Anaesthesia and intensive care
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Despite the increasing use of a variety of different analgesic strategies, opioids continue as the mainstay for management of moderate to severe acute pain. However concerns remain about their potential adverse effects on ventilation. The most commonly used term, respiratory depression, only describes part of that risk. ⋯ Opioids given for management of acute pain must be titrated to effect for each patient. However strategies aiming for better pain scores alone, without highlighting the need for appropriate monitoring of OIVI, can and will lead to an increase in adverse events. Therefore, all patients must be monitored appropriately for OIVI (at the very least using sedation scores as a '6th vital sign') so that it can be detected at an early stage and appropriate interventions triggered.
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Anaesth Intensive Care · May 2011
Review Meta AnalysisIntensity of continuous renal replacement therapies in patients with severe sepsis and septic shock: a systematic review and meta-analysis.
The purpose of this study was to assess the efficacy of continuous renal replacement therapies in patients with severe sepsis or septic shock, with or without acute kidney injury. We performed a systematic search in Medline, Embase, Web of Knowledge, Cochrane Library and Clinicaltrials.gov and a hand search of the retrieved studies. We included both randomised controlled clinical trials and subgroups of randomised trials that assessed the effect of continuous renal replacement therapies (at traditional or high doses) and reported clinical outcomes in adult patients with severe sepsis or septic shock. ⋯ The effect on mortality was not modified (interaction P values non significant) by the dose of continuous renal replacement therapies, the severity of illness or the risk of bias. The available evidence suggests that these therapies in patients with severe sepsis or septic shock are not associated with an improvement in other outcomes such as haemodynamics, pulmonary gas exchange, multiple organ dysfunction syndrome or length of stay. The best available evidence does not support the routine use of continuous renal replacement therapies (at traditional or high doses) in patients with severe sepsis or septic shock.
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Anaesth Intensive Care · May 2011
ReviewDoes the pulmonary artery catheter still have a role in the perioperative period?
The pulmonary artery catheter (PAC) was introduced into clinical practice in the early 1970s. Its use quickly expanded beyond patients with acute myocardial infarction to critically ill patients in the intensive care unit. Increasingly, it was used in the perioperative period in patients having major cardiac and noncardiac surgery. ⋯ Despite these flaws, there is no clear evidence of benefit, nor harm, in cardiac, intensive care or perioperative patients. Selected indications for the PAC may remain, such as complex cardiac surgery or solid organ transplantation. However, its routine use is difficult to justify and increasingly, most of the haemodynamic data available from the PAC can be obtained less invasively with echocardiography.
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Melatonin is a substance chiefly produced by the pineal gland and has a key role in the sleep-wake cycle. It also has an important antioxidant role. Exogenous melatonin has a short half-life and is available in a range of preparations. ⋯ The antioxidant properties of melatonin are being investigated for use in sepsis and reperfusion injuries. It would appear that patients on melatonin supplements should continue taking them perioperatively because there may be benefits. Melatonin and its analogues will be increasingly encountered in the perioperative setting.
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Anaesth Intensive Care · Jan 2011
ReviewImpact of assessments on learning and quality of life during anaesthesia training in Australia and New Zealand.
Assessments are a major factor in the life of anaesthesia trainees, and the impact of assessments on learning is widely acknowledged. Assessment format can have a significant impact on how trainees learn and the extent to which they reach the goals of the curriculum. The assessment format can affect approaches to learning, encouraging surface, deep or strategic learning. ⋯ Specialist examinations are stressful and examination preparation has a major impact on lifestyle, stress and burnout, which have been identified as major concerns in doctors. The additional burden of assessments may contribute. A better understanding of the impact of assessments on both learning and quality of life is required to better inform decisions on future directions in anaesthesia training in Australia and New Zealand.