Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2007
Randomized Controlled Trial Comparative StudyEffects of reduction of the caudal morphine dose in paediatric circumcision on quality of postoperative analgesia and morphine-related side-effects.
This study compared the efficacy and adverse effects of three low doses of morphine (10, 15 and 30 microg x kg(-1)) for caudal epidural analgesia in children undergoing circumcision. A total of 135 boys undergoing out-patient circumcision were randomly assigned to receive 10, 15 or 30 microg x kg(-1) of caudal morphine. Anaesthesia was induced and maintained with propofol. ⋯ Pruritus occurred in 8.9%, 11% and 15.6% in the 10, 15 and 30 microg.kg(-1) groups but was localised and did not require treatment. This study was not powered to assess concerns that low dose epidural morphine may rarely be associated with delayed apnoea and is therefore considered unsuitable for outpatient use in many centres. Increases in caudal morphine dose above 10 microg.kg1 produce some 'paracetamol sparing' but no improvement in analgesia, some pruritus and a significant increase in nausea and vomiting.
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Anaesth Intensive Care · Oct 2007
Case ReportsInspiratory muscle training to enhance weaning from mechanical ventilation.
This report describes the use of specific inspiratory muscle training to enhance weaning from mechanical ventilation in a patient who had failed conventional weaning strategies. A 79-year-old man remained ventilator-dependent 17 days following laparotomy. ⋯ By day 27, mechanical ventilation was no longer required. Inspiratory muscle training can be implemented effectively in the difficult to wean patient and should be considered for patients who have failed conventional weaning strategies.
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Anaesth Intensive Care · Oct 2007
Multicenter StudyAnticoagulation, bleeding and blood transfusion practices in Australasian cardiac surgical practice.
We surveyed contemporary Australasian cardiac surgical and anaesthetic practice, focusing on antiplatelet and antifibrinolytic therapies and blood transfusion practices. The cohort included 499 sequential adult cardiac surgical patients in 12 Australasian teaching hospitals. A total of 282 (57%) patients received red cell or component transfusion. ⋯ Despite frequent (67%) use of antifibrinolytic therapy, there was a marked variability in red cell transfusion rates between centres (range 17 to 79%, P < 0.001). This suggests opportunities for improvement in implementation of guidelines and effective blood-sparing interventions. Many patients presenting for surgery receive antiplatelet and/or antifibrinolytic therapy, yet the subsequent benefits and risks remain unclear.