Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2006
The margin of safety of a left double-lumen tracheobronchial tube depends on the length of the bronchial cuff and tip.
The left tracheobronchial double-lumen tube is the commonest device to separate the left and right lungs for differential ventilation. With the appropriate tube, the left bronchial cuff is positioned in the bronchus so that the cuff is beyond the carina but the tip of the tube does not occlude the aperture of the left upper lobe bronchus. The difference between the length of the left main bronchus and the length of the cuff and tip of the bronchial segment of the tube has been termed "the margin of safety" by Benumof. ⋯ There was also a marked variation in cuff-tip lengths of the same size tube from the same manufacturer. The largest variation was 18 mm for the Portex 41 but substantial variation of 8 mm or more was found in at least one French size of all manufacturers. Users must be aware that significant cuff-tip length variation occurs and match the selected tube to the patient to ensure an adequate margin of safety.
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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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Propofol is widely used for sedation in critically ill patients. Several adult patients, all with acute neurological disorders, have been reported suffering from propofol infusion syndrome, which occurs in patients receiving high-dose propofol and catecholamines and/or steroids. We present a case of a septic patient without neurological illness who developed propofol infusion syndrome.
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Anaesth Intensive Care · Oct 2006
Association of obesity with increased mortality in the critically ill patient.
The impact of obesity on critical care outcomes has been an issue for debate in the literature. Variable data and conflicting results have been reported. The purpose of our study is to examine the impact of obesity on the outcome of patients admitted to a tertiary closed Intensive Care Unit (ICU) in Saudi Arabia. ⋯ In conclusion, mortality of obese critically ill patients was not higher than patients with normal weight. In fact, the hospital mortality was lower for patients with BMI >40 kg/m2 compared to the normal BMI group despite similar severity of illness. Obesity might have a protective effect, although further studies are needed to substantiate this finding.
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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.