Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2006
Randomized Controlled TrialBispectral index guided timing of intubation without neuromuscular blockade during sevoflurane induction of anaesthesia in adults.
The aim of this study was to assess the effectiveness of bispectral index monitoring (BIS) as a guide to the timing of intubation during sevoflurane induction of anaesthesia without the use of neuromuscular blocking agents in adults, and specifically, whether a target BIS value of 25 provides better intubating conditions than a target BIS of 40. Forty patients were randomized into one of two groups, a target BIS 25 (n =21) or a target BIS 40 (n =19). Patients received premedication with midazolam 20 microg/kg and fentanyl 0.5 microg/kg. ⋯ End-tidal sevoflurane concentration upon reaching the target BIS was higher in the BIS 25 group (5.3% +/- 1.2%) vs the BIS 40 group (3.5% +/- 0.95) (P<0.001). There was no statistical difference in haemodynamic parameters between groups. A target BIS value of 25 provides good to excellent intubating conditions and better intubating conditions than a target BIS of 40 during sevoflurane induction of anaesthesia without the use of neuromuscular blocking agents.
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Awareness is the spontaneous recall of an event(s) that occurred during general anaesthesia and surgery. The incidence of awareness is approximately 0.2% of cases where neuromuscular blockers are used and half that where they are omitted. ⋯ We report a case of awareness associated with an out-of-hospital transportation of a critically ill patient requiring a medical escort (retrieval). We discuss the risk factors associated with awareness during retrieval, in particular the trend toward excessive administration of neuromuscular blockers, and the unique challenges for the prevention of awareness within the retrieval environment.
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The aim of the current study was to assess the direct effect of protamine on conventional thrombelastography in vitro. Protamine was added to blood samples collected from 25 adult cardiac surgical patients prior to the induction of anaesthesia and after separation from cardiopulmonary bypass. The final protamine concentrations were 0 (control), 0.05 mg/ml, 0.1 mg/ml and 0.2 mg/ml (i.e. sufficient to reverse heparin 0, 5, 10 and 20 IU/ml respectively, assuming a 1:1 reversal ratio). ⋯ The results indicate that protamine has a direct anticoagulant effect on conventional thrombelastography in vitro. This effect occurs whether protamine is present alone, or whether protamine is present in excess after neutralization of heparin. Unless this effect is taken into account, excess protamine may confound the interpretation of conventional thrombelastography in cardiac surgical patients.
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Anaesth Intensive Care · Oct 2006
Case ReportsSalmon calcitonin in the treatment of post herpetic neuralgia.
A 78-year-old man with severe chronic obstructive pulmonary disease presented to our pain medicine clinic for treatment of post herpetic neuralgia. Pharmacotherapy with tricyclic antidepressants, anticonvulsants, tramadol and traditional analgesics had failed, primarily due to adverse drug effects, particularly sedation, dizziness and nausea. Consequently, intravenous salmon calcitonin was administered, based on evidence of efficacy in the treatment of other neuropathic pain syndromes and its relatively benign side-effects profile. The patient reported immediate and sustained improvement in his post herpetic neuralgia for over two months, without adverse effects from the calcitonin therapy.
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Anaesth Intensive Care · Oct 2006
Randomized Controlled Trial Comparative StudyA comparison of 5% dextrose in 0.9% normal saline versus non-dextrose-containing crystalloids as the initial intravenous replacement fluid in elective surgery.
Intravenous fluid replacement in adult elective surgery is often initiated with dextrose-containing fluids. We sought to determine if this practice resulted in significant hyperglycaemia and if there was a risk of hypoglycaemia if non-dextrose-containing crystalloids were used instead. We conducted a randomized controlled trial in 50 non-diabetic adult patients undergoing elective surgery which did not involve entry into major body cavities, large fluid shifts, or require administration of >500 ml of intravenous fluid in the first two hours of peri-operative care. ⋯ There was no significant difference in plasma glucose between the groups at one hour after infusion, but 33% of patients receiving DS had plasma glucose > or = 8 mmol/l. We conclude that initiation of intravenous fluid replacement with dextrose-containing solutions is not required to prevent hypoglycaemia in elective surgery. On the contrary, a relatively small volume of 500 ml causes significant, albeit transient, hyperglycaemia, even in non-diabetic patients.