Anaesthesia and intensive care
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Melatonin is a substance chiefly produced by the pineal gland and has a key role in the sleep-wake cycle. It also has an important antioxidant role. Exogenous melatonin has a short half-life and is available in a range of preparations. ⋯ The antioxidant properties of melatonin are being investigated for use in sepsis and reperfusion injuries. It would appear that patients on melatonin supplements should continue taking them perioperatively because there may be benefits. Melatonin and its analogues will be increasingly encountered in the perioperative setting.
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Anaesth Intensive Care · Mar 2011
Randomized Controlled TrialNon-invasive ventilation after extubation in patients with chronic obstructive airways disease: a randomised controlled trial.
Non-invasive positive pressure ventilation (NPPV) is a well established therapy for acute respiratory failure in patients with chronic obstructive pulmonary disease, however its role in post-extubation period is uncertain. The objective of this study was to find the effect of NPPV on rate of re-intubation, intensive care unit and hospital stay, and physiological parameters in severe chronic obstructive pulmonary disease patients after planned extubation. Forty patients with severe chronic obstructive pulmonary disease were randomised immediately after planned extubation to receive NPPV (n=20) or conventional therapy (n=20). ⋯ Reintubation rate among NPPV (15%) and conventional (25%) were similar (P=0.44). The duration of intensive care unit stay after extubation (2.05 +/- 2.15 vs 1.55 +/- 0.82 days, P=0.34) and hospital stay (16.10 +/- 6.29 vs 18.25 +/- 7.91 days, P=0.34) in both groups were comparable. Given the load of chronic obstructive pulmonary disease patients and wide availability of NPPV it is safe to recommend its use in these patients soon after extubation, although clear benefit is not documented in this study.
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Anaesth Intensive Care · Mar 2011
Comparative StudyResponses to dural puncture during institution of combined spinal-epidural analgesia: a comparison of 27 gauge pencil-point and 27 gauge cutting-edge needles.
Pencil-point spinal needles are popular for combined spinal-epidural analgesia because they cause less dural puncture headache than cutting-edge spinal needles. However many parturients move, grimace, vocalise or experience paraesthesia or dysaesthesia during dural puncture when performing 'needle through needle' combined spinal-epidural analgesia. We compared dural puncture responses induced by pencil-point and cutting-edge needles (both 27 gauge). ⋯ Pooled data analysis revealed that pencil-point and cutting-edge needles induced grimacing and movement in 17 (22%) and 2 (5%), spontaneous vocalisation in 4 (5%) and 1 (3%) and was perceived by 13 (17%) and 3 (8%) parturients (P < 0.025, P=NS, P=NS), respectively. Overall, 34 and 6 objective and subjective patient responses (P < 0.005) occurred when inserting these needles, respectively. Dural puncture by a 27 gauge pencil-point needle inserted 'needle through needle' when instituting combined spinal-epidural analgesia induces more iatrogenic responses than a 27 gauge cutting-edge needle.
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Anaesth Intensive Care · Mar 2011
Preferences of critical care registrars in fluid resuscitation of major trauma patients: concordance with current guidelines.
Fluid resuscitation of patients with major trauma remains a controversial topic. We hypothesised that current practice amongst critical care registrars at our centre might differ from current clinical guidelines. Sixty-six registrars from anaesthesia, intensive care and emergency medicine completed a survey giving their preferences for fluid resuscitation in major trauma patients. ⋯ In addition, participants would transfuse an older patient (P=0.02) or an actively bleeding patient (P < 0.01) earlier than the younger or not visibly bleeding trauma patient. We concluded that our study demonstrated general consistency with current clinical guidelines but with interesting interdepartmental variations. We suggest that this type of study could enhance clinical practice by pointing to targeted additional learning opportunities.