Anaesthesia
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We report the first known case of acute upper and lower airway obstruction due to retropharyngeal haemorrhage secondary to acquired haemophilia A. The patient required tracheal intubation and ventilation followed by surgical tracheostomy, prior to transfer to the intensive care unit for management of her coagulopathy with recombinant clotting factor products under the care of the haematologists.
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Randomized Controlled Trial Comparative Study
Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy.
Pain after craniotomy remains a significant problem. The effect of morphine and tramadol patient-controlled analgesia (PCA) on arterial carbon dioxide tension is unknown in patients having such surgery. Sixty craniotomy patients were randomly allocated to receive morphine PCA, tramadol PCA or codeine phosphate 60 mg intramuscularly. ⋯ Morphine produced significantly better analgesia than tramadol at all time points (p < 0.005) and better analgesia than codeine at 4, 12 and 18 h. Patients were more satisfied with morphine than with codeine or tramadol (p < 0.001). Vomiting and retching occurred in 50% of patients with tramadol, compared with 20% with morphine and 29% with codeine.
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Multicenter Study
The use of single-use devices in anaesthesia: balancing the risks to patient safety.
Single-use devices are designed, manufactured and sold to be used once and then discarded. This paper addresses growing concerns about the quality of some devices. ⋯ Interview data suggests that when choosing to use a single-use device, clinicians balance concerns about the risk of infection against those about the risk of injury. However, despite reservations about induced harm and the unknown risk of an iatrogenic disease, most clinicians would want single-use devices used on themselves and their family if they were patients.
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Case Reports
Fatal neuroglycopaenia after accidental use of a glucose 5% solution in a peripheral arterial cannula flush system.
A patient on an Intensive Care Unit who was recovering from multiple organ failure was being given an intravenous infusion of insulin to maintain normoglycaemia. On her 20th day in the unit, she suddenly became unresponsive. A cerebrovascular accident was suspected as other clinical and laboratory parameters remained normal apart from a blood glucose value of 20.6 mmol.l(-1). ⋯ The prolonged period of severe hypoglycaemia led to neuroglycopaenia and irreversible brain injury. The patient died 9 days later without regaining consciousness. Such a complication has not previously been reported in this context and has particular significance given the increasing use of insulin therapy to maintain normoglycaemia in critically ill patients.