Anaesthesia
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The clinical features of propofol infusion syndrome (PRIS) are acute refractory bradycardia leading to asystole, in the presence of one or more of the following: metabolic acidosis (base deficit > 10 mmol.l(-1)), rhabdomyolysis, hyperlipidaemia, and enlarged or fatty liver. There is an association between PRIS and propofol infusions at doses higher than 4 mg.kg(-1).h(-1) for greater than 48 h duration. Sixty-one patients with PRIS have been recorded in the literature, with deaths in 20 paediatric and 18 adult patients. ⋯ Predisposing factors include young age, severe critical illness of central nervous system or respiratory origin, exogenous catecholamine or glucocorticoid administration, inadequate carbohydrate intake and subclinical mitochondrial disease. Treatment options are limited. Haemodialysis or haemoperfusion with cardiorespiratory support has been the most successful treatment.
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Comment Letter Case Reports
Pre-emptive use of haloperidol in ICU to prevent emergence agitation.
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Randomized Controlled Trial Comparative Study
A comparison of the clinical use of the Laryngeal Tube S and the ProSeal Laryngeal Mask Airway by first-month anaesthesia residents in anaesthetised patients.
The Laryngeal Tube S and the LMA-ProSeal are supraglottic instruments with an improved airway seal and a drainage tube to protect against regurgitation and to facilitate passage of a gastric tube. We compared the feasibility of these two instruments in a randomised, controlled clinical trial. One hundred and sixty patients were randomly allocated to undergo insertion of a Laryngeal Tube S (n = 82) or an LMA-ProSeal (n = 78). ⋯ Gastric tube placement was successful in all patients in the Laryngeal Tube S group, but failed in 12 patients in the LMA-ProSeal group (p < 0.001). Dysphagia was reported by 22% of Laryngeal Tube S group and 3% of LMA-ProSeal group (p = 0.001). These findings demonstrate the applicability of the devices and a learning effect in the hands of anaesthesia residents with limited experience.
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Randomized Controlled Trial Comparative Study
Effect site concentration during propofol TCI sedation: a comparison of sedation score with two pharmacokinetic models.
Target controlled infusion (TCI) pumps function using a programme based on a pharmacokinetic/pharmacodynamic model. We compared the Marsh and Schnider models to find out which better correlates with the clinically observed effect of propofol as assessed by the Observer Assessment of Alertness/Sedation (OAAS) score and the Bispectral index. ⋯ We calculated the effect site concentration predicted by both models for all the patients. Changes in the sedation score and Bispectral index correlated better with the Marsh than with the Schnider effect site prediction in both study groups.