Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2013
ReviewInterventional neuroradiological procedures-a review for anaesthetists.
Interventional neuroradiology is a rapidly expanding field, and the complexity and duration of these procedures makes anaesthetic support essential to their success. Such has been the development in this area, that the American Heart Association has published a scientific statement on the indications for these procedures. ⋯ This article will cover the management of intracranial aneurysms, cerebral vasospasm following intracranial haemorrhage, intracranial and spinal arteriovenous malformations, idiopathic intracranial hypertension, carotid artery stenting, intra-arterial thrombolysis for stroke and endovascular treatment of intracranial atherosclerosis. Protection from ionising radiation and acute kidney injury are also discussed.
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Lung protective ventilation limiting tidal volumes and airway pressures were proven to reduce mortality in patients with acute severe respiratory failure. Hypercapnia and hypercapnic acidosis is often noted with lung protective ventilation. ⋯ To the contrary, some clinicians do not tolerate hypercapnic acidosis and use various techniques including extracorporeal carbon dioxide elimination to treat hypercapnia and acidosis. This review aims at defining the effects of hypercapnia and hypercapnic acidosis with a focus on the pros and cons of clearing carbon dioxide and the modalities that may enhance carbon dioxide clearance.
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Anaesth Intensive Care · Mar 2013
ReviewIs suppression of apoptosis a new therapeutic target in sepsis?
Sepsis remains as a leading cause of death in critically ill patients. Unfortunately, there have been very few successful specific therapeutic agents that can significantly reduce the attributable mortality and morbidity of sepsis. ⋯ In this review article, we summarise the critical role of apoptosis of the immune cells in the pathophysiology of sepsis and propose that blocking cell-signaling pathways leading to apoptosis may present a promising specific therapy for sepsis. Various methods to inhibit apoptosis including the cell surface Fas receptor pathway inhibitors, caspase inhibitors, over-expression of anti-apoptotic genes and small interfering ribonucleic acid therapy are discussed.
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Anaesth Intensive Care · Mar 2013
Simulation training for rare medications in the intensive care unit-a study with bivalirudin.
The purpose of this study was to assess whether simulation training can improve the clinician's ability to predict the effect of bivalirudin infusion. Six clinicians with experience using bivalirudin and six without experience (Groups Exp and NoExp) entered predictions for partial thromboplastin time while viewing a running display of clinical data obtained retrospectively from intensive care unit patients who had received bivalirudin infusion after cardiac surgery. All clinicians entered guesses for the same sequence of 30 patients. ⋯ The guessing-errors of Group NoExp were significantly higher than Group Exp in the first and second terciles, with no significant difference in the third tercile. Linear regression indicated a significantly steeper learning curve in Group NoExp than Exp. Brief simulation training using retrospective patient data improved the ability of inexperienced clinicians to predict the effect of bivalirudin as compared to experienced clinicians.