Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2008
Analgesic efficacy using loss of resistance to air vs. saline in combined spinal epidural technique for labour analgesia.
Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. ⋯ However patients in the air group had a higher incidence of recurrent breakthrough pain P = 0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.
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Anaesth Intensive Care · Sep 2008
Meta AnalysisUse of isotonic sodium bicarbonate to prevent radiocontrast nephropathy in patients with mild pre-existing renal impairment: a meta-analysis.
Acute renal dysfunction after radiocontrast in patients with pre-existing renal impairment is not uncommon and is associated with significant morbidity and mortality. Isotonic sodium bicarbonate solution was first reported to reduce radiocontrast nephropathy in 2004. This first study was, however; limited by its small sample size and as such, the use of isotonic sodium bicarbonate to prevent radiocontrast nephropathy is still not widely used by many anaesthetists and intensivists. ⋯ The incidence of acute renal failure requiring dialysis was low (1.4%) and was not significantly different after the use of isotonic sodium bicarbonate (relative risk 0.59, 95% CI: 0.15 to 2.42, P = 0.47; F = 0%). With the limited data available, isotonic sodium bicarbonate appears to be safe and very effective in reducing radiocontrast nephropathy in patients with mild pre-existing renal impairment. A large randomised controlled study is needed to confirm whether isotonic bicarbonate can improve patient centred clinical outcomes.
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Anaesth Intensive Care · Sep 2008
Case ReportsAnterior ultrasound-guided superior hypogastric plexus neurolysis in pelvic cancer pain.
The hypogastric plexus block is classically performed by a posterior approach, but there are recent reports of a computed tomography-guided anterior approach for patients who have difficult access to the hypogastric plexus by the posterior approach. We present two patients who were successfully given ultrasound-guided superior hypogastric plexus block by an anterior approach. ⋯ We believe this block can be useful in cancer patients who are having difficulty in lying prone, because it is a bedside procedure performed in the supine position and it is less time-consuming. It also avoids the radiation exposure involved with a computed tomography-guided anterior approach.
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Anaesth Intensive Care · Sep 2008
Antimicrobial effects of two anaesthetic agents: dexmedetomidine and midazolam.
Some anaesthetic agents are known to inhibit microbial growth. The aim of this in vitro study was to investigate possible antimicrobial effects of two frequently used agents in intensive care units, dexmedetomidine and midazolam. Antimicrobial effect was tested on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Pseudomonas aeruginosa by broth microdilution method. ⋯ Midazolam had inhibitor and bactericidal effects on S. aureus and E. faecalis. Dexmedetomidine had only inhibitor effects on S. aureus, E. coli and P aeruginosa. Further studies are needed to determine the antimicrobial mechanisms and clinical applications.
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Anaesth Intensive Care · Sep 2008
Glomerular hyperfiltration and albuminuria in critically ill patients.
Glomerular hyperfiltration and albuminuria are two pathological conditions that could alter renal drug elimination, but they have been rarely studied in a critical care setting. The aims of this descriptive, prospective study performed on 89 critically ill patients are to determine rates of glomerular hyperfiltration (main objective) and albuminuria (secondary objective). ⋯ Seventy-five percent showed albuminuria on admission, with rates remaining high throughout the week of the study. Since glomerular hyperfiltration as well as albuminuria are frequent pathophysiological conditions in critical care patients, the implications that these phenomena may have regarding drug elimination need further evaluation.