Case ReportsSuccessful use of ECMO in adults with life-threatening infections.
Two cases of critically ill patients who received extracorporeal membrane oxygenation (ECMO) using different forms of circuitry and for different indications are presented. Both patients had life-threatening infections with septic shock and were not able to be supported by conventional means. ⋯ The second patient had psittacosis and received venovenous ECMO for respiratory failure. We discuss the expanding indications for this technology and the role it has to play in adult intensive care.
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Anaesth Intensive Care · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialEffect of metoclopramide on pain on injection of propofol.
We undertook a randomized, double-blind, placebo-controlled study to examine the efficacy of metoclopramide at three different doses (2.5 mg, 5 mg, 10 mg) for reducing pain on injection of propofol in 100 patients scheduled for elective surgery. Patients received intravenously the study drug, with venous occlusion for one minute, followed by propofol 2 mg/kg into a dorsal hand vein. ⋯ No difference between metoclopramide 2.5 mg and the placebo groups was found. We conclude that pretreatment of a dorsal hand vein with metoclopramide in a dose of 5 or 10 mg, with venous occlusion for one minute, effectively decreases the incidence of pain caused by propofol injection.
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Anaesth Intensive Care · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialPain during injection of propofol: the effect of prior administration of ephedrine.
Propofol causes pain on intravenous injection in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. In a randomized, double-blind, placebo-controlled trial, we compared the efficacy of ephedrine 30 microg/kg pretreatment to lignocaine 40 mg for prevention of propofol-induced pain. ⋯ In the lignocaine group, propofol-induced pain was observed in only 13 (42%) when compared with other study groups (P<0.05). Pretreatment with ephedrine 30 microg/kg did not attenuate pain associated with intravenous injection of propofol, nor did it improve haemodynamic stability during induction. However, pretreatment with 2% lignocaine (40 mg) was effective in attenuating propofol-associated pain.
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Anaesth Intensive Care · Oct 2004
Multicenter Study Comparative StudyThe use of end-tidal carbon dioxide monitoring to confirm endotracheal tube placement in adult and paediatric intensive care units in Australia and New Zealand.
The use of end-tidal carbon dioxide monitoring to assist in confirming endotracheal tube placement is currently not mandatory in intensive care units (ICUs) in Australia and New Zealand. Early detection of failed tracheal intubation is vital to optimize management and to prevent complications. Questionnaires were sent to the lead clinician/head of department of all 66 intensive care units approved for training purposes by the Joint Faculty of Intensive Care Medicine in Australia and New Zealand. ⋯ Thirty-eight respondents (62.3%) thought that end-tidal carbon dioxide monitoring should be mandatory to confirm tracheal intubation in the intensive care unit. If it were available, 42 respondents (68.8%) would use end-tidal carbon dioxide monitoring for confirmation of every intubation. Mandatory end-tidal carbon dioxide confirmation of endotracheal tube placement was policy in 33 (54.1%) of the intensive care units.