Anaesthesia and intensive care
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Anaesth Intensive Care · May 2012
Randomized Controlled TrialThe effect of body mass index on spinal anaesthesia for total knee replacement arthroplasty: a dose-response study.
The aim of this study was to compare the duration of spinal anaesthesia in obese and non-obese subjects. We also quantified the effect of body mass index (BMI) on spinal anaesthesia by comparing the median effective dose (ED50) of intrathecal hyperbaric bupivacaine required in the two cohorts. One hundred and eight patients undergoing elective total knee replacement arthroplasty under combined spinal-epidural anaesthesia were enrolled as a non-obese group (BMI <27.5 kg/m(2)) or obese (O) group (BMI ≥ 27.5 kg/m(2)). ⋯ However, the incidence of tourniquet pain was lower in group O and the ED50 for block of tourniquet pain was less in group O. This study suggests that bupivacaine dose reduction is not necessary, but analgesic duration may be prolonged in patients with higher BMI. These patients require careful consideration of spinal anaesthetic dose to minimise the risk of unnecessary prolongation of anaesthesia.
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Anaesth Intensive Care · May 2012
Donation after cardiac death in Queensland: review of the pilot project.
Organ transplantation is a viable therapeutic option for patients with endstage organ failure when other therapies have been exhausted. Donation after cardiac death (DCD) is re-emerging as a potential option to expand the donor pool to meet an increasing demand for organ transplantation. In this review, we evaluate the evolution of the Queensland DCD pilot project since its inception in August 2008. ⋯ The DCD pilot project resulted in an increase in solid organ transplantation in Queensland. It allowed the development of policies to facilitate DCD, in accordance with state's legislation and DonateLife practices. If implemented state-wide, the program has the potential to be an effective way to improve organ donation rates in Queensland.
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Anaesth Intensive Care · May 2012
Comparative StudyLactate/pyruvate ratio as a marker of tissue hypoxia in circulatory and septic shock.
In this prospective, observational study, we measured arterial lactate and pyruvate concentrations within the first four hours of shock and at four hour intervals during the first 24 hours in 26 patients with septic and 13 with cardiogenic shock. We also studied 10 intensive care unit patients with normal lactate levels as controls. Seven patients (18%) died during the first 24 hours of shock, 12 (31%) patients died later in the intensive care unit and 21 (54%) were discharged alive from the intensive care unit. ⋯ All patients with cardiogenic shock had hyperlactataemia at the onset of shock, and 69% had a high lactate/pyruvate ratio. Only 65% of patients with septic shock had hyperlactataemia at the onset of shock and 76% of these also had a high lactate/pyruvate ratio. In conclusion, the lactate/pyruvate ratio confirms that hyperlactataemia is frequently, but not solely, due to hypoxia, especially at the onset of shock.
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Anaesth Intensive Care · May 2012
Case ReportsSuccessful perioperative management of a patient with C1 esterase inhibitor deficiency with a novel bradykinin receptor B2 antagonist.
We present the case of a 28-year-old female with a previous diagnosis of C1 esterase inhibitor deficiency presenting for dental extractions under general anaesthesia. Following prophylaxis with a new bradykinin receptor 2 antagonist (icatibant), surgery was carried out uneventfully with an unremarkable postoperative course.