Anaesthesia and intensive care
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Anaesth Intensive Care · May 2008
Randomized Controlled Trial Comparative StudyHaemodynamic and Bispectral index response to insertion of the Streamlined Liner of the Pharynx Airway (SLIPA): comparison with the laryngeal mask airway.
The newly developed supralaryngeal airway Streamlined Liner of the Pharynx Airway (SLIPA) has been compared successfully to the LMA, but the haemodynamic response to its insertion has not been evaluated in a randomised study. We compared haemodynamic and Bispectral index (BIS) responses to insertion of the SLIPA with classic LMA after standardising the anaesthetic technique using BIS to monitor and control the anaesthetic depth. One hundred patients were randomised to receive either a classic LMA or SLIPA following induction with fentanyl and propofol titrated to a target BIS of 40 and compared heart rate, mean arterial pressure and BIS responses to insertion. ⋯ BIS increased significantly (P<0.05) at one, two, three, four and five minutes following insertion of both the devices, but there was no significant difference between the groups. There was a significantly higher (P=0.001) incidence of blood on the device with the SLIPA (20/50 vs. 6/50 with LMA). Thus, insertion of SLIPA causes significantly higher blood-pressure response but similar BIS response compared to the LMA.
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Anaesth Intensive Care · May 2008
The effect of aprotinin on risk of acute renal failure requiring dialysis after on-pump cardiac surgery.
The use of aprotinin in cardiac surgery to reduce perioperative bleeding and transfusion is controversial. We assessed the effect of aprotinin on the risk of acute renal failure in 423 patients who underwent on-pump cardiac surgery between January 1, 2005 and December 31, 2006. Of these 423 patients, 318 (75.2%) received aprotinin (median dose=3.0 million KIU, standard deviation=2.8 million KIU; interquartile range: 2 million KIU to 4 million KIU). ⋯ The use of aprotinin was not associated with a reduction in transfusion nor an increased risk of renal failure requiring dialysis, atrial fibrillation, cerebrovascular accident or mortality in the univarate analyses. In the multivariate analysis, only preoperative serum creatinine concentration (odds ratio [OR] 1.06 per 10 micromol/l increment in creatinine, 95% confidence interval [CI]: 1.01 to 1.14, P=0.029) and urgency of the surgery (urgent vs. scheduled surgery: OR 12.8, CI: 2.3 to 70.8, P=0.004; emergency vs. scheduled surgery: OR 23.1, CI: 3.0 to 180.2, P=0.003) were significantly associated with an increased risk of acute renal failure requiring dialysis. The use of low-dose aprotinin did not significantly reduce perioperative transfusion requirements and was not a significant risk factor for acute renal failure requiring dialysis in our patients.
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Anaesth Intensive Care · May 2008
Risk factors for treatment failure in patients with severe acute cardiogenic pulmonary oedema.
Intubation is necessary in 7 to 20% of patients with severe acute cardiogenic pulmonary oedema despite optimal treatment. This study evaluated the usefulness of parameters largely available in clinical practice to predict the need for intubation in a population of acute cardiogenic pulmonary oedema patients treated with medical therapy and continuous positive airway pressure. The present retrospective cohort study involved 142 patients with severe acute cardiogenic pulmonary oedema who were admitted to coronary care or the intensive care unit of a university hospital and were treated by an in-hospital protocol. ⋯ The rate of intubation according to this score ranged from 0% (score of 0) to 90% (score of 3). Our study found that simple parameters available in clinical practice are significantly associated with the need for intubation in acute cardiogenic pulmonary oedema patients treated with continuous positive airway pressure and medical therapy. A simple score to evaluate the need for endotracheal intubation is proposed.