Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2011
Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study.
Mortality of patients with critical bleeding requiring massive transfusion is high. Although hypothermia, acidosis and coagulopathy have been well described as important determinants of mortality in patients with critical bleeding requiring massive transfusion, the risk factors and outcome associated with hypocalcaemia in these patients remain uncertain. This cohort study assessed the relationship between the lowest ionised calcium concentration during the 24-hour period of critical bleeding and the hospital mortality of 352 consecutive patients, while adjusting for diagnosis, acidosis, coagulation results, transfusion requirements and use of recombinant factor VIIa. ⋯ In conclusion, ionised calcium concentrations had an inverse concentration-dependent relationship with mortality of patients with critical bleeding requiring massive transfusion. Both acidosis and the amount of fresh frozen plasma transfused were the main risk factors for severe hypocalcaemia. Further research is needed to determine whether preventing ionised hypocalcaemia can reduce mortality of patients with critical bleeding requiring massive transfusion.
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Anaesth Intensive Care · Jan 2011
Randomized Controlled TrialEffect of intravenous ondansetron on sensory and motor block after spinal anaesthesia with hyperbaric bupivacaine.
Ondansetron is a potent antiemetic and a competitive antagonist at serotonin receptors, which are also involved in modulation of pain. This study was designed to assess the effect of systemic ondansetron on sensory and motor block after subarachnoid anaesthesia with hyperbaric bupivacaine. Sixty patients undergoing transurethral resection of bladder tumours were randomly assigned to one of two groups. ⋯ No differences in regression of sensory block were noted at any time. The mean duration of motor block also did not differ (P = 0.44), with similar regression of block at all time intervals except at 90 minutes. We concluded that intravenous ondansetron does not affect the intensity or duration of sensory and motor block after spinal anaesthesia with hyperbaric bupivacaine.
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Anaesth Intensive Care · Jan 2011
ReviewImpact of assessments on learning and quality of life during anaesthesia training in Australia and New Zealand.
Assessments are a major factor in the life of anaesthesia trainees, and the impact of assessments on learning is widely acknowledged. Assessment format can have a significant impact on how trainees learn and the extent to which they reach the goals of the curriculum. The assessment format can affect approaches to learning, encouraging surface, deep or strategic learning. ⋯ Specialist examinations are stressful and examination preparation has a major impact on lifestyle, stress and burnout, which have been identified as major concerns in doctors. The additional burden of assessments may contribute. A better understanding of the impact of assessments on both learning and quality of life is required to better inform decisions on future directions in anaesthesia training in Australia and New Zealand.
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Anaesth Intensive Care · Jan 2011
Randomized Controlled TrialThe effects of positive or negative words when assessing postoperative pain.
Negative or harsh words such as 'pain' and 'sting' used to describe sensations prior to potentially painful procedures have been shown to increase pain. We aimed to determine whether the reporting of pain and its severity is affected by the way it is assessed during anaesthesia follow-up after caesarean section. Following caesarean section, 232 women were randomised prior to post-anaesthesia review. ⋯ The assessment of pain after caesarean section, using more positive words, decreases its incidence but does not affect its severity when measured by pain scores. Words that focus the patient on pain during its assessment may lead some to interpret sensations as pain which they might not do otherwise. These findings may have important implications when assessing and researching postoperative pain.
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Anaesth Intensive Care · Jan 2011
Randomized Controlled Trial Comparative StudyUltrasound-guided lateral femoral cutaneous nerve block: comparison of two techniques.
The aim of this study was to compare the feasibility and efficacy between two techniques of ultrasound-guided lateral femoral cutaneous nerve with or without locating the nerve. The study enrolled 106 patients undergoing knee surgery who received 5 ml of 1% mepivacaine immediately under the inguinal ligament 1 to 2 cm medial to the anterior superior iliac spine (subinguinal technique) or around the lateral femoral cutaneous nerve located (nerve-targeting technique). ⋯ However, a significantly higher percentage of patients obtained loss of pinprick sensation on the lateral thigh within 10 minutes with the subinguinal technique than with the nerve-targeting technique. The findings suggest that ultrasound-guided lateral femoral cutaneous nerve blocks can be easily performed and that injecting local anaesthetic immediately under the inguinal ligament rather than around the nerve itself blocks the nerve more reliably.