Anaesthesia and intensive care
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Anaesth Intensive Care · May 2012
Cyanoacrylate tissue adhesives - effective securement technique for intravascular catheters: in vitro testing of safety and feasibility.
Partial or complete dislodgement of intravascular catheters remains a significant problem in hospitals despite current securement methods. Cyanoacrylate tissue adhesives (TA) are used to close skin wounds as an alternative to sutures. These adhesives have high mechanical strength and can remain in situ for several days. ⋯ Of removal agents, only acetone was associated with a significant decrease in IVC strength (P <0.05). Both TAs and Statlock significantly increased the pull-out force (P <0.01). TA was quick and easy to apply to IVCs, with no irritation or skin damage noted on removal and no bacterial colony growth under either TA.
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Anaesth Intensive Care · May 2012
Preparation of Datex-Ohmeda Aestiva and Aisys anaesthetic machines for use in malignant hyperthermia susceptible patients.
Preparation of anaesthesia machines for use by malignant hyperthermia susceptible patients requires purging the machines of halogenated anaesthetic agents. The endpoint of this process is to reach a gas concentration of 5 ppm or less, which has been arbitrarily chosen as the safe limit of exposure to avoid triggering a malignant hyperthermia event. We examined the washout characteristics of sevoflurane and desflurane from the Datex-Ohmeda Aestiva Anaesthesia System and Aisys Anaesthesia Carestation anaesthetic machines. ⋯ All configurations of machines and anaesthetic gases demonstrated a rebound effect in agent concentration above 5 ppm when the fresh gas flow was subsequently reduced from 10 to 2 l/minute. Aestiva and Aisys anaesthetic machines require a prolonged period to adequately purge them of halogenated volatile anaesthetic agent. The rebound effect poses a serious concern, suggesting that after the purging period, fresh gas flows of 10 l/minute should be maintained for the duration of anaesthesia care of the malignant hyperthermia susceptible patient.
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Anaesth Intensive Care · May 2012
Randomized Controlled TrialEfficacy of an intravenous bolus of morphine 2.5 versus morphine 7.5 mg for procedural pain relief in postoperative cardiothoracic patients in the intensive care unit: a randomised double-blind controlled trial.
As pain in the intensive care unit (ICU) is still common despite important progress in pain management, we studied the efficacy of an intravenous bolus of morphine 2.5 vs 7.5 mg for procedural pain relief in patients after cardiothoracic surgery in the ICU. In a prospective double-blind randomised study, 117 ICU patients after cardiothoracic surgery were included. All patients were treated according a pain titration protocol for pain at rest, consisting of continuous morphine infusions and paracetamol, applied during the entire ICU stay. ⋯ At rest (baseline), overall incidence of unacceptable pain (Numeric Rating Scale ≥4) was low (Numeric Rating Scale >4; 14 vs 17%, P=0.81) for patients allocated to morphine 2.5 and 7.5 mg respectively. For procedure-related pain, there was no difference in incidence of unacceptable pain (28 vs 22%, P=0.53) mean pain scores (2.6 [95% confidence interval 2.0 to 3.2] vs 2.7 [95% confidence interval 2.0 to 3.4]) between patients receiving morphine 2.5 and 7.5 mg respectively. In intensive care patients after cardiothoracic surgery with low pain levels for pain at rest, there was no difference in efficacy between intravenous morphine 2.5 mg or morphine 7.5 mg for pain relief during a painful intervention.
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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.