Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2011
The association between intraoperative electroencephalogram-based measures and pain severity in the post-anaesthesia care unit.
This observational study aimed to identify simple electroencephalogram indices of inadequate intraoperative opioid-mediated nociceptive blockade and to compare these indices with routinely used clinical predictors of severe postoperative pain in adults. Intraoperative trend and waveform data (electrocardiogram, pulse oximetry and electroencephalogram) were collected, pain intensity in the post-anaesthesia care unit was quantified using an 11-point Verbal Rating Score, and opioid administration was recorded. ⋯ Fifty-two patients had moderate or severe pain (Verbal Rating Score > or = 5). State entropy was lower (46.5 +/- 2.9 vs 43.1 +/- 1.9, P = 0.04) and spindle-like activity higher (0.42 +/- 0.03 vs 0.50 +/- 0.02, P = 0.03) in the moderate/severe pain group. [corrected] These findings suggest that there is a modest association between electroencephalogram measures near the end of surgery and the severity of postoperative pain.
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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 · Sep 2011
Comparative StudyCerebrospinal fluid cytology in patients undergoing combined spinal epidural versus spinal anaesthesia without an introducer.
The problem of tissue coring exists despite the availability of smaller gauge spinal needles with special tip designs. The aim of the study was to test the hypotheses that a) subarachnoid block given as a part of a combined spinal epidural intervention by needle-through-needle technique introduces a lesser number of epithelial cells into the subarachnoid space compared to isolated subarachnoid block, and b) after lumbar puncture, the initial few drops of cerebrospinal fluid from the spinal needle will have a higher number of epithelial cells than the subsequent sample. One hundred and seven patients of American Society of Anesthesiologists physical status I to III undergoing infra-umbilical surgery were enrolled. ⋯ The median (interquartile range) number of cells in group A, for samples 1 and 2 was 6 (3 to 12.5) and 6 (3 to 10); and in group B, 3.5 (1 to 10) and 4 (1 to 8) respectively. Significant tissue coring was observed with both techniques. Discarding eight to 12 drops of cerebrospinal fluid did not help in reducing the epithelial cell load.
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Anaesth Intensive Care · Sep 2011
Case ReportsComputed tomography changes of alveoli and airway collapse after laryngospasm.
An eight-month-old girl underwent a computed axial tomographic study of the chest and neck for investigation of expiratory stridor. Following the scout scan, severe laryngospasm developed. While no cause for the laryngospasm was found, the computed axial tomographic chest study showed marked changes in the lungs consistent with absorption atelectasis which we postulate occurred secondary to laryngospasm.
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Anaesth Intensive Care · Sep 2011
Case ReportsAnaesthetic management of emergency caesarean section in a patient with seizures and likely raised intracranial pressure due to tuberculous meningitis.
We report the anaesthetic management of a term pregnant woman with active tuberculous meningitis, who had experienced seizures, had signs of raised intracranial pressure and required emergency caesarean section. Peripartum anaesthetic management of a patient with tuberculous meningitis is a rare event.