Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2011
Review Meta AnalysisC-reactive protein as a predictor of mortality in critically ill patients: a meta-analysis and systematic review.
C-reactive protein is a marker of inflammatory response and has been widely investigated in cardiovascular and infectious diseases, especially to monitor therapeutic success. However, its role as a predictor of clinical outcome in critically ill patients remains uncertain and controversial. The objective of this study was to investigate the predictive value of C-reactive protein in critically ill patients. ⋯ The subgroup analysis showed that the weighted mean difference in early (within 48 hours) C-reactive protein levels between survivors and non-survivors was not significantly different, in contrast to the late (beyond 48 hours) C-reactive protein level. This was significantly greater in non-survivors with a weighted mean difference of 63.80 mg/l (95% confidence interval 35.67 to 91.93). Our systematic review shows that while the early C-reactive protein concentration is not a good predictor of survival in critically ill patients, the late C-reactive protein concentration may help to identify patients who are at risk of death.
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All chronic pain was once acute, but not all acute pain becomes chronic. The transition of acute postoperative pain to chronic post surgical pain is a complex and poorly understood developmental process. ⋯ In future, the increasing understanding of genetic factors and the transitional mechanisms involved may reveal important clues to predict which patients will go on to develop chronic pain. This may assist the development of appropriate interventions affecting not only the individual concerned, but also ultimately the community at large.
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Anaesth Intensive Care · Sep 2011
ReviewAcute pain management in opioid-tolerant patients: a growing challenge.
In Australia and New Zealand, in parallel with other developed countries, the number of patients prescribed opioids on a long-term basis has grown rapidly over the last decade. The burden of chronic pain is more widely recognised and there has been an increase in the use of opioids for both cancer and non-cancer indications. While the prevalence of illicit opioid use has remained relatively stable, the diversion and abuse of prescription opioids has escalated, as has the number of individuals receiving methadone or buprenorphine pharmacotherapy for opioid addiction. ⋯ Discharge planning should commence at an early stage and may involve the use of a 'Reverse Pain Ladder' aiming to limit duration of additional opioid use. Legislative requirements may restrict which drugs can be prescribed at the time of hospital discharge. At all stages, there should be appropriate and regular consultation and liaison with the patient, other treating teams and specialist services.
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Anaesth Intensive Care · Jul 2011
ReviewEmergency surgical airway in life-threatening acute airway emergencies--why are we so reluctant to do it?
'Can't intubate, can't oxygenate' scenarios are rare but are often poorly managed, with potentially disastrous consequences. In our opinion, all doctors should be able to create a surgical airway if necessary. More practically, at least all anaesthetists should have this ability. ⋯ Standardisation of difficult airway equipment in areas where anaesthesia is performed is a step toward ensuring that an emergency surgical airway will be performed appropriately Information on the incidence and clinical management of 'can't intubate, can't oxygenate' scenarios should be compiled through various sources, including national coronial inquest databases and anaesthetic critical incident reporting systems. A systematic approach to teaching and maintaining human factors in airway crisis management and emergency surgical airway skills to anaesthetic trainees and specialists should be developed: in our opinion participation should be mandatory. Importantly, the view that performing an emergency surgical airway is an admission of anaesthetist failure should be strongly countered.
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Obesity is increasing in the population as a whole, and especially in the obstetric population, among whom pregnancy-induced physiological changes impact on those already present due to obesity. In particular, changes in the cardiovascular and respiratory systems during pregnancy further alter the physiological effects and comorbidities of obesity. ⋯ Obese pregnant women appear to have increased morbidity and mortality associated with caesarean delivery and general anaesthesia for caesarean delivery in particular, and more anaesthesia-related complications. This article summarises the physiological and pharmacological implications of obesity and pregnancy and describes the issues surrounding the management of these women for labour and delivery.