Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2009
Multicenter StudyUsers' opinions on intensive care unit alarms--a survey of German intensive care units.
Monitoring of physiologic parameters in critically ill patients is associated with an enormous number of alarms, leading to reduced clinical value with high sensitivity but low specificity. To evaluate opinions of intensive care unit (ICU) staff on current monitoring we conducted a survey of German ICUs. Furthermore, the survey aimed to assess requirements and requests for future alarm systems. ⋯ Free text commentaries focused on the need for reducing alarms caused by artefacts and called for improvement of the monitor-user interfaces. Our survey demonstrates the dissatisfaction of clinical staff with the current alarm systems regarding alarm frequency and specificity in German ICUs, thereby confirming data raised in single institutions. ICU staff's acceptance for new alarm algorithms like signal extraction or detection of trends as a basis for smart monitoring appealed to the majority of users.
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Anaesth Intensive Care · Jan 2009
Randomized Controlled TrialA prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa.
The direct visualisation of nerves and adjacent anatomical structures may make ultrasonography the preferred method for nerve localisation. In this prospective randomised study, we investigated whether, for distal sciatic nerve block in the popliteal fossa, an ultrasound guided technique would result in the use of less local anaesthetic without changing block characteristics and quality. Using electrical nerve stimulation or ultrasound guidance, the nerve was identified in two groups of 20 patients scheduled for lower limb surgery. ⋯ The attending anaesthesiologist assessed the injected volume. Significantly less local anaesthetic was injected in the ultrasound group compared to the nerve stimulation group (17 vs. 37 ml, P < 0.001), while the overall success rate was increased (100% vs. 75%; P = 0.017). We conclude that the use of ultrasound localisation for distal sciatic nerve block in the popliteal fossa reduces the required dose of local anaesthetic significantly, and is associated with a higher success rate compared to nerve stimulation without changing block characteristics.
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Anaesth Intensive Care · Jan 2009
Randomized Controlled Trial Comparative StudyComparison of computer-integrated patient-controlled epidural analgesia and patient-controlled epidural analgesia with a basal infusion for labour and delivery.
Computer-integrated patient-controlled epidural analgesia (CIPCEA) is a novel epidural drug delivery system. It automatically adjusts the background infusion based on the individual parturient's need for analgesia as labour progresses. In this randomised controlled trial, we compared the local anaesthetic consumption by parturients using either CIPCEA or patient-controlled epidural analgesia with a moderate basal infusion (PCEABI) of 5 ml/hour. ⋯ The CIPCEA group had a higher infusion rate during the second stage of labour (mean (SD) 7.0 (4.1) ml/hour vs. 4.5 (1.5) ml/hour P = 0.008), but did not have a longer duration of this stage. There were no differences between the groups in obstetric or foetal outcomes or side-effect profiles. The CIPCEA system has similar time-weighted, hourly consumption of local anaesthetic to PCEABI and may increase patient satisfaction.
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Anaesth Intensive Care · Jan 2009
Dose-related effect of propofol on pancreatic enzymes and triglyceride levels in patients undergoing non-abdominal surgery.
Various case reports have indicated a possible relationship between propofol and pancreatitis. However, it is not clear whether this relationship (if any) is dose-related or idiosyncratic. Therefore, a prospective study was conducted to evaluate the effect of different doses of propofol on postoperative pancreatic enzymes and serum triglyceride levels. ⋯ These values did not differ significantly in between the groups even despite the significantly different doses of propofol in the three groups (P < 0.001). None of the patients in the three groups developed any feature suggestive of acute pancreatitis in the postoperative period. These findings indicate that propofol administration at recommended doses does not produce dose-related increases in pancreatic enzyme and triglyceride levels in ASA physical status I and II patients.
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Anaesth Intensive Care · Jan 2009
Case ReportsThe use of "ketofol" (ketamine-propofol admixture) infusion in conjunction with regional anaesthesia.
We present four patients in whom a "ketofol" (ketamine 200 mg and propofol 200 mg) infusion was used in conjunction with regional anaesthesia. The patients were considered 'high risk' due to their medical condition or age. The ketofol proved safe and effective in all four cases. Advantages of this technique included analgesia, airway preservation, maintenance of spontaneous respiration, haemodynamic stability and rapid recovery.