Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2018
Randomized Controlled TrialMorbid obesity impairs adequacy of thoracic compressions in a simulation-based model.
Adequate cardiopulmonary resuscitation is an important predictor of survival, however, obesity provides a significant physical barrier to thoracic compressions. This study explores the effect of morbid obesity on compression adequacy. We performed a prospective randomised controlled crossover study, assessing the adequacy of thoracic compressions on a manikin modified to emulate a morbidly obese patient. ⋯ Participants were not fully aware of how ineffective compressions were. There is evidence of earlier fatigue further reducing effectiveness. These findings have significant implications for the training of rescuers in a clinically relevant population and the planning of future research.
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Anaesth Intensive Care · Mar 2018
Case ReportsPostoperative euglycaemic diabetic ketoacidosis associated with sodium-glucose cotransporter-2 inhibitors (gliflozins): a report of two cases and review of the literature.
Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated euglycaemic diabetic ketoacidosis (euDKA) is a serious and increasingly recognised complication of treatment with this class of oral hypoglycaemic agents and can present a diagnostic challenge, resulting in delayed recognition, inappropriate treatment and potentially life-threatening acidosis. We present two cases of patients developing SGLT2i-associated euDKA in the early postoperative period. We support ceasing SGLT2i for 72 hours preoperatively and would suggest continuing to withhold the medication until oral intake is restored, and recommend a wider awareness of SGLT2i-associated diabetic ketoacidosis (DKA) amongst patients and their healthcare providers with an emphasis on checking ketone levels irrespective of blood glucose levels in the postoperative setting.
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Anaesth Intensive Care · Mar 2018
ReviewRecent advances and anaesthetic considerations in corneal transplantation.
Significant surgical advances have been made recently in corneal transplantation. Penetrating keratoplasty was the dominant method from 1905, until selective lamellar keratoplasty emerged as the preferred technique over the last 20 years. Advanced techniques such as corneal limbal stem cell transplant and keratoprosthesis are also available. ⋯ General anaesthesia remains suitable for a wide range of these procedures especially in repeat surgery, difficult, or prolonged procedures. Regional ophthalmic blocks are ideal for endothelial keratoplasty but can be used in penetrating keratoplasty based on individual risk-benefit assessment, and as a supplement to general anaesthesia. Topical anaesthesia provides an alternative when general anaesthesia and ophthalmic regional blocks are less desirable but overall its use is limited.
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Anaesth Intensive Care · Mar 2018
Comparative StudyPatients retrieved to intensive care via a dedicated retrieval service do not have increased hospital mortality compared with propensity-matched controls.
This study was performed to estimate the effect of the retrieval process on mortality for patients admitted to a mixed adult intensive care unit (ICU) compared with propensity-matched, non-retrieved controls. Patients retrieved to the Royal Adelaide Hospital (RAH) ICU between 2011 and 2015 were propensity-score matched for age, gender, Aboriginal and Torres Strait Islander status, Acute Physiology and Chronic Health Evaluation (APACHE) III score and diagnostic group with non-retrieved ICU patients to estimate the average treatment effect of retrieval on hospital mortality. Factors associated with mortality in those retrieved were assessed by multiple logistic regression. ⋯ Time from retrieval team activation to arrival with the patient, rural location, radial distance from the RAH and population size at the retrieval location were not significantly associated with mortality. The hospital mortality for retrieved patients was not significantly different when compared with propensity-matched controls. Mortality in those retrieved was associated with increasing age, APACHE III score and diagnostic category; however, was independent of time from team activation to arrival with the patient.