Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2013
Asialoglycoprotein receptor scintigraphy with 99mTc-galactosyl human serum albumin (99mTc-GSA) as an early predictor of survival in acute liver failure.
This study evaluated the usefulness of asialoglycoprotein receptor scintigraphy with 99mTc-galactosyl human serum albumin (99mTc-GSA scintigraphy) as an early predictor for prognosis of acute liver failure. Forty-eight patients with acute liver failure and without a past history of chronic liver disease were enrolled. Patients were divided into survival and non-survival groups by 28-day mortality. 99mTc-GSA scintigraphy to detect uptake ratio of the heart at 15 minutes to that at three minutes (HH15) and uptake ratio of the liver at 15 minutes to the liver plus the heart at 15 minutes (LHL15), and measurements of serum total bilirubin, hepatocyte growth factor and prothrombin time were performed immediately after the diagnosis of acute liver failure. ⋯ HH15 and LHL15 uptake ratios in the survival group were 0.670 and 0.875, and they were significantly lower and higher than those in the non-survival group, respectively. All patients with LHL15 <0.760 died, and the area under the receiver operating characteristic curve for LHL15 were significantly larger than the areas under the receiver operating characteristic curves of serum variables and model for end-stage liver disease score. In summary, in patients with acute liver failure without chronic liver disease, HH15 and LHL15 of 99mTc-GSA scintigraphy are more useful variables in predicting prognosis than serum variables and model for end-stage liver disease score.
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Anaesth Intensive Care · Jul 2013
Prediction of fluid responsiveness using dynamic preload indices in patients undergoing robot-assisted surgery with pneumoperitoneum in the Trendelenburg position.
We investigated the abilities of pulse pressure variation (PPV) and stroke volume variation (SVV) to predict fluid responsiveness during robot-assisted laparoscopic prostatectomy, requiring pneumoperitoneum and the Trendelenburg position. In 42 patients without cardiopulmonary disease, PPV and SVV were measured before and after administration of 500 ml colloid under pneumoperitoneum combined with the steep Trendelenburg position (35°). Fluid responsiveness was defined as a ≥15% increase in stroke volume after the fluid loading measured using transoesophageal echocardiography. ⋯ A PPV of ≥9.5% identified responders with a sensitivity of 77.3% and a specificity of 90.0%, and a SVV of ≥9.5% also identified responders with a sensitivity of 77.3% and a specificity of 75.0%. The area under receiver operating characteristic curves for PPV and SVV were 0.87 (P <0.001) and 0.81 (P=0.001), respectively. The findings suggest that both PPV and SVV could be useful predictors of fluid responsiveness in patients without cardiopulmonary disease undergoing robotic laparoscopic surgery with pneumoperitoneum in the Trendelenberg position.
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Anaesth Intensive Care · Jul 2013
Decontamination of ultrasound equipment used for peripheral ultrasound-guided regional anaesthesia.
Portable ultrasound machines are frequently used in operating theatres for peripheral single-shot nerve block procedures. This equipment must be decontaminated by reducing the microbial load to a sufficient level to reduce the risk of nosocomial infection. In our institution we use a simple three-step decontamination protocol utilising 70% isopropyl alcohol as chemical disinfectant. ⋯ Of the remaining 15% (n=18), commensal organisms commonly found on skin, oral and environmental surfaces were isolated. Our results suggest that our decontamination protocol may be an effective, rapid and cost-effective method of cleaning ultrasound equipment used for peripheral invasive single-shot nerve blocks. Further guidance from national bodies is required to define appropriate cleaning protocols for these machines.
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Anaesth Intensive Care · Jul 2013
Historical ArticleThe role of Dr Isaac Aaron and the Australian Medical Journal in the dissemination of information about etherisation in the 1840s.
Isaac Aaron (1804 to 1877), an ambitious young medical practitioner, arrived in Sydney from Britain in 1838 and was registered by the New South Wales Medical Board the following year. After contributing to the Australian Medical Journal, established in August 1846 by William Baker, he became the editor in December and acquired it in May the following year. Dr Pugh became the most prolific local contributor to the journal but he and the editor had a somewhat 'prickly' relationship. ⋯ Aaron repeatedly appealed for experimental evidence and rational decision-making to determine the place of etherisation in medical practice. Unfortunately for Australian medicine, Aaron had to suspend the publication of the journal in October 1847, lacking both time and the support of the profession necessary to maintain it. This created an unanticipated adverse outcome for Dr Pugh.