Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2014
ReviewPreventing cerebral oedema in acute liver failure: the case for quadruple-H therapy.
Severe cerebral oedema is a life-threatening complication of acute liver failure. Hyperammonaemia and cerebral hyperaemia are major contributing factors. A multimodal approach, which incorporates hyperventilation, haemodiafiltration, hypernatraemia and hypothermia (quadruple-H therapy), may prevent or attenuate severe cerebral oedema. ⋯ The administration of concentrated saline increases serum tonicity and further reduces cerebral swelling. In addition, the pathologically increased cerebral blood-flow is further attenuated by therapeutic hypothermia. The combination of all four treatments in a multimodal approach may be a safe and effective means of attenuating or treating the cerebral oedema of acute liver failure and preventing death from neurological complications.
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Anaesth Intensive Care · Jan 2014
Comparative StudyA ten-year audit of fresh gas flows in a New Zealand hospital: the influence of the introduction of automated agent delivery and comparisons with other hospitals.
Reducing fresh gas flow (FGF) rates with volatile anaesthetics reduces waste, with positive financial and environmental consequences. We have audited FGF since 2001 by analysis of data collected from anaesthetic machines. We recently introduced Aisys(®) (GE Healthcare, Madison, WI, USA) machines that allow automated control of end-tidal levels of volatile anaesthetics. ⋯ The proportion of time spent in automated delivery mode has increased from 35% to 63%. Users valued the workload reduction with end-tidal control. Our findings suggest that in daily practice, with a wide range of practitioners at different levels of training and a broad patient mix, mean flow rates of around 1.3 l/minute with median flows in the range 0.5 to 1.0 l/minute are achievable targets.
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Anaesth Intensive Care · Jan 2014
Case ReportsPituitary apoplexy with reversible cerebral vasoconstrictive syndrome after spinal anaesthesia for emergency caesarean section: an uncommon cause for postpartum headache.
Pituitary apoplexy is a rare condition involving pituitary necrosis following either pituitary haemorrhage or infarction. Similarly, reversible cerebral vasoconstrictive syndrome is a cerebrovascular disorder characterised by diffuse, multifocal narrowing of cerebral arteries. ⋯ We report the case of a patient who developed pituitary apoplexy during an emergency caesarean section under spinal anaesthesia. It was further complicated by the development of reversible cerebral vasoconstriction syndrome and stroke.