Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2013
Historical ArticleOn the origin of the first Australian Medical Journal.
The Australian Medical Journal is important to Australian anaesthesia in that, as well as associated editorials, it recorded the first use of ether for surgical operations. Though it survived from 1 August 1846 until 1 October 1847, its first issue was surrounded with mystery, referring to an earlier publication. Proof of this earlier issue of April 1846 has been discovered though no copy remains extant.
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Anaesth Intensive Care · Jul 2013
Review Meta Analysis Comparative StudyHigh volume local infiltration analgesia compared to peripheral nerve block for hip and knee arthroplasty-what is the evidence?
Since being reported in 2008, high volume local infiltration analgesia (HVLIA) has rapidly gained popularity for patients undergoing hip and knee replacement. We undertook this review to investigate whether there was evidence for equivalence of HVLIA compared to peripheral nerve block techniques with respect to early postoperative analgesia and functional recovery, or for other outcomes such as cost and process efficiency, persistent postsurgical pain and arthroplasty revision rate. ⋯ Nor is it possible to state whether HVLIA provides benefits in terms of persistent postsurgical pain or cost and process efficiency. Well designed trials directly comparing peripheral nerve block with a standardised HVLIA technique are urgently required.
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Anaesth Intensive Care · Jul 2013
Current oxygenation practice in ventilated patients-an observational cohort study.
Oxygen therapy is a mainstay of critical care medicine, yet its optimal therapeutic use has not been systematically evaluated. A detailed understanding of current practice in oxygen therapy in intensive care is required to enable future interventional studies. We aimed to describe current oxygenation practice in patients requiring ≥48 hours of mechanical ventilation (MV) at an academic tertiary referral centre. ⋯ Wide variability in the mean SpO2 and PaO2 was observed in patients with comparable ALI scores. Inspired oxygen therapy in these MV patients was 'liberal', with PaO2 and SpO2 values generally above 80 mmHg and 96% respectively. An interventional study comparing current practice to more conservative targets (PaO2≍60 to 65 mmHg and/or SpO2≍90 to 92%) appears possible.
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Anaesth Intensive Care · Jul 2013
Randomized Controlled Trial Comparative StudyEpidural versus continuous transversus abdominis plane catheter technique for postoperative analgesia after abdominal surgery.
Transversus abdominis plane block is an effective postoperative analgesic technique after abdominal surgery, but no study has compared continuous transversus abdominis plane block with continuous epidural analgesia. We designed a randomised controlled trial comparing these techniques for major abdominal surgery. Patients in the epidural group received a bolus of 8 to 15 ml of ropivacaine 0.2% and an infusion of 5 to 15 ml/hour and the transversus abdominis plane block group a bolus dose of 20 ml of ropivacaine 0.375% bilaterally and an infusion of 0.2% ropivacaine 8 ml/hour bilaterally, for three days. ⋯ No differences were found in regards to point pain scores or scores over time, either immediately postoperatively or in surgical wards; total fentanyl requirement and Likert satisfaction scores were also similar in both groups. In this underpowered study we found comparable results between continuous transversus abdominis plane technique and epidural analgesia in regard to pain, analgesic use and satisfaction after abdominal surgery. To confirm this finding, randomised trials with larger numbers of participants are needed.