Anaesthesia and intensive care
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Anaesth Intensive Care · May 2009
Randomized Controlled Trial Comparative StudyRemifentanil-induced abdominal pain: a randomised clinical trial.
Remifentanil is an ultra-short-acting opioid, widely used for induction and maintenance of anaesthesia in various types of operations. We recently noted that a great number of patients receiving remifentanil in their anaesthetic regimen experienced postoperative abdominal pain. As a result, we performed this study to investigate its incidence. ⋯ Abdominal pain was observed in 79 patients (52.6%) in the remifentanil group, 10 of whom required a therapeutic intervention, but in only three patients in the control group, none of whom required an intervention (P value = 0.001). Postoperative nausea and vomiting were reported in seven and 10 patients (4.7%) in the remifentanil and control group, respectively. These findings indicate that abdominal pain is very common in patients receiving remifentanil by infusion for cataract surgery.
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Anaesth Intensive Care · May 2009
ReviewPoint-of-care assessment of antiplatelet agents in the perioperative period: a review.
The aim of this paper was to review the strengths and limitations of current 'point-of-care' techniques for the detection of antiplatelet drug effects. The review was based on a Medline search for articles with key words related to "platelet function tests", "point-of-care", and "anaesthesia", published in English between January 1996 and September 2008. It was found that global assessments of 'haemostasis', such as the standard thrombelastograph, Sonoclot, Clot Signature Analyser and Hemodyne, are not specific for platelet function and are essentially insensitive to cyclooxygenase inhibitors (aspirin, non-steroidal anti-inflammatory drugs) and P2Y12 antagonists (ticlopidine, clopidogrel). ⋯ All three categories of devices detect G(p)II(b)/III(a) antagonists (abciximab, tirofiban, eptifibatide) activity, but not all provide quantitative assessments for monitoring therapy. The limitations appeared to be related to the complexity of platelet function, the multiple pathways of platelet activation, the wide interpatient variability in platelet responses and the interdependence between platelets and other aspects of coagulation. The strengths and limitations of point-of-care devices should be appreciated before they are used to assist clinical decision-making in the perioperative period.
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Our 850-bed, academic, tertiary care hospital uses a four-bed dedicated 'shock room' situated between the Departments of Emergency Medicine and Intensive Care to stabilise all acutely ill patients from outside or inside the hospital before transfer to the intensive care unit or other department. Admitted patients stay a maximum of four hours in the shock room. ⋯ After diagnosis and initial treatment, 54% of patients were transferred to an intensive care unit or a coronary care unit; 2.5% of patients died in the shock room. The shock room provides a useful area of collaboration between emergency department and intensive care unit staff and enables acutely ill patients to be assessed and treated rapidly to optimise outcomes.
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Anaesth Intensive Care · May 2009
Randomized Controlled Trial Comparative StudyEase of Proseal Laryngeal Mask Airway insertion and its fibreoptic view after placement using Gum Elastic Bougie: a comparison with conventional techniques.
The Proseal Laryngeal Mask Airway (PLMA) is routinely inserted by the digital and introducer tool techniques but a newer Gum Elastic Bougie (GEB) guided insertion technique has been described. The aims and objectives were to compare the ease of PLMA insertion and fibreoptic view of PLMA after placement using GEB and conventional techniques. Ninety-six ASA I or II patients of either gender aged 18 to 60 years, scheduled for elective surgery under general anaesthesia in the supine position were included in this study. ⋯ Time taken for successful placement was significantly shorter in the GEB-guided group after two attempts (G 22 +/- 2 seconds, I 31.9 +/- 18.8 seconds, D 29.5 +/- 18.6 seconds, P < 0.05). The fibreoptic view through the airway tube was significantly better in the GEB-guided group (P < 0.01). Incidence of trauma was significantly less in the GEB-guided group (P < 0.05).