Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2016
The effects of residual pump blood on patient plasma free haemoglobin levels post cardiac surgery.
At the end of cardiopulmonary bypass, there are invariably several hundred millilitres of residual pump blood in the reservoir, which can either be re-transfused or discarded. The objective of this prospective observational study was to investigate the quality of the residual pump blood, focusing on plasma free haemoglobin (pfHb) and blood cell counts. Fifty-one consecutive patients were included in the study. ⋯ Our data showed that haemoglobin, haematocrit, and erythrocyte counts of residual pump blood were approximately 40% of the values in standardised RBC concentrates. Plasma free haemoglobin was significantly higher in residual pump blood compared to RBC concentrates, and nearly twice as high as the pfHb in patient blood samples taken contemporaneously. Our findings indicate that residual pump blood pfHb levels are markedly higher compared to patients' blood and RBC concentrates, but that its administration does not significantly increase patients' pfHb levels.
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Anaesth Intensive Care · Sep 2016
Anaesthetists' experiences with the early labour epidural recommendation for obese parturients: a qualitative study.
Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. ⋯ These anaesthetists were inconsistent in how they interpreted and applied early epidural analgesia for obese parturients, with some questioning the validity of the practice. The combination of uncertainty, urgency and technical difficulty presented by obese parturients provoked anxiety in these clinicians, particularly the anticipation of unplanned general anaesthesia. Consistent anaesthetic practice could improve the implementation of early epidural analgesia in obese parturients.
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Anaesth Intensive Care · Sep 2016
Case ReportsThe Alfred Hospital experience of resumption of cardiac activity after withdrawal of life-sustaining therapy.
With the advent of donation after circulatory death programs in Australia and New Zealand, greater knowledge is needed about physiologic variation in haemodynamic activity following withdrawal of cardiorespiratory support. The ANZICS Statement on Death and Organ Donation allows provision for variation in the observation times between two and five minutes after cessation of the circulation prior to declaration of death. We report our experience of two cases, the first where electrical activity and pulse returned after a 102 second pause and the second where electrical activity returned after a three minute pause; both longer than previously reported cases.
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Anaesth Intensive Care · Sep 2016
The utility of procalcitonin in the prediction of serious bacterial infection in a tertiary paediatric intensive care unit.
To determine utility of procalcitonin (PCT) for the prediction of bacterial infection in critically ill children, we analysed the relationship between serum PCT, cultures and other laboratory markers of bacterial sepsis or viral infection in a tertiary paediatric intensive care unit (PICU). The outcome measures were levels of PCT in proven bacteraemia, pneumonia and viral respiratory infection; and comparison of PCT to immature to total neutrophil ratio (ITR) in prediction of bacteraemia. In 420 children with suspected sepsis, 1,226 serum PCT levels were analysed. ⋯ In children with viral respiratory tract infection only, the median PCT was 1.26 ng/ml (0.35-5.5), and in those with likely bacterial pneumonia the median PCT was 0.80 ng/ml (IQR 0.28-1.70). In a heterogeneous population of children in a tertiary PICU, PCT measured at a single timepoint was a moderate predictor of proven bacteraemia. In our population PCT did not reliably identify localised bacterial infection or distinguish bacterial from viral respiratory infection.
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Anaesth Intensive Care · Sep 2016
Novel transoesophageal echocardiographic views attain superior incident angles for tricuspid, but not pulmonary, valvular Doppler interrogation.
For accurate spectral Doppler valvular evaluation, intraoperative sonographers must use transoesophageal echocardiographic (TOE) views that offer optimal incident angles. We hypothesised that views added to the 2013 American Society of Echocardiography/Society of Cardiovascular Anesthesiologists (ASE/SCA) standard views and other novel views we have described of the tricuspid (TV) and pulmonary valves (PV) offered superior incident angles to those included in the original 1999 ASE/SCA recommendations for comprehensive intraoperative TOE examination. We compared the acquisition feasibility and incident angles obtained by these views in 62 patients undergoing elective cardiac surgery, who received TOE monitoring as standard care. ⋯ PV view acquisition feasibility between the 1999 ASE/SCA standard, 2013 ASE/SCA standard and novel views was not significantly different (acquisition rate difference 11%, P ≥0.11). We conclude that the 2013 ASE/SCA TV standard and novel views obtained superior incident angles for the tricuspid, but not pulmonary valves. We recommend that intraoperative sonographers consider the use of these views, particularly when incident angles obtained with standard views are suboptimal.