Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2007
Case ReportsAnaesthesia for robotic-assisted radical prostatectomy: considerations for laparoscopy in the Trendelenburg position.
Two cases of anaesthetic complications after robotic-assisted laparoscopic radical prostatectomy using the da Vinci Remote-Controlled Surgical System are presented. Case 1 describes a patient with post-extubation respiratory distress requiring re-intubation and subsequent ventilation in an intensive care unit. ⋯ Case 2 describes a patient with mild brachial plexus neurapraxia, which was most likely due to compression by shoulder braces (to prevent cephalad sliding) during the exaggerated head-down tilt. For this procedure, the authors recommend limiting the duration and extent of head-down tilt as much as possible, avoiding excessive intravenous fluids and careful positioning of the patient with avoidance of shoulder braces whenever possible.
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Anaesth Intensive Care · Apr 2007
Case ReportsPneumothorax in association with spontaneous ventilation general anaesthesia--an unusual cause of hypoxaemia.
A 43-year-old ASA PS II male patient developed a pneumothorax while breathing pontaneously through a supraglottic airway device during a general anaesthetic. Unexplained hypoxaemia occurred after an episode of coughing. ⋯ The pneumothorax responded to conventional management and the patient made an uneventful recovery. We recommend a high index of suspicion in any patient who coughs and later has unexplained hypoxaemia during general anaesthesia, even if a supraglottic airway device has been inserted.
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Anaesth Intensive Care · Apr 2007
Comparative StudyAcid-base and bio-energetics during balanced versus unbalanced normovolaemic haemodilution.
Fluids balanced to avoid acid-base disturbances may be preferable to saline, which causes metabolic acidosis in high volume. We evaluated acid-base and bio-energetic effects of haemodilution with a crystalloid balanced on physical chemical principles, versus crystalloids causing metabolic acidosis or metabolic alkalosis. Anaesthetised, mechanically ventilated Sprague-Dawley rats (n=32, allocated to four groups) underwent six exchanges of 9 ml crystalloid for 3 ml blood. ⋯ In this group mean kidney ATP concentration was significantly less than controls and renal energy charge significantly lower than SID 0 mEq/l and control groups. We conclude that a crystalloid SID of 24 mEq/l provides balanced haemodilution. Bio-energetic perturbations with higher SID haemodilution may be more severe and need further investigation.
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We describe a technique for using a portable ultrasound scanner (38 mm broadband (10-5 MHz) linear array transducer (Sonosite Titan SonoSite, Inc. 21919 30th Drive SE Bothell, WA.)) to guide dorsal penile nerve block in children under general anaesthesia. Real-time scanning is used to guide bilateral injections into the sub-pubic space, deep to Scarpa's fascia either side of the midline fundiform ligament. Scanning can confirm that the local anaesthetic has spread to contact the deep fascia on each side. A subcutaneous wheal of local anaesthetic along the penoscrotal junction completes the block.
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Anaesth Intensive Care · Apr 2007
The cardiovascular effects of adrenaline, dobutamine and milrinone in rabbits using pressure-volume loops and guinea pig isolated atrial tissue.
This study evaluated the effects of milrinone, adrenaline and dobutamine with pressure-volume loops and isolated atrial tissue. Agonist dose-response curves to incremental drug infusions were acquired in 11 anesthetised rabbits using pressure-volume loops and preload recruitable stroke work indicated contractility. Agonist concentration-response curves were completed in eight guinea pig isolated atria, for effects on atrial rate and force. ⋯ Adrenaline decreased heart rate (P < 0.001), whereas dobutamine and milrinone increased it (P = 0.006 and 0.011). Milrinone increased the force of left atrial contraction, but its inotropic effect was weak and significantly less than with dobutamine and adrenaline (P < 0.001). Adrenaline acted as an inoconstrictor, dobutamine an inodilator and milrinone predominantly a vasodilator