Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2007
ReviewThe use of statins in intensive care unit patients with sepsis.
The incidence of sepsis is increasing and remains the leading cause of death in critically ill patients. The statin group of drugs appear to have important anti-inflammatory effects and may have a role in the treatment of sepsis. However, current prescribing guidelines recommend that statin therapy is discontinued in critically ill patients. We found no evidence to support commencing statin therapy in patients with sepsis on an intensive care unit and low levels of evidence to support continuing established therapy in this patient population.
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Anaesth Intensive Care · Apr 2007
Comparative StudyChanging from epidural to multimodal analgesia for colorectal laparotomy: an audit.
In April 2002 our practice ceased routine use of epidural analgesia for colorectal laparotomy in favour of a six-drug multimodal regimen comprising ketamine, clonidine, morphine, tramadol, paracetamol and a non-steroidal anti-inflammatory drug. The records of 54 patients who received this multimodal analgesia regimen (MM) after April 2002 were compared to the 59 patients who had previously received epidural analgesia (EPI). Patients had the same surgeon and anaesthetist. ⋯ MM patients had shorter anaesthetic preparation time (20 +/- 8 min vs. 32 +/- 8 min, P < 0.001), shorter high-dependency unit stay (0.4 +/- 1.2 days vs. 4.5 +/- 0.9 days, P < 0.001), and shorter hospital stay (10 +/- 4 days vs. 13 +/- 8 days, P = 0.003). In our practice, changing from epidural to multimodal analgesia produced comparable pain relief with reduction in anaesthesia preparation time, high-dependency unit stay and hospital stay and the requirement for staff interventions. There was also a reduction in the incidence of major complications and side-effects.
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Anaesth Intensive Care · Apr 2007
ICU staffing: identification and survey of staff involved in providing technical support services to Australian and New Zealand intensive care units.
We conducted a survey of all (200) Australian and New Zealand intensive care units to determine the presence and nature of staff employed in a technical support role. Specifically, we attempted to identify staff who are formally employed in a role where they are directly responsible for the equipment used in intensive care. Of 130 returned surveys, 80 units (62%) reported not having any personnel in this role. ⋯ The most common duties performed were equipment troubleshooting (92%), training (80%), equipment evaluation (80%), ordering supplies (77%), consumable evaluation (75%), equipment cleaning (73%), delivery of supplies (70%), handling product recalls (65%), equipment maintenance (65%) and sitting on hospital committees (52%). This is the first attempt to identify and understand the technical support role in Australian and New Zealand intensive care units. Numerous issues remain and future work will hopefully add to our findings, with the possibility of formal recognition of the role, training and/or accreditation and its extension into other hospital departments.
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Anaesth Intensive Care · Apr 2007
The cardiovascular effects of adrenaline, dobutamine and milrinone in rabbits using pressure-volume loops and guinea pig isolated atrial tissue.
This study evaluated the effects of milrinone, adrenaline and dobutamine with pressure-volume loops and isolated atrial tissue. Agonist dose-response curves to incremental drug infusions were acquired in 11 anesthetised rabbits using pressure-volume loops and preload recruitable stroke work indicated contractility. Agonist concentration-response curves were completed in eight guinea pig isolated atria, for effects on atrial rate and force. ⋯ Adrenaline decreased heart rate (P < 0.001), whereas dobutamine and milrinone increased it (P = 0.006 and 0.011). Milrinone increased the force of left atrial contraction, but its inotropic effect was weak and significantly less than with dobutamine and adrenaline (P < 0.001). Adrenaline acted as an inoconstrictor, dobutamine an inodilator and milrinone predominantly a vasodilator
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Anaesth Intensive Care · Apr 2007
Editorial Comment Comparative StudyEpidural vs. multimodal analgesia for colorectal laparotomy.