Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2010
A retrospective observational study examining the admission arterial to end-tidal carbon dioxide gradient in intubated major trauma patients.
Major trauma patients who are intubated and ventilated are exposed to the potential risk of iatrogenic hypercapnic and hypocapnic physiological stress. In the pre-hospital setting, end-tidal capnography is used as a practical means of estimating arterial carbon dioxide concentrations and to guide the adequacy of ventilation. In our study, potentially deleterious hypercapnia (mean 47 mmHg, range 26 to 83 mmHg) due to hypoventilation was demonstrated in 49% of 100 intubated major trauma patients arriving at a major Australian trauma centre. ⋯ However in this study, scene and arrival patient hypoxia was more predictive of hypoventilation and an increased arterial to end-tidal carbon dioxide gradient than physiological markers of shock. Greater vigilance for hypercapnia in intubated trauma patients is required. Additionally, a larger study may confirm that lower end-tidal carbon dioxide levels could be safely targeted in the pre-hospital and emergency department ventilation strategies of the subgroup of major trauma patients with scene hypoxia.
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Anaesth Intensive Care · Mar 2010
Patients' understanding of technical terms used during the pre-anaesthetic consultation.
Communication between patients and anaesthetists is being recognised as an increasingly important aspect of clinical care. Patients need to understand the nature and consequences of any proposed procedure prior to giving informed consent. In this regard, anaesthetists have a responsibility to provide adequate information about anaesthesia and related procedures in a form that patients are likely to understand. ⋯ We have identified many technical terms that may not be understood by patients presenting for anaesthesia care. An awareness of commonly misunderstood words may facilitate better transfer of information during pre-anaesthesia consultations. Our study findings should remind doctors that patients frequently fail to understand or take in what we tell them.
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Anaesth Intensive Care · Mar 2010
Randomized Controlled TrialThe effect of transdermal nitroglycerine on intrathecal fentanyl with bupivacaine for postoperative analgesia following gynaecological surgery.
Fentanyl is a short-acting synthetic opioid with spinal analgesic properties and dose-dependent side-effects. The analgesic effect of opioids is mediated in part through activation of inhibitory descending pain pathways involving nitric oxide (as a central neurotransmitter) through the NO-cGMP system. This NO-cGMP pathway plays an important role in spinal nociception. ⋯ The times to two-segment regression in group F-N and group F were 132.87 +/- 31.2 min and 126.40 +/- 26.81 min respectively. The visual analog scale pain score at the time of the first rescue analgesic was similar in all groups. We conclude that nitroglycerine does not result in postoperative analgesia but enhances the analgesic effect of intrathecal fentanyl.
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Anaesth Intensive Care · Mar 2010
Randomized Controlled TrialA randomised controlled trial of hyperbaric bupivacaine with opioids, injected as either a mixture or sequentially, for spinal anaesthesia for caesarean section.
It is common practice to mix opioids with hyperbaric bupivacaine in a single syringe before intrathecal injection of the mixture. Mixing these drugs may alter the density of the hyperbaric solution, affecting the spread of local anaesthetic and opioid. Forty-eight women having elective caesarean section under spinal anaesthesia were recruited to this double-blind, randomised trial. ⋯ There was no difference between groups in the incidence of hypotension, need for vasopressor or side-effects. Morphine consumption was significantly higher in group M (13.3 +/- 11.2 vs. 6.2 +/- 7.2 mg, P = 0.015). Mixing of fentanyl and morphine with hyperbaric bupivacaine results in a higher level of sensory block than sequential administration of bupivacaine then opioid and may be associated with higher postoperative opioid requirement.
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Anaesth Intensive Care · Mar 2010
ReviewRegional anaesthesia for bilateral upper limb surgery: a review of challenges and solutions.
Regional anaesthesia for bilateral upper limb surgery can be challenging, yet surgeons are becoming increasingly interested in performing bilateral procedures at the same operation. Anaesthetists have traditionally avoided bilateral brachial plexus block due to concerns about local anaesthetic toxicity, phrenic nerve block and pneumothorax. We discuss these three concerns and review whether advances in ultrasound guidance and nerve catheter techniques should make us reconsider our options. ⋯ Since phrenic nerve block remains an issue even with low doses of local anaesthesia, bilateral interscalene blocks are still not recommended. Peripheral nerve blocks have excellent safety profiles and are ideal for ultrasound guidance. Regional anaesthesia can be a suitable option for bilateral upper limb surgery.