Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2018
Review Case ReportsPotential consequences of high-dose infusion of ketamine for refractory status epilepticus: case reports and systematic literature review.
Our goal was to provide comprehensive data on the effectiveness of ketamine in refractory status epilepticus (RSE) and to describe the potential consequences of long-term ketamine infusion. Ketamine, an N-methyl D-aspartate (NMDA) receptor antagonist, blocks excitatory pathways contributing to ongoing seizure. While ketamine use is standard in anaesthetic induction, no definitive protocol exists for its use in RSE, and little is known about its adverse effects in long-term, high-dose administration. ⋯ Ketamine is effective in RSE by antagonising excitotoxic NMDA receptors. However, there is high variability in ketamine dosing and scarce data on its safety in long-term infusion. Metabolic acidosis and haemodynamic instability associated with the use of long-term, high-dose ketamine infusions must be of concern to clinicians administering ketamine to critically ill patients.
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Anaesth Intensive Care · Sep 2018
Randomized Controlled Trial Comparative StudyA randomised controlled trial comparing fibreoptic-guided tracheal intubation through two supraglottic devices: Ambu® AuraGain™ laryngeal mask and LMA® Fastrach™.
The Ambu®AuraGain™ laryngeal mask (LM) (Ambu A/S, Ballerup, Denmark) is one of the few readily available second-generation supraglottic airway devices (SADs) that offer a conduit for fibreoptic-guided endotracheal intubation. We aimed to compare fibreoptic intubation through this device with the LMA® (laryngeal mask airway) Fastrach™ (Teleflex Medical, Co. Westmeath, Ireland), which has been a recommended dedicated rescue device for the management of the unanticipated difficult airway. ⋯ The AuraGain LM was also quicker to insert compared to the Fastrach LMA. Similar rates of minor complications, such as sore throat and dysphonia occurred in both groups. Our study indicates that when used in patients with complete muscle relaxation and no known airway pathology, the AuraGain LM achieves better laryngeal alignment and quicker, easier and more successful fibreoptic-guided ETT intubation than the Fastrach LMA.
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Anaesth Intensive Care · Sep 2018
ReviewNutritional prehabilitation: physiological basis and clinical evidence.
In this narrative review, we describe the physiological basis for nutritional prehabilitation and evaluate the clinical evidence for its current roles in the perioperative period. Surgical stress and fasting induce insulin resistance as a result of altered mitochondrial function. Insulin resistance in the perioperative period leads to increased morbidity in a dose-dependent fashion, while preoperative carbohydrate loading attenuates insulin resistance, minimises protein loss and improves postoperative muscle function. ⋯ Clinical studies evaluating nutritional interventions have been marred by conflicting data, which may be due to small sample sizes, as well as heterogeneity of patients and surgical procedures. At present, it is known that carbohydrate loading is safe and improves patients' wellbeing, but does not appear to influence length of hospital stay or rate of postoperative complications. This should be appreciated before its routine inclusion in ERAS programs.
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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.