Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2009
Case ReportsA technique that may improve the reliability of endobronchial blocker positioning during adult one-lung anaesthesia.
We describe a novel technique, previously applied to small children, for adult one-lung anaesthesia in which a single-lumen endotracheal tube is used with an endobronchial balloon blocker The main aims of the technique are to reduce the likelihood of cephalad displacement of the balloon into the trachea and to facilitate directional placement of the endobronchial balloon. We present five illustrative cases of one-lung anaesthesia in patients of adult size, in which the endotracheal tube-endobronchial balloon technique was considered preferable to the use of a double-lumen tube technique. The situations included difficult intubation, need for postoperative ventilation, a tortuous trachea and an unexpected need to perform one-lung anaesthesia. The technique involved deliberate placement of the endotracheal tube tip near the carina to block cephalad dislodgement of the blocker The chance of the balloon blocking the endotracheal tube tip could be further reduced by having the intraluminal endobronchial balloon blocker emerge through the Murphy eye.
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Anaesth Intensive Care · Nov 2009
Incidence of contrast-induced nephropathy in intensive care patients undergoing computerised tomography and prevalence of risk factors.
Computerised tomography (CT) with contrast is frequently used in intensive care. Contrast-induced nephropathy (CIN) is an important complication largely studied in stable cardiology patients and can lead to acute renal failure. The aim of this study was to determine the incidence of CIN in an intensive care unit (ICU) setting and describe the prevalence of associated risk factors. ⋯ ICU and hospital length of stay was not significantly different in CIN positive and negative patients and persisting renal impairment was not found in CIN positive survivors. Based on this study, we cannot predict who will develop CIN in ICU using the described risk factors. Further prospective studies are needed to evaluate the incidence and outcomes of CIN in an ICU setting.
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Anaesth Intensive Care · Nov 2009
ReviewThe efficacy of landiolol for suppressing the hyperdynamic response following laryngoscopy and tracheal intubation: a systematic review.
Landiolol is a recently developed, selective short-acting beta1-antagonist. The aim of the study was to evaluate the efficacy of landiolol for suppressing haemodynamic changes induced by laryngoscopy and tracheal intubation (LTI) in Japanese patients. A comprehensive search was undertaken to identify all randomised comparisons of landiolol with placebo that examined effects on haemodynamic responses following LTI. ⋯ The other two studies used bolus administration of landiolol (0.1 to 0.3 mg/kg), but it was difficult to evaluate the efficacy because of the limited amount of data. Landiolol administration at 0.125 mg/kg/minute for one minute followed by 0.04 mg/kg/minute effectively suppresses the increases in heart rate and blood pressure following LTI. For a bolus regimen of landiolol, further studies are required to determine the efficacy and the optimal dose and timing for suppression of haemodynamic responses following LTI.
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Anaesth Intensive Care · Nov 2009
Randomized Controlled Trial Comparative StudyComparison of equipotent doses of ropivacaine-fentanyl and bupivacaine-fentanyl in spinal anaesthesia for lower abdominal surgery.
The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 microg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 microg (group R, n =26) or plain bupivacaine 13 mg with fentanyl 20 microg (group B, n =26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. ⋯ The duration of motor block (Bromage score >0) was shorter in group R (139+/-39 minutes vs group B 182+/-46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90+/-25 minutes vs 130+/-40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 microg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 microg for spinal anaesthesia in lower abdominal surgery.
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Anaesth Intensive Care · Nov 2009
Case ReportsRegional anaesthesia and analgesia on the front line.
Deployment to a combat zone with the military poses many challenges to the anaesthetist. One of these challenges is the safe, rapid and comfortable initial wound management and repatriation of wounded combat soldiers to their home country or tertiary treatment facility for definitive care and rehabilitation. The current conflict in Afghanistan is associated with injury patterns that differ from wars such as Vietnam or Korea. This report describes the experience of an Australian military anaesthetist and the value of regional anaesthesia and analgesia for the care of the wounded combat soldier