Anaesthesia and intensive care
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Acute pancreatitis is an inflammatory process of the pancreas with variable involvement of regional tissues and remote organs. This review gives a comprehensive overview of the aetiology, pathophysiology, diagnosis and therapy of acute pancreatitis relevant to the intensivist. Recent international guidelines on the management of acute pancreatitis are summarised. ⋯ Computed tomography-guided fine needle aspiration is the technique of choice to differentiate between sterile and infected pancreas necrosis. While sterile pancreatic necrosis should be managed conservatively, infected pancreatic necrosis requires debridement and drainage supplemented by antibiotic therapy. Surgical necrosectomy is the traditional approach, but less invasive techniques (retroperitoneal or laparoscopic necrosectomy, computed tomography-guided percutaneous catheter drainage) may be equally effective.
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Anaesth Intensive Care · Mar 2009
Randomized Controlled Trial Comparative StudyA randomised, double-blind comparison of three different volumes of hypobaric intrathecal bupivacaine for orthopaedic surgery.
This study was designed to evaluate different doses of hypobaric 0.15% bupivacaine administered to achieve unilateral orthopaedic surgery under subarachnoid block. Using a randomised, double-blinded protocol, 150 ASA I to II patients scheduled for elective unilateral orthopaedic surgery were allocated to received a subarachnoid block with hypobaric bupivacaine 0.15% 4.5 mg (3 ml) (Group 1), 6.0 mg (4 ml) (Group 2) or 7.5 mg (5 ml) (Group 3). Measurements included cardiovascular and haemodynamic stability, incidence of unilateral anaesthesia, time to recover from motor block, postoperative urinary retention, transitory neurological symptoms and postdural puncture headache. ⋯ Seventy percent of patients had unilateral block. It was concluded that the spinal anaesthesia in all groups was suitable for single limb orthopaedic surgery. The smallest dose (4.5 mg) of hypobaric 0.15% bupivacaine resulted in more unilateral blocks, with narrower distribution and shorter duration.
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Anaesth Intensive Care · Mar 2009
Outcome of patients receiving high dose vasopressor therapy: a retrospective cohort study.
The aim of this study was to determine the hospital survival of patients receiving high doses of catecholamines. A retrospective observational study was conducted in a 22-bed multidisciplinary adult intensive care unit of a tertiary referral university hospital. All patients (n = 64) receiving > 100 microg/min of adrenaline or noradrenaline or adrenaline and noradrenaline combined over a one-year period were studied to determine survival to intensive care unit and hospital discharge. ⋯ None of the 32 patients who received > 200 microg/min noradrenaline survived. We conclude that the survival of patients requiring high doses of catecholamines is poor but the use of such doses is probably not futile. It remains for individual clinicians, patients and their surrogates to decide whether use of high doses of vasopressor is appropriate, given the low probability of survival.
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Anaesth Intensive Care · Mar 2009
Case ReportsA patient with intractable posthypoxic myoclonus (Lance-Adams syndrome) treated with sodium oxybate.
Posthypoxic myoclonus is a rare and devastating complication of near-fatal cardiopulmonary arrest. Despite treatment with available anti-myoclonic agents, some patients may recover cognitively but remain completely disabled by severe myoclonus. We report a 16-year-old patient with severe treatment-refractory posthypoxic myoclonus, which improved markedly with administration of the drug sodium oxybate.