Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2000
Case ReportsPostoperative fibrinolysis diagnosed by thrombelastography.
Thrombelastography is a useful method for the monitoring of bedside coagulation, especially for fibrinolysis. We report a case where thrombelastography facilitated early detection of fibrinolysis with significant clinical bleeding in a patient immediately following hip replacement surgery. The early diagnosis enabled institution of antifibrinolytic therapy and monitoring of the patient's response. It is likely to have led to less blood product transfusion and may possibly have prevented unnecessary surgical re-exploration.
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Anaesth Intensive Care · Feb 2000
Sevoflurane anaesthesia with the Komesaroff vaporizer inside the circle system.
This study assessed the safety of sevoflurane anaesthesia using two Komesaroff vaporizers inside the circle with both spontaneous and controlled ventilation. Sevoflurane concentrations were continuously monitored using a mass spectrometer and the anaesthetic depth was easily controlled. ⋯ With continuous monitoring of sevoflurane concentrations, induction and maintenance of anaesthesia using a vaporizer inside the circle is safe during both controlled and spontaneous ventilation. However the high incidence of involuntary movements may limit the feasibility of induction in spontaneously breathing patients.
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Anaesth Intensive Care · Feb 2000
Randomized Controlled Trial Clinical TrialEffect of timing of ondansetron administration on incidence of postoperative vomiting in paediatric strabismus surgery.
This prospective, randomized, double-blinded study evaluated the effect of the timing of ondansetron administration on its antiemetic efficacy in children undergoing elective strabismus surgery. One hundred and twenty children aged one to 15 years, ASA physical status 1 or 2, were randomly allocated to receive intravenous ondansetron 100 micrograms/kg either at induction (Group 1) or at the end of the surgery (Group 2). All patients had general anaesthesia induced and maintained with nitrous oxide and halothane, muscle relaxation with vecuronium, endotracheal intubation, reversal with neostigmine and glycopyrrolate, and pethidine 0.5 mg/kg analgesia. ⋯ The incidence of emesis in the first 24 hours following surgery was similar in both groups (35% Group 1, 33.3% Group 2, P = 1.00). Severity of emesis (median number of emetic episodes, rescue antiemetic requirement and mean time to the onset of first episode of emesis) and mean time to discharge from the post anaesthesia care unit were also similar in the two groups. We conclude that the timing of ondansetron administration either before or after the surgical manipulation of extraocular muscles had similar antiemetic efficacy following strabismus surgery in children.
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Anaesth Intensive Care · Feb 2000
Randomized Controlled Trial Clinical TrialMorphine-sparing effect of ketoprofen after abdominal surgery.
In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P < 0.05), we have determined that the administration of two doses of intravenous ketoprofen 100 mg, one at the end of surgery and the second 12 hours postoperatively, was associated with a significant reduction in morphine consumption at eight (P = 0.028), 12 (P = 0.013) and 24 hours (P = 0.013) but not four hours (P = 0.065) postoperatively, as compared to placebo, when assessed by patient-controlled analgesia. There was no difference between the groups in pain scores or in the incidence of nausea and vomiting. ⋯ There were no other adverse effects. The results of this study show that ketoprofen does provide a morphine-sparing effect in the management of postoperative pain after abdominal surgery.
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Anaesth Intensive Care · Feb 2000
Case ReportsFixed, dilated pupils in the ICU: another recoverable cause.
A 41-year-old woman presented unconscious with fixed dilated pupils following a massive overdose of carbamazepine and an unknown quantity of venlafaxine prescribed for the management of bipolar affective disorder. Her course in the intensive care unit was marked by a number of complications related to the overdose including prolonged coma, seizures and cardiac arrest. The patient eventually recovered to leave hospital.