Anaesthesia and intensive care
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Anaesth Intensive Care · May 2011
Randomized Controlled TrialMini-ventilation for improved oxygenation during lung resection surgery.
Lung separation is frequently used during lung resection to facilitate surgery and hypoxaemia may occur because of increasing pulmonary shunt. In this study, we tested a method of mini-ventilation to the non-dependent lung and compared it to continuous positive airway pressure (CPAP) to improve oxygenation during lung resection. Thirty-eight adult patients participated in this randomised, single-blinded crossover study. ⋯ The surgical conditions were similar with both methods in 53% of the patients, while the surgeon preferred CPAP in 44% and mini-ventilation in 3%. In conclusion, mini-ventilation is a simple method which improves oxygenation during lung resection. However due to interference with surgical field exposure, it should be reserved for cases in which CPAP does not relieve hypoxaemia.
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Anaesth Intensive Care · May 2011
Randomized Controlled TrialEffect of daily sedative interruption on sleep stages of mechanically ventilated patients receiving midazolam by infusion.
Daily sedative interruption (DSI) may reduce excessive sedation and shorten the duration of mechanical ventilation. It is not clear, however, how DSI affects sleep characteristics. For patients receiving mechanical ventilation, we compared the effect on sleep quality of DSI and continuous sedation (CS). ⋯ In the DSI group, the amount of stage 3 and 4 non-rapid eye movement sleep (slow wave sleep) was longer (6 vs 0 minutes, P = 0.04) and rapid eye movement sleep was longer than in CS (54 vs 0 minutes, P = 0.02). In the CS group, total sleep time during night-time was longer (8.7 vs 7.3 hours, P = 0.047) and frequency of arousal was lower (2.2 vs 4.4 event/hour, P = 0.03) than those in the DSI group. All mechanically ventilated patients demonstrated abnormal sleep architecture, but, compared with CS, DSI increased the amount of slow wave sleep and rapid eye movement sleep.
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Anaesth Intensive Care · May 2011
Case ReportsSuccessful treatment of peripartum massive pulmonary embolism with extracorporeal membrane oxygenation and catheter-directed pulmonary thrombolytic therapy.
Chronic thromboembolic pulmonary hypertension during pregnancy is uncommon but is associated with maternal mortality in excess of 35%. We report a case of decompensated thromboembolic pulmonary hypertension requiring emergency caesarean section and postpartum treatment with extracorporeal membrane oxygenation and thrombolytic therapy with urokinase. The use of extracorporeal membrane oxygenation, catheter-directed pulmonary thrombolytic therapy and other pulmonary vasodilators for management of this life-threatening disease is discussed.
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Anaesth Intensive Care · May 2011
Observational study of anaesthetists' fresh gas flow rates during anaesthesia with desflurane, isoflurane and sevoflurane.
Reducing excessive fresh gas flow rates (FGF) is an established and simple strategy to reduce the administration of volatile anaesthetic agents. We studied clinicians' FGF use to understand better why two previous clinical trials achieved significant reductions in FGF by using feedback to anaesthetists. Anaesthesia information management system data from a US academic medical centre were analysed retrospectively. ⋯ Even if all anaesthetists had identical mean FGF, the standard deviation of FGF among cases would be reduced by less than 0.1 l/minute for all agents. Most of the achievable reductions in FGF were small reductions in FGF for the many cases with < 3 l/minute. These results show that departments choosing to use inexpensive automatic email feedback on FGF should target all anaesthetists and focus on variation in FGF among anaesthetists' cases.
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Anaesth Intensive Care · May 2011
Comment Letter Case ReportsThe use of sugammadex to reverse rocuronium in a patient with myotonic dystrophy.