Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 1993
Comparative StudyChemical dependence in anaesthetic registrars in Australia and New Zealand.
The Supervisors of Anaesthetic Training in Australia and New Zealand were surveyed and asked to report any cases of chemical dependence from anaesthetic registrars at their hospital from 1981 to 1991. From 83 questionnaires there were 65 (78%) returned. There were 14 departments (22%) with experience of one or more cases during this interval. ⋯ It is estimated that 1.3% of those who entered anaesthetic training during the interval were recognised to become chemically dependent during their training. Follow-up was available on only six of the 13 registrars and only one was reported to have completed training. The results of this survey indicate that chemical dependence is already a major health problem amongst anaesthetic registrars in Australia and New Zealand.
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Anaesth Intensive Care · Apr 1993
Randomized Controlled Trial Comparative Study Clinical TrialHigh-dose adrenaline in adult in-hospital asystolic cardiopulmonary resuscitation: a double-blind randomised trial.
Forty intensive care unit patients requiring cardiopulmonary resuscitation were randomised to receive either the standard dose of adrenaline (1 mg every five minutes) or high-dose adrenaline (10 mg every five minutes). In the majority of patients, overwhelming sepsis was the major contributing factor leading to cardiac arrest. In this group of patients no difference could be detected in response to high-dose adrenaline compared with the standard dose. Although no side-effects were noted with this high dose of adrenaline, more investigation is required prior to its routine use in cardiopulmonary resuscitation.
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Anaesth Intensive Care · Apr 1993
Randomized Controlled Trial Clinical TrialBackground infusion with patient-controlled analgesia: effect on postoperative oxyhaemoglobin saturation and pain control.
The aim of this study was to determine whether the addition of a background infusion (BI) to patient-controlled analgesia (PCA) would lead to significantly improved pain control or poorer oxyhaemoglobin saturation (SpO2) after gynaecological surgery. Sixty-two patients were studied for 24 hours postoperatively; pain scores and morphine dose were recorded hourly, SpO2 was recorded every 10 seconds. ⋯ Despite the increased morphine dose pain scores also were similar in the two groups. Addition of a BI at 1 mg/hr did not confer any advantage over PCA alone and is not recommended when PCA is used in this patient group.
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Anaesth Intensive Care · Apr 1993
Aminoglycoside volume of distribution and illness severity in critically ill septic patients.
The volume of distribution of amikacin and the APACHE II score were determined in 42 critically ill patients being treated for a gram-negative infection. The mean volume of distribution (Vdt) was 0.41 +/- 0.12 l/kg with a wide range (normal of 0.25 l/kg). ⋯ Critically ill patients should receive larger loading doses of aminoglycosides in order to achieve therapeutic blood levels. The aminoglycoside Vdt may be useful in determining the degree of capillary leak and tissue oedema that accompanies sepsis.
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Chronic phenytoin therapy causes resistance to some nondepolarising muscle relaxants. We have confirmed that this resistance is seen with vecuronium and suggest that at least a week of phenytoin therapy is required for a significant effect to develop. ⋯ We have shown that an exaggerated rise in serum potassium after succinylcholine does not occur in patients with demonstrated resistance to vecuronium from chronic phenytoin therapy. This would suggest that significant extrajunctional acetylcholine receptor proliferation is an unlikely mechanism.