Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Jun 2019
Observational StudyAdmission to surgical intensive care unit in time with intensivist coverage and its association with postoperative 30-day mortality: The role of intensivists in a surgical intensive care unit.
This study aimed to investigate the association between postoperative surgical Intensive Care Unit (ICU) admission during a time when there was intensivist coverage and 30-day mortality after ICU admission. ⋯ This study showed an increase in post-operative 30-day mortality, and length of hospital and ICU stay for surgical ICU admission among those without intensivist coverage.
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Anaesth Crit Care Pain Med · Jun 2019
Meta AnalysisLevosimendan in patients with low cardiac output syndrome undergoing cardiac surgery: A systematic review and meta-analysis.
Levosimendan is an inotropic agent that has been shown in small studies to treat low cardiac output syndrome in cardiac surgery. However, large randomised controlled trials (RCTs) have been recently published and presented neutral results. We sought to determine the effect of levosimendan on mortality in adults with low ejection fraction undergoing cardiac surgery. ⋯ Our meta-analysis showed no significant difference between levosimendan versus placebo mortality at 30-day [odds radio (OR): 0.62; 95% confidence intervals (CI): 0.32 to 1.20; I2 = 33%; high quality evidence] and mortality beyond 30-day (OR: 0.71; 95% CI: 0.46 to 1.11; I2 = 0%). Similarly, there were no significant differences between the levosimendan versus placebo in the incidence of acute kidney injury (OR: 0.61, 95% CI: 0.33-1.13) and myocardial infarction (OR: 0.41, 95% CI: 0.08 to 1.22). The current evidence suggests that levosimendan is not associated with significantly reduced mortality in patients with reduced ejection fraction undergoing cardiac surgery.
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Anaesth Crit Care Pain Med · Apr 2019
Review Historical ArticleOpioid-free anaesthesia. Why and how? A contextual analysis.
If the use of natural opiates, such as opium, is more than millennial, the history of synthetic opioids begins after 1950, with the development of the so-called 'modern' anaesthetic techniques. In 1962, in Belgium, the use of fentanyl, the first synthetic opioid for use in anaesthesia, is described. Subsequently, the use of opioids at high doses during surgery became common. ⋯ The so-called opioid-free anaesthesia (OFA) techniques were developed in parallel with a better understanding of perioperative pain. In this work, the following questions are addressed: Why is the human body producing endogenous opioids? Is the concept of pain valid during general anaesthesia? What are the effects of intraoperative opioids on postoperative pain? Is anaesthesia without opioids actually possible? With these questions, the reader can question the use of intraoperative opioids within an historical and evolutionary perspective. In the same time, if OFA is feasible, the research agenda still includes a formal testing of its added value over classical opioid-sparing techniques.
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Anaesth Crit Care Pain Med · Apr 2019
Comparative Study Observational StudyComparison of Proaqt/Pulsioflex® and oesophageal Doppler for intraoperative haemodynamic monitoring during intermediate-risk abdominal surgery.
To compare cardiac index (CI) between Proaqt/PulsioFlex® and oesophageal Doppler (OD) and the ability of the PulsioFlex® to track CI changes induced by fluid challenge and secondly to assess the impact of the time interval between two auto-calibrations of PulsioFlex® on the accuracy of the measured CI. ⋯ The Proaqt/Pulsioflex® system is not equivalent to OD for haemodynamic monitoring during non-vascular abdominal surgery in intermediate-risk patients. More studies are required to define the effect of the auto-calibration on the system.