Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2018
Observational StudyFasting or starving? Measurement of blood ketone levels in 100 fasted elective and emergency adult surgical patients at an Australian tertiary hospital.
Prolonged fasting leads to a shift from carbohydrate to fat as the primary energy source, resulting in the production of ketones such as beta-hydroxybutyrate. Hyperketonaemia and ketoacidosis have been observed in young children fasting for surgery. The aim of this study was to investigate ketonaemia in adults fasted for surgery. ⋯ No patient demonstrated beta-hydroxybutyrate levels suggestive of ketoacidosis (above 3 mmol/l). No relationship between fasting duration and ketone or glucose levels was observed. We found no evidence that prolonged preoperative fasting led to beta-hydroxybutyrate levels consistent with ketoacidosis.
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Anaesth Intensive Care · Sep 2018
Randomized Controlled TrialDoes a catheter over needle system reduce infusate leak in continuous peripheral nerve blockade: a randomised controlled trial.
Continuous peripheral nerve blockade is a common technique in the analgesic management for many procedures. Leakage of local anaesthetic from around the nerve catheter insertion site can increase the chance of catheter dislodgement, risks infective complications, and could divert anaesthetic away from the nerve causing the block to fail. We conducted a randomised controlled trial to assess whether the type of nerve catheter influenced local anaesthetic leak rate. ⋯ All seven instances of inadvertent catheter dislodgement occurred in the CTN group (P=0.006). There was no statistically significant difference between groups in the proportion of patients who had adequate analgesia on day one (CON 80% versus CTN 86.5%; P=0.294) and day two postoperatively (CON 85.5% versus CTN 91.8%; P=0.369). Our findings show the overall leak rate to be very low with both catheter systems; however, the CON system may have advantages in terms of speed of use and rate of inadvertent catheter dislodgement.