Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2009
Randomized Controlled TrialEffect of remifentanil on tracheal intubation conditions and haemodynamics in children anaesthetised with sevoflurane and nitrous oxide.
This study examined the effect of remifentanil added to inhalation agents on intubating conditions in children (aged one to seven years). As is our routine, all patients were premedicated with 0.004 mg/kg glycopyrrolate intramuscularly 30 minutes before anaesthesia to prevent bradycardia and salivary secretion, and received intravenous 1 mg/kg ketamine prior to transfer into the operating room to facilitate separation of the child from the parents. Laryngoscopy was attempted after ventilation with 8% sevoflurane in 50% nitrous oxide and 50% oxygen for two minutes, and intravenous administration of either a placebo bolus of saline (Group S) or one of two doses of remifentanil, 1 microg/kg (Group R1) or 2 microg/kg (Group R2) given over 30 seconds, commenced at the beginning of the sevoflurane administration. ⋯ Mean blood pressure was lower in Group R1 and R2 compared with Group S (P < 0.005). Our routine use of ketamine and glycopyrrolate may have influenced the relative lack of significant hypotension and bradycardia. Sevoflurane, nitrous oxide and remifentanil provided acceptable conditions for tracheal intubation in children and could be an acceptable alternative to intravenous induction and neuromuscular blocking agents.
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Anaesth Intensive Care · Jul 2009
Comparative StudyPreventing pain on injection of propofol: a comparison between peripheral ketamine pre-treatment and ketamine added to propofol.
The purpose of this study was to examine possible peripheral mechanisms for the reduction of propofol injection pain by the addition of ketamine. We hypothesised that pH changes associated with the addition of ketamine to propofol decrease propofol-induced pain on injection. We compared the efficacy of intravenous ketamine pretreatment under tourniquet with ketamine added to the propofol. ⋯ Forty-eight patients (51%) in Group P complained of pain on injection compared with 28 patients (30%) in Group M (P = 0.005). The pH of the 1% propofol-ketamine mixture was 5.84 while 1% propofol had a pH of 7.86. Our results support pH changes as a more important cause for the decrease in propofol injection pain with the addition of ketamine to propofol than a peripheral effect of ketamine.
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Our objective was to survey all consultant surgeons, including obstetricians/gynaecologists, in the State of Western Australia to assess their experience with, and readiness to assist anaesthetists with a difficult or failed airway. Survey questionnaires were mailed to all surgeons registered in Western Australia (n = 445). A total of 238 responses (53%) were received, mostly from general surgeons, obstetrician/gynaecologists and orthopaedic surgeons. ⋯ These findings indicate that surgeons in Western Australia perform surgical airways infrequently and only occasionally assist anaesthetists with difficult airway management. However, some surgeons lack confidence and training in surgical airway management. Because anaesthetists cannot always rely on their surgical colleagues to provide a surgical airway during a crisis, we recommend that anaesthetists discuss airway management with their surgical colleagues for all patients with identified difficult airways and that anaesthesia training should include surgical airway management.
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Anaesth Intensive Care · Jul 2009
Potency of mephentermine for prevention of post-spinal hypotension.
This study was designed to determine the minimum effective dose (ED50) of mephentermine for prevention of post-spinal hypotension in women undergoing elective caesarean section. Dixon's up-down method of sequential allocation was used to determine the patient's dose of vasopressor drug. ⋯ The ED50 of mephentermine of 3.7 mg (95% confidence interval 2.4 to 5.7 mg) was much less than that of ephedrine, as calculated in our previous study using the same methodology. Using these values gives a potency ratio of ephedrine to mephentermine of 1:6.8 (95% confidence interval 6.0 to 7.5).
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Anaesth Intensive Care · Jul 2009
Sixteen years of severe Tiger snake (Notechis) envenoming in Perth, Western Australia.
We aimed to describe the characteristics, clinical course, management and outcome of patients presenting to Perth teaching hospitals after envenoming by Tiger snakes. We undertook a chart review from six Perth teaching hospitals over a 16 year period from 1990 to 2005. Data were collected by a trained investigator using a preformatted data abstraction tool. ⋯ This is the largest series of Tiger snake envenoming reported in Australia. Only one patient of 23 (4%) died, despite all patients being significantly envenomed. With rapid antivenom treatment and modem emergency and intensive care management, most patients envenomed by Tiger snakes survive.