Anaesthesia and intensive care
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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.
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Anaesth Intensive Care · Sep 2009
An audit of potentially recyclable waste from anaesthetic practice.
Little is known about the amount of anaesthesia waste that is recyclable. We tested the hypotheses: 1) that anaesthetists produce a small proportion (< 10%) of total operating suite waste, 2) that much of this waste (> 30%) is recyclable and 3) that there is little (< 10%) cross-contamination of infectious and non-infectious waste. For five weekdays in a metropolitan hospital with six operating theatres, we weighed waste and determined the proportion of anaesthesia waste that was recyclable. ⋯ Anaesthesia waste was a quarter of total operating suite waste. Almost 60% of anaesthesia general waste could be recycled. Failure to eliminate infectious waste from general waste could be a barrier to recycling.
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Anaesth Intensive Care · Sep 2009
Case ReportsContinuous venovenous haemodiafiltration for metformin-induced lactic acidosis.
A 74-year-old man with cardiac failure and renal impairment was admitted to the cardiothoracic intensive care unit with metformin-induced lactic acidosis and shock. He was successfully treated with high-dose (80 ml/kg/hour) continuous venovenous haemodiafiltration. Lactic acidosis is a known complication of metformin and is associated with a high mortality. The use of high-dose continuous venovenous haemodiafiltration for this condition has not previously been reported.
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Anaesth Intensive Care · Sep 2009
Inflammation, vitamin deficiencies and organ failure in critically ill patients.
It is unknown whether biochemical vitamin deficiencies in critical illness are associated with severity of illness, organ dysfunction, inflammation or mortality. This nested cohort study recruited 98 patients admitted as emergencies to the intensive care unit, who had a stay of greater than 48 hours. Patient data were prospectively collected. ⋯ Vitamin A concentration was weakly associated with the C-reactive protein concentrations on days one and five (Spearman's r = -0.5 [P = 0.001], -0.4 [P = 0.03], respectively). Change in deficiency status of any of the vitamins over time in the first week of intensive care admission did not appear to influence mortality. We conclude that while weak correlations were identified between vitamins A and B12 and C-reactive protein and Sequential Organ Failure Assessment scores, the importance of these associations and their relationship to hospital mortality remain to be determined.
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Anaesth Intensive Care · Sep 2009
Non-invasive assessment of the microcirculation in critically ill patients.
Sepsis is associated with abnormalities of muscle tissue oxygenation and of microvascular function. We investigated whether the technique of near-infrared spectroscopy can evaluate such abnormalities in critically ill patients and compared near-infrared spectroscopy-derived indices of critically ill patients with those of healthy volunteers. We studied 41 patients (mean age 58 +/- 22 years) and 15 healthy volunteers (mean age 49 +/- 13 years). ⋯ Furthermore, oxygen consumption rate was significantly lower in patients with septic shock than patients with SIRS. Reperfusion rate was significantly lower in patients with SIRS (336 +/- 141%/minute, P < 0.001), severe sepsis (257 +/- 150%/minute, P < 0.001) or septic shock (146 +/- 101%/minute, P < 0.001) than in healthy volunteers (713 +/- 223%/minute) and significantly lower in the septic shock than in the SIRS group. Near-infrared spectroscopy can detect tissue oxygenation deficits and impaired microvascular reactivity in critically ill patients, as well as discriminate among groups with different disease severity.