Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2005
ReviewAcute pain management pharmacology for the patient with concurrent renal or hepatic disease.
The clinical utility of most analgesic drugs is altered in the presence of patients with impaired renal or hepatic function not simply because of altered clearance of the parent drug, but also through production and accumulation of toxic or therapeutically active metabolites. Some analgesic agents may also aggravate pre-existing renal and hepatic disease. A search was performed, taking in published articles and pharmaceutical data to determine available evidence for managing acute pain effectively and safely in these two patient groups. ⋯ The agent least subject to alteration in this context is remifentanil; however the drugs' potency has other inherent dangers. Other agents must only be used with caution and close patient monitoring. Amitriptyline, carbamazepine and valproate should be avoided as the risk of fulminant hepatic failure is higher in this population, and methadone is contraindicated in the presence of severe liver disease.
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Anaesth Intensive Care · Jun 2005
Biography Historical ArticleVivian Richard Ebsary, A.M. biomedical engineer, inventor, philanthropist.
Vivian Ebsary was an inventor, designer and manufacturer of varied pieces of medical equipment, particularly those involving pumps. These included hypothermia machines and the heart-lung cardiopulmonary bypass machines used in Australian and New Zealand hospitals from the mid 1950s until well into the 1970s. Ebsary also designed and manufactured anaesthetic machines, a hyperbaric unit, scoliosis implant equipment, a chairlift and many other devices for use in the general community. This paper presents an overview of his life's involvement with medicine and medical technology in Australia.
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Anaesth Intensive Care · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialComparative study between propofol in a long-chain triglyceride and propofol in a medium/long-chain triglyceride during sedation with target-controlled infusion.
This study was performed to compare the pharmacological characteristics of propofol in an emulsion of both medium- and long-chain triglycerides (MCT/LCT) with those of propofol in an LCT emulsion, by measuring the sedative level and the plasma concentration of propofol during sedation using a target-controlled infusion (TCI) technique. Forty ASA 1 or 2 adult patients who required spinal anaesthesia for surgery were enrolled in this study. The patients were divided into two groups: a propofol LCT group (n = 20) and a propofol MCT/LCT group (n = 20). ⋯ There were no significant differences between the two groups in BIS index or in plasma concentration of propofol at each predicted concentration. Computer-generated TCI of propofol MCT/LCT during sedation is comparable with that of propofol LCT with respect to pharmacokinetics and pharmacodynamics. The formulation of MCT/LCT has a beneficial effect with respect to less pain on injection.
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Anaesth Intensive Care · Jun 2005
ReviewOutcome-based clinical indicators for intensive care medicine.
The clinical indicator is a tool used to monitor the quality of health care. Its use in the Intensive Care Unit (ICU) is desirable for many reasons: the maintenance of minimum standards, the development of best practice and the delivery of cost-effective health care. ⋯ Monitoring of adverse events, system descriptors, and resource indicators is valuable but they have a limited relationship to the quality of care. ICU mortality prediction models provide a global measure of quality and, despite their inherent deficiencies, remain one of the most robust and useful clinical indicators.