Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2002
The cerebrovascular effects of adrenaline, noradrenaline and dopamine infusions under propofol and isoflurane anaesthesia in sheep.
Infusions of catecholamines are frequently administered to patients receiving propofol or isoflurane anaesthesia. Interactions between these drugs may affect regional circulations, such as the brain. The aim of this animal (sheep) study was to determine the effects of ramped infusions of adrenaline, noradrenaline (10, 20, 40 micrograms/min) and dopamine (10, 20, 40 micrograms/kg/min) on cerebral blood flow (CBF), intracranial pressure (ICP), cerebrovascular resistance (CVR) and cerebral metabolic rate for oxygen (CMRO2). ⋯ Under propofol and isoflurane anaesthesia, the cerebrovascular effects of catecholamines were significantly different from the awake, physiological state, with dopamine demonstrating the most pronounced effects, particularly under propofol. Dopamine-induced hyperaemia was associated with other cerebrovascular changes. In the presence of an equivalent effect on mean arterial pressure, the exaggerated cerebrovascular effects under anaesthesia appear to be centrally mediated, possibly induced by propofol- or isoflurane-dependent changes in blood-brain barrier permeability, thereby causing a direct influence on the cerebral vasculature.
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Anaesth Intensive Care · Dec 2002
Randomized Controlled Trial Clinical TrialThe effects of intravenous lignocaine on haemodynamics and seizure duration during electroconvulsive therapy.
Electroconvulsive therapy (ECT) is commonly associated with acute hyperdynamic cardiovascular responses, and we hypothesize that intravenous lignocaine can blunt this response. We have measured the effect of lignocaine 1.5 mg/kg i.v. on heart rate and mean arterial pressure during electroconvulsive therapy. Furthermore, we also assessed seizure duration using both the cuff method and two-lead electroencephalography. ⋯ The use of intravenous lignocaine was, however, associated with a remarkably shortened seizure duration. Due to the reduction in seizure duration, routine administration of intravenous lignocaine may not be advisable since it may interfere with the psychotherapeutic efficacy of electroconvulsive therapy. However, intravenous lignocaine medication for electroconvulsive therapy is potentially useful for reducing tachycardia in high-risk patients and reducing the severity of propofol injection pain in comparison with a placebo.
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Anaesth Intensive Care · Dec 2002
Reliability of procalcitonin as a severity marker in critically ill patients with inflammatory response.
Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. ⋯ PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.
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Anaesth Intensive Care · Dec 2002
Transient lumbar pain after 5% hyperbaric lignocaine spinal anaesthesia in patients having minor vascular surgery.
Transient lumbar pain has been reported to occur frequently in patients having surgery using 5% hyperbaric lignocaine for spinal anaesthesia. The incidence of transient lumbar pain is highest with this agent in patients having surgery in the lithotomy position and in outpatients. The aim of this audit was to determine the incidence of transient lumbar pain in patients having minor surgery for the complications of peripheral vascular disease, a group of patients in whom short duration spinal anaesthesia is desirable. ⋯ All patients had 5% hyperbaric lignocaine spinal anaesthesia and were followed up postoperatively utilizing a standardized questionnaire to determine the incidence of transient lumbar pain. The condition was found to occur in 4% of patients. This low incidence of transient lumbar pain justifies the continued use of 5% hyperbaric lignocaine for spinal anaesthesia in this group of patients.
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An intellectually impaired adult with a history of escalating violence towards hospital personnel was given an anaesthetic in his home prior to transfer to hospital for surgery. We review the implications and problems encountered, and suggest means by which such a retrieval can occur smoothly.