Anaesthesia and intensive care
-
Anaesth Intensive Care · Mar 2013
ReviewIs suppression of apoptosis a new therapeutic target in sepsis?
Sepsis remains as a leading cause of death in critically ill patients. Unfortunately, there have been very few successful specific therapeutic agents that can significantly reduce the attributable mortality and morbidity of sepsis. ⋯ In this review article, we summarise the critical role of apoptosis of the immune cells in the pathophysiology of sepsis and propose that blocking cell-signaling pathways leading to apoptosis may present a promising specific therapy for sepsis. Various methods to inhibit apoptosis including the cell surface Fas receptor pathway inhibitors, caspase inhibitors, over-expression of anti-apoptotic genes and small interfering ribonucleic acid therapy are discussed.
-
Anaesth Intensive Care · Mar 2013
Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy.
The number of patients in buprenorphine opioid substitution therapy (BOST) or methadone opioid substitution therapy (MOST) programs is increasing. If these patients require surgery, it is generally agreed that methadone should be continued perioperatively. While some also recommend that buprenorphine is continued, concerns that it may limit the analgesic effectiveness of full mu-opioid agonists have led others to suggest that it should cease before surgery. ⋯ There were also no significant differences in patient-controlled analgesia requirements between BOST and MOST patient groups overall, or between patients who did or did not receive MOST on the day after surgery. BOST patients who were not given their usual buprenorphine the day after surgery used significantly more patient-controlled analgesia opioid (P=0.02) compared with those who had received their dose. These results confirm that continuation of buprenorphine perioperatively is appropriate.
-
Anaesth Intensive Care · Mar 2013
Effectiveness of a patient blood management data system in monitoring blood use in Western Australia.
The aim of this paper is to describe a linked patient blood management (PBM) data system and to demonstrate its usefulness by presenting the blood usage data obtained. Our existing datasets already collected much of the required information in relation to PBM. However, these datasets were not linked. ⋯ The post-transfusion haemoglobin in RBC transfusions exceeded 100 g/l in 33% of patients. Databases were successfully linked to produce a powerful tool to monitor blood utilisation and transfusion practices within a pilot PBM program. This will facilitate effective targeting of PBM strategies and ongoing monitoring of their impact.
-
Anaesth Intensive Care · Mar 2013
Case ReportsDifferentiating athlete's heart from inherited cardiac pathology: the challenge of repolarisation abnormalities presenting during anaesthesia.
This case report describes an asymptomatic healthy male professional athlete who underwent general anaesthesia for a routine orthopaedic operation. Peri-procedure, pronounced ST elevation suggestive of myocardial ischaemia manifested on the electrocardiogram lasting for four hours post-procedure, upon which the athlete developed deep and diffuse inferolateral T-wave inversion. These changes resolved spontaneously and the patient remained clinically stable throughout. This case demonstrates the clinical conundrum facing anaesthetists attempting to differentiate between repolarisation anomalies that are commonly observed in high-level athletes and those of inherited cardiac pathology, namely hypertrophic cardiomyopathy, which is the leading cause of sudden cardiac death in young athletes.
-
Anaesth Intensive Care · Mar 2013
Case ReportsSpontaneous coronary artery dissection in pregnancy requiring emergency caesarean delivery followed by coronary artery bypass grafting.
Spontaneous coronary artery dissection is a rare and often fatal condition of pregnancy. The long-term morbidity is unknown, but a small cohort of patients develop severe ventricular dysfunction as a consequence. ⋯ There is little information about the long-term outcomes and the specific anaesthesia management of combined emergency caesarean delivery and cardiac surgery in pregnancy for spontaneous coronary artery dissection. Therefore, we outline our multidisciplinary management of this critically ill pregnant woman.