Anaesthesia and intensive care
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Advanced haemodynamic monitoring remains a cornerstone in the management of the critically ill. While rates of pulmonary artery catheter use have been declining, there has been an increase in the number of alternatives for monitoring cardiac output as well as greater understanding of the methods and criteria with which to compare devices. The PiCCO (Pulse index Continuous Cardiac Output) device is one such alternative, integrating a wide array of both static and dynamic haemodynamic data through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis. ⋯ While the accuracy of trans-cardiopulmonary thermodilution as a measure of cardiac output is well established, several other PiCCO measurements require further validation within the context of their intended clinical use. As with all advanced haemodynamic monitoring systems, efficacy in improving patient-centred outcomes has yet to be conclusively demonstrated. The challenge with PiCCO is in improving the understanding of the many variables that can be measured and integrating those that are clinically relevant and adequately validated with appropriate therapeutic interventions.
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Anaesth Intensive Care · May 2012
Case ReportsPerineural entrapment of an interscalene stimulating catheter.
A patient undergoing elective total shoulder arthroplasty had an Arrow Stimucath™ (Arrow International Reading, PA, USA) stimulating catheter inserted in the region of the interscalene brachial plexus using an ultrasound-guided in-plane approach. There was subsequent difficulty in removing the catheter and traction was associated with painful paraesthesia in the patient's thumb. Plain X-ray revealed a hook-shaped deformity of the tip and surgical exploration was required to remove the catheter, the tip of which appeared to be trapped within the sheath of the brachial plexus. ⋯ We recommend that removal of peripheral nerve catheters be attempted only after resolution of sensory block so as to enable patients to report pain or paraesthesia. Imaging with ultrasound or X-rays may help ascertain catheter tip location and confirm whether deformity is present. We also recommend a low threshold for proceeding to surgical extraction, particularly if neurological symptoms are present.
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Anaesth Intensive Care · May 2012
Randomized Controlled TrialAssessing the performance of a continuous infusion for potassium supplementation in the critically ill.
Hypokalaemia is a common problem in critically ill patients, which if untreated, can result in dysrhythmia or another adverse outcome. We assessed the safety and efficacy of a continuous infusion of potassium chloride versus an existing intermittent infusion regimen. In this open-label randomised parallel-arm active-controlled pilot study, critically ill adults with plasma potassium concentration between 2.5 and 3.8 mmol/l were randomised to receive either a continuous infusion or intermittent infusions of potassium chloride for establishment and maintenance of normokalaemia. ⋯ We recorded no adverse events directly attributable to infusion of potassium chloride in either study arm. Although titrated continuous infusion did not demonstrate a clinically important difference by comparison with intermittent infusions for the maintenance of normokalaemia, there was more consistent control of plasma potassium with no observed complications or adverse events. Therefore, this trial showed an acceptable efficacy and safety profile for the continuous infusion regimen, suggesting scope for further study.
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Anaesth Intensive Care · May 2012
Randomized Controlled Trial Comparative StudyDreaming during sevoflurane or propofol short-term sedation: a randomised controlled trial.
Prior reports suggest that dreaming during anaesthesia is dependent on recovery time. Dreaming during sedation may impact patient satisfaction. The current study explores the incidence and content of dreaming during short-term sedation with sevoflurane or propofol and investigates whether dreaming is affected by recovery time. ⋯ Anaesthesia administered had no effect on patient satisfaction. The results suggest that the incidence of dreaming was not affected by recovery time. Patient satisfaction was not influenced by choice of sedative and/or by the occurrence of dreaming during sevoflurane or propofol short-term sedation.
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Anaesth Intensive Care · May 2012
Clinical TrialAccuracy of ProSeal™ laryngeal mask airway intracuff pressure estimation using finger palpation technique - a prospective, observational study.
The incidence of pharyngolaryngeal adverse events associated with laryngeal mask airways can be reduced by the use of manometry to limit the laryngeal mask airway intracuff pressures. We conducted a prospective, observational study in 80 patients undergoing general anaesthesia with the ProSeal™ laryngeal mask airway to determine the accuracy of a finger palpation technique compared to actual readings obtained from a hand-held manometer by different anaesthesia personnel. The strength of association of estimated versus actual intracuff pressures, R, for nurse anaesthesia assistants, junior anaesthetists and senior anaesthetists were 0.21 (weak), 0.35 (moderate) and 0.78 (strong) respectively. ⋯ In all groups, the palpation technique tended to underestimate the actual intracuff pressure by a mean of 10.3 cmH2O. Palpation accuracy decreased when actual intracuff pressures were >80 cmH2O. These findings suggest that cuff pressure manometry should be recommended as standard of care with the use of laryngeal mask airways.