Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2009
Case ReportsThe use of "ketofol" (ketamine-propofol admixture) infusion in conjunction with regional anaesthesia.
We present four patients in whom a "ketofol" (ketamine 200 mg and propofol 200 mg) infusion was used in conjunction with regional anaesthesia. The patients were considered 'high risk' due to their medical condition or age. The ketofol proved safe and effective in all four cases. Advantages of this technique included analgesia, airway preservation, maintenance of spontaneous respiration, haemodynamic stability and rapid recovery.
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Anaesth Intensive Care · Jan 2009
Comparative StudyDose requirements for propofol anaesthesia for dental treatment for autistic patients compared with intellectually impaired patients.
We had clinical grounds to suspect that patients with autism had greater propofol requirements during dental procedures than patients with intellectual impairment without autism. This hypothesis was tested by an audit of a standard anaesthetic technique. The audit was approved by our Hospital Ethics Committee. ⋯ The propofol infusion rates of the intellectually impaired group showed significant decline with age (propofol rate of requirement mg x kg(-1) x h(-1), mean [SD]): < six years 13.6 (3.6), seven to 19 years 9.5 (3.0) (P = 0.008 cf < six years group), > 19 years group 8.5 (2.4) (P = 0.001 cf < six years group). The propofol requirement was greater in the autism group than in the intellectual disability group, and the proportion of the cases where bolus propofol administration was needed after induction was significantly higher in the autistic patient group than in the intellectually impaired patients (P < 0.002). This suggests that autistic patients have greater propofol requirements for anaesthesia during ordinary dental treatment compared with intellectually impaired patients.
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Anaesth Intensive Care · Jan 2009
Letter Case ReportsAprepitant for postoperative nausea and vomiting.
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Anaesth Intensive Care · Jan 2009
Changes in serum procalcitonin and C-reactive protein following antimicrobial therapy as a guide to antibiotic duration in the critically ill: a prospective evaluation.
Serial procalcitonin is reported to be useful to titrate duration of antibiotic therapy in the non critically ill patient with pneumonia. The aim of this study was to examine the relationship between antibiotic therapy and serial serum procalcitonin concentrations in a cohort of critically ill septic patients and examine for any differences between culture positive (CP) and culture negative (CN) sepsis. Seventy-five critically ill patients with suspected sepsis were enrolled in this prospective observational study. ⋯ The mean procalcitonins in the relapsed subgroup were lower than those in the remission subgroup (P = 0.02). Therapy for proven or presumed infections was associated with declining serum procalcitonin and C-reactive protein in critically ill septic patients. The marked variability and overlap in plasma profile of these markers between CP and CN sepsis makes it difficult to define a nadir plasma concentration at which one can recommend discontinuation of antibiotic therapy.
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Anaesth Intensive Care · Jan 2009
Dose-related effect of propofol on pancreatic enzymes and triglyceride levels in patients undergoing non-abdominal surgery.
Various case reports have indicated a possible relationship between propofol and pancreatitis. However, it is not clear whether this relationship (if any) is dose-related or idiosyncratic. Therefore, a prospective study was conducted to evaluate the effect of different doses of propofol on postoperative pancreatic enzymes and serum triglyceride levels. ⋯ These values did not differ significantly in between the groups even despite the significantly different doses of propofol in the three groups (P < 0.001). None of the patients in the three groups developed any feature suggestive of acute pancreatitis in the postoperative period. These findings indicate that propofol administration at recommended doses does not produce dose-related increases in pancreatic enzyme and triglyceride levels in ASA physical status I and II patients.