Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2008
Clinical TrialNon-invasive cardiac output measurement using a fast mixing box to measure carbon dioxide elimination.
This study investigated the accuracy of a new technique for measuring cardiac output using the derivative Fick principle based on the ratio of change in the partial pressures of end-tidal and mixed expired carbon dioxide produced by short periods of partial rebreathing. A prospective clinical study involving 24 patients following cardiopulmonary bypass for coronary artery bypass grafting or valvular surgery was undertaken in the intensive care unit of a university-affiliated hospital. Haemodynamic measurements were performed after admission to the intensive care unit. ⋯ Cardiac output measurement using the new technique demonstrated a significant but consistent underestimate, with a bias of -0.60 +/- 0.87 l/min. This new adaptation of the partial rebreathing technique is reliable in measuring cardiac output in postoperative patients. Reasons for the consistent discrepancy between thermodilution and partial rebreathing techniques are discussed.
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Anaesth Intensive Care · Sep 2008
Antimicrobial effects of two anaesthetic agents: dexmedetomidine and midazolam.
Some anaesthetic agents are known to inhibit microbial growth. The aim of this in vitro study was to investigate possible antimicrobial effects of two frequently used agents in intensive care units, dexmedetomidine and midazolam. Antimicrobial effect was tested on Staphylococcus aureus, Enterococcus faecalis, Escherichia coli and Pseudomonas aeruginosa by broth microdilution method. ⋯ Midazolam had inhibitor and bactericidal effects on S. aureus and E. faecalis. Dexmedetomidine had only inhibitor effects on S. aureus, E. coli and P aeruginosa. Further studies are needed to determine the antimicrobial mechanisms and clinical applications.
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Anaesth Intensive Care · Sep 2008
Glomerular hyperfiltration and albuminuria in critically ill patients.
Glomerular hyperfiltration and albuminuria are two pathological conditions that could alter renal drug elimination, but they have been rarely studied in a critical care setting. The aims of this descriptive, prospective study performed on 89 critically ill patients are to determine rates of glomerular hyperfiltration (main objective) and albuminuria (secondary objective). ⋯ Seventy-five percent showed albuminuria on admission, with rates remaining high throughout the week of the study. Since glomerular hyperfiltration as well as albuminuria are frequent pathophysiological conditions in critical care patients, the implications that these phenomena may have regarding drug elimination need further evaluation.
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Dreaming is reported by one in five patients who are interviewed on emergence from general anaesthesia, but the incidence, predictors and consequences of dreaming during procedural sedation are not known. In this prospective observational study, 200 patients presenting for elective colonoscopy under intravenous sedation were interviewed on emergence to determine the incidences of dreaming and recall. Sedation technique was left to the discretion of the anaesthetist. ⋯ Frank recall of the procedure was reported by 4% of the patients, which was consistent with propofol doses commensurate with light general anaesthesia. The only significant predictor of recall was lower propofol dose. Satisfaction with care was generally high, however dreamers were more satisfied with their care than non-dreamers.
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Anaesth Intensive Care · Sep 2008
Letter Randomized Controlled TrialLimiting peak plasma concentration effectively decreases remifentanil-induced coughing during target-controlled infusion.