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
Randomized Controlled Trial Comparative StudyPostoperative analgesia and respiratory events in patients with symptoms of obstructive sleep apnoea.
Symptoms of obstructive sleep apnoea are common in patients presenting for surgery and are associated with increased morbidity. Analgesia contributes significantly to postoperative respiratory depression and obstruction, so we compared standard morphine patient-controlled analgesia with an opioid-sparing protocol (tramadol patient-controlled analgesia, parecoxib and rescue-only morphine) in these patients. Sixty-two patients presenting for elective surgery with body mass index > or = 28 and signs or symptoms suggesting obstructive sleep apnoea were randomised to receive either the opioid or opioid-sparing postoperative analgesia protocol, with continuous respiratory monitoring for 12 hours on the first postoperative night. ⋯ There was no difference between treatment groups in the number of obstructive apnoeas, hypopnoeas or central apnoeas. However, central apnoeas and a rate of respiratory events > 15 per hour were related to postoperative morphine dose (P = 0.005 and P = 0.002). In patients at risk of obstructed breathing, intention to treat with an opioid-sparing analgesia protocol did not decrease the rate of respiratory events, although the rate was still related to the total morphine dose.
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Anaesth Intensive Care · Sep 2009
Comparative StudyMortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital.
Mortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged > or =65 years admitted into ICU (n = 272); aged -65 years admitted into general ward (n = 610) and aged < 65 years admitted into ICU (n = 1617). Hospital mortality predictors were characterised as odds ratios (OR) using logistic regression. The impact of predictor variables on (log) total hospital-stay costs was determined using least squares regression. ⋯ Mortality cost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.
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Anaesth Intensive Care · Sep 2009
Randomized Controlled TrialAmbulatory continuous femoral analgesia for major knee surgery: a randomised study of ultrasound-guided femoral catheter placement.
Needle-nerve stimulation has a false negative motor response rate, which may increase needle passes. This prospective, randomised study tested the hypothesis that femoral nerve catheters placed with ultrasound-only guidance could provide comparable postoperative analgesia to those placed using a conventional nerve stimulation endpoint. Patients presenting for major knee surgery to the lead investigator were recruited. ⋯ The median (quartiles) needle time under the skin was 58 seconds (51 to 76) in the ultrasound group and 120 seconds (95 to 178) in the nerve stimulation group (P = 0.001). The median (quartiles) insertion numerical rating pain score was 2 (0 to 2) in the ultrasound group and 4 (2 to 6) in the nerve stimulation group (P = 0.014). Femoral nerve catheters placed for major knee surgery using an ultrasound endpoint provided postoperative analgesia comparable to that obtained when using a nerve stimulation endpoint and were associated with a reduction in both needle manipulations and procedure-related pain.