Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2009
Randomized Controlled TrialAn intraoperative pre-incision single dose of intravenous ketamine does not have an effect on postoperative analgesic requirements under clinical conditions.
Evidence about the effectiveness of the N-methyl-D-aspartate antagonist ketamine to reduce postoperative acute and long-lasting pain is inconclusive. The aim of this study was to investigate effects of adding an intraoperative, pre-incision single intravenous dose of ketamine to a routine anaesthesia regimen on postoperative analgesic requirements, side-effects and persisting pain up to three months. After obtaining Ethical Committee approval and written informed patient consent, 120 patients were included in this prospective, randomised, double-blinded, placebo-controlled study. ⋯ Data were compared by t-test and Kruskall-Wallis test with alpha = 0.05. There was no difference between the groups in the assessed variables. These findings indicate that with the anaesthesia regimen described, and in the doses used, a single intravenous dose of ketamine does not reduce postoperative analgesic requirement or postoperative pain at three months.
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Anaesth Intensive Care · Sep 2009
ReviewDiagnosis of postoperative arrhythmias following paediatric cardiac surgery.
Arrhythmias are commonly encountered in the paediatric intensive care unit setting, most frequently in the setting of postoperative congenital heart disease. Postoperative arrhythmias are an important cause of morbidity in children in the postoperative period following cardiac surgery for congenital cardiac lesions. It is important for all paediatric critical care physicians involved in the care of these children to understand the potential mechanisms involved and how to make an accurate diagnosis. ⋯ There is a paucity of literature to guide the clinician in approaching arrhythmias in the paediatric intensive care unit setting. Our objective was to review the recognition and diagnosis of paediatric arrhythmias in the postoperative period following congenital cardiac surgery. Timely and accurate identification of the rhythm disturbance is mandatory and allows for the institution of effective, rhythm specific management strategies.
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Anaesth Intensive Care · Sep 2009
Comparative StudyThe influence of gender and experience on intubation ability and technique: a manikin study.
Female anaesthetists in early training commonly question whether their strength is adequate for tracheal intubation. This study investigated the influence of gender and experience on intubation ability and laryngoscopic technique. A manikin model and purpose-designed force-transducing laryngoscope was used to test three cohorts at different levels of experience (novice, intermediate and experienced males and females, n = 65) for the axial force and torque exerted, best laryngoscopic view obtained, success with and time for intubation and laryngoscopic technique. ⋯ With experience, the forces generated during intubation reduced and ability improved. Proximal laryngoscope grips (close to the blade) generated lower forces than distal grips. Female and male intubators did not differ in ability to intubate or in the forces they exerted during direct laryngoscopy.
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Anaesth Intensive Care · Sep 2009
Case ReportsTakotsubo cardiomyopathy during emergence from general anaesthesia.
Takotsubo cardiomyopathy, or stress-induced cardiomyopathy, is a clinical syndrome mimicking acute myocardial infarction. We report a case of a 55-year-old man who developed Takotsubo cardiomyopathy during emergence from general anaesthesia for an elective procedure to remove a spinal cord stimulator The perioperative state is known to induce stress, but there are few cases describing the onset of Takotsubo syndrome during this period. The case presented demonstrates that Takotsubo cardiomyopathy may occur on emergence from anaesthesia and that the pattern of left ventricular dysfunction produced may not be typical.