Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialRandomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions.
The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. ⋯ Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
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Trauma is the leading non-obstetric cause of maternal death. Optimal management of the pregnant trauma patient requires a multidisciplinary approach. The anaesthetist and critical care physician play a pivotal role in the entire continuum of fetomaternal care, from initial assessment, resuscitation and intraoperative management, to postoperative care that often involves critical care support and patient transfer. ⋯ Recognizing and understanding the mechanisms of injury, the factors that may predict fetal outcome, and the pathophysiological changes that can result from trauma, will allow early identification and treatment of fetomaternal injury. This in turn should improve morbidity and mortality. A framework for the acute care of the pregnant trauma patient is presented.
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Anaesth Intensive Care · Apr 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparison of oxygen cost of breathing between pressure-support ventilation and airway pressure release ventilation.
We compared the oxygen cost of breathing between pressure-support ventilation (PSV) and airway pressure release ventilation (APRV). This prospective, randomized, crossover study was conducted in a mixed ICU of a university hospital. Twenty clinically stable and spontaneously breathing patients after long-term mechanical ventilation were included. ⋯ There were no statistically significant differences with regard to respiratory rate, minute volume, and blood gas analysis. All patients tolerated both ventilatory modes without signs of discomfort. PSV and APRV produced similar results in terms of oxygen cost of breathing and other metabolic variables.
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Serotonin syndrome results from excessive activation of serotonin (5-hydroxytryptamine; 5-HT) receptors in the nervous system, on the surface of platelets, and on the vascular endothelium. The clinical manifestations are a triad of altered conscious state, autonomic dysfunction, and neuromuscular excitability. Clinical diagnostic criteria remain poorly defined and unvalidated, and there are no available investigations to confirm the diagnosis. ⋯ Neuromuscular excitability is likely to be the cause of rhabdomyolysis seen in severe cases and should be treated with benzodiazepines and muscle relaxants. Supportive therapies are required to treat hyperthermia and autonomic dysfunction. Cyproheptadine is the most commonly administered serotonergic antagonist, but is unavailable in parenteral form.
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Anaesth Intensive Care · Apr 2005
Randomized Controlled Trial Clinical TrialThe ProSeal laryngeal mask airway size selection in male and female patients in an Asian population.
The aim of this study was to investigate if size 5 compared with size 4 ProSeal laryngeal mask airway (PLMA) in Asian men and size 4 compared with size 3 ProSeal laryngeal mask airway (PLMA) in Asian women, would give a better glottic seal. We conducted a randomized crossover study involving 30 male and 30 female patients of Asian origin. Size 4 and size 5 PLMA were studied in men and size 3 and size 4 PLMA were studied in women. ⋯ The mean volume of air required to achieve an intracuff pressure of 60 cmH2O was less than the maximum recommended by the manufacturers. The size 5 PLMA in Asian men and size 4 PLMA in Asian women resulted in a more effective glottic seal. The use of size 5 PLMA in Asian men led to increased mucosal injury.