Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2007
Perioperative complications in patients with drug-eluting stents: a three-year audit at Geelong Hospital.
Drug-eluting stents are a recommended treatment for lesions in the coronary arteries. Stent insertion requires the patient remain on anti-platelet medication for a minimum of six months after insertion. A serious consequence of ceasing anti-platelet medication is late stent thrombosis leading to myocardial infarction in the territory of the drug-eluting stent. ⋯ The risk of myocardial infarction when clopidogrel is stopped prior to surgery is 20%, if alternative anti-thrombotic prophylaxis is not used. This risk persists beyond one year after insertion of drug-eluting stents. Some treatments appear to be effective in reducing the risk of myocardial infarction.
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Anaesth Intensive Care · Dec 2007
Propofol-induced changes in myoplasmic calcium concentrations in cultured human skeletal muscles from RYR1 mutation carriers.
Malignant hyperthermia is a pharmacogenetic disorder caused by autosomal dominant mutations in the ryanodine receptor type 1 gene. Propofol has been reported as a safe anaesthetic for malignant hyperthermia susceptible patients but has not been tested on cultured cells from patients with the ryanodine receptor type 1 mutation. The aim of this study was to determine whether propofol could trigger abnormal calcium fluxes in human myotubes isolated from malignant hyperthermia susceptible patients harbouring the native ryanodine receptor type 1 mutation. ⋯ The half-maximal activation concentrations (EC50) for propofol from patients 1 and 2 were 181.1 and 420.5 microM, respectively. Increases in calcium concentrations in response to propofol dosage were limited to doses at least 100-fold greater than those used in clinical settings. These observations correlate well with clinical observations that propofol does not trigger malignant hyperthermia in susceptible humans.
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Anaesth Intensive Care · Dec 2007
Randomized Controlled TrialA modified fascia iliaca compartment block has significant morphine-sparing effect after total hip arthroplasty.
We assessed whether a modified fascia iliaca compartment block in unilateral total hip arthroplasty provides a morphine-sparing effect in the first 24 hours. This involved a randomised, double blind study of 44 patients. Both groups received a modified fascia iliaca block with the trial group receiving 30 ml 0.5% bupivacaine with 1:200,000 adrenaline, 150 microg clonidine and 9 ml 0.9% saline and the control group receiving 40 ml 0.9% saline. ⋯ The median morphine usage at 24 hours was 37.5 mg in the control patients and 22 mg in the trial patients. Pain scores were similar between groups. We conclude that a modified fascia iliaca compartment block has a significant morphine-sparing effect in unilateral total hip arthroplasty.
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Anaesth Intensive Care · Dec 2007
ReviewDrug abuse and dependency during pregnancy: anaesthetic issues.
Drug abuse is a significant social problem that can lead to serious obstetric complications, some of which may be confused with pregnancy-related disease states. Substance abuse poses a number of challenges with respect to the management of pain and the conduct of anaesthesia in the peripartum period. This review was based on information from a literature search of epidemiological, research and review papers on substance abuse during pregnancy, obtained for the purpose of preparing a background paper for the Ministerial Council on Drug Strategy, Commonwealth Government of Australia. ⋯ A multidisciplinary approach will involve obstetricians, anaesthetists and staff of the Drug and Alcohol Service. In acute admissions of women by whom antenatal care was not accessed, a high index of suspicion for illicit drug use should arise. Because illicit substance use is so prevalent, if untoward reactions occur during an otherwise uneventful anaesthetic, the possibility of drug abuse should be considered.
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Anaesth Intensive Care · Dec 2007
Clinical TrialThe influence of head rotation on ProSeal laryngeal mask airway sealing during paediatric myringotomy.
Myringotomy with ventilation tube insertion in children involves turning the head from neutral to allow surgical access to the ear. In adults, rotation of the head from the mid-line generally increases the oropharyngeal leak pressure when a ProSeal laryngeal mask airway (PLMA) is used to manage the airway. There are concerns that these manoeuvres may distort or obstruct the paediatric airway. ⋯ Only 7% (2 of 29) of subjects had a decrease in oropharyngeal leak pressure with head rotation, the maximum decrease being 2 cmH2O. Airway obstruction did not occur in any of the positions. We conclude that the efficacy of the seal for the pediatric sizes PLMA is improved by head rotation for myringotomy.