Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2012
Clinical TrialLignocaine plasma levels following topical gel application in laparoscopic and hysteroscopic procedures.
The study aim was to determine plasma lignocaine concentrations resulting from topical application of a newly formulated, sterile two-pack lignocaine gel in laparoscopic and hysteroscopic procedures. This was an open label single-centre study in which six female patients underwent laparoscopy and six underwent hysteroscopy. One venous blood sample was extracted pre-gel application, followed by 10 samples over a 24 hour period following application. ⋯ Application of gel in doses between 2.7 and 5.8 mg/kg of lignocaine resulted in a maximum plasma concentration in any patient of 1520 ng/ml lignocaine and 240 ng/ml monoethyl-glycinexylidide. These maximum concentrations were recorded in a patient undergoing a laparoscopic procedure and patients undergoing hysteroscopic procedures all recorded lower maximum concentrations compared with patients undergoing laparoscopy; the maximum observed concentrations in a patient having a hysteroscopy were 420 ng/ml lignocaine and 56 ng/ml of monoethyl-glycinexylidide. A new sterile two-pack topical lignocaine gel, applied at the end of laparoscopic and hysteroscopic procedures in doses up to 5.84 mg/kg, resulted in plasma lignocaine levels below those known to have the potential to cause central nervous system toxicity.
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The demand for increased patient safety has led to greater use of simulation training of health professionals performing medical procedures. The study aim was to evaluate the usefulness of the Mediseus® Epidural Simulator in teaching basic epidural needle-handling skills. Three groups of 15 anaesthetists (Novice=zero to two year anaesthesia trainees; Intermediate=three- to five-year anaesthesia trainees; Expert=consultants and regional-specialist anaesthetists) from three different medical centres participated. ⋯ Each group rated the usefulness of the simulator for training novices at greater than 3.0 out of 5.0. The Mediseus® Epidural Simulator seems to be an appropriate training device for an introduction to epidural needle insertion. For medical professionals with procedural knowledge, the simulation is not realistic enough and the simulator did not distinguish between the groups based on the errors made.
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Anaesth Intensive Care · Mar 2012
ReviewHistamine-releasing and allergenic properties of opioid analgesic drugs: resolving the two.
Opioid analgesics are amongst the most commonly administered drugs in hospitals. Whether natural or synthetic, they show some common structural features, morphine-like pharmacological action and binding specificity for complementary opioid receptors. Tramadol differs from the other opioid analgesics in possessing monoaminergic activity in addition to its affinity for the µ opioid receptor. ⋯ Despite their heavy use and occasional apparent anaphylactic-like side-effects, immunoglobulin E antibody-mediated immediate hypersensitivity reactions to the drugs are not often encountered. Uncertainties associated with skin testing with these known histamine-releasers, and the general unavailability of opioid drug-specific immunoglobulin E antibody tests contribute to the frequent failure to adequately investigate and establish underlying mechanisms of reactions by distinguishing anaphylactoid from true anaphylactic reactions. Clinical implications for diagnosis of reactions and some speculations on the rarity of true Type 1 allergies to these drugs are presented.
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Anaesth Intensive Care · Mar 2012
Clinical TrialAn observational study exploring amplitude-integrated electroencephalogram and spectral edge frequency during paediatric anaesthesia.
Processed electroencephalography is used in adults to guide anaesthesia, but the algorithms used may not apply to infants. Knowledge of infants' electroencephalogram (EEG) responses to anaesthetics is fragmentary. An earlier pilot study suggested amplitude-integrated EEG (aEEG) may be a useful measure of anaesthetic effect. ⋯ These findings suggest that SEF90 and aEEG can discriminate between awake and anaesthetised states in older children. In younger children aEEG changes are less pronounced and SEF90 either cannot discriminate between states or responds paradoxically. The aEEG may be marginally better than other EEG parameters in measuring anaesthetic depth in children.
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Anaesth Intensive Care · Mar 2012
Performance of the PIRO score for predicting mortality in patients with ventilator-associated pneumonia.
The ventilator-associated pneumonia (VAP) PIRO score is a new scoring system based on the PIRO concept. The aim of this study was to validate the PIRO score against the Acute Physiology and Chronic Health Evaluation (APACHE) II and VAP APACHE II in an independent group of VAP patients. Areas under the receiver operating characteristic curves were compared to determine the tests' abilities to predict intensive care unit and 28-day mortality. ⋯ Variables independently associated with intensive care unit mortality were bacteraemia (adjusted odds ratio 7.16, 95% confidence interval 1.19 to 42.98, P=0.03) and APACHE II (1.06, 1.01 to 1.11, P=0.006). VAP PIRO score was not a good predictor of intensive care unit and 28-day mortality. The low sensitivity and specificity of VAP PIRO score preclude its use clinically.