Anaesthesia and intensive care
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We describe a case of a patient undergoing open abdominal aneurysm surgery who developed a severe, life-threatening allergic reaction immediately after administration of sugammadex. The manifestation was purely a cardiovascular collapse. ⋯ Sugammadex was confirmed as the cause of the anaphylaxis by a positive intradermal allergy test (25 mm diameter response to 1:100 dilution), with a normal saline control and a negative response to the other drugs used during the event. This case report is a reminder that the use of sugammadex is associated with rare but serious risks.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialPatient factors associated with frequent clotting of dialysers during haemodiafiltration in critically ill patients: a post hoc analysis of a randomised controlled study.
Continuous haemodiafiltration (CVVHDF) is the main form of renal replacement therapy in critically ill patients with severe acute kidney injury. Clotting of the dialysers during CVVHDF is frequent, because most patients with acute kidney injury have an increased risk of bleeding and cannot be systemically anticoagulated. Using data from a randomised controlled trial comparing the efficiency of CVVHDF by placing the dialysis catheter tip at the right atrium or superior vena cava, this study assessed the patient factors associated with an increased risk of frequent clotting of the dialysers-defined by >1 dialysers clotted per day of CVVHDF. ⋯ Use of aspirin or clopidogrel, causes of acute kidney injury and daily dose of unfractionated heparin used were not significantly associated with the risk of frequent clotting of dialysers. In the multivariate parsimony model, only a high body mass index (odds ratio 1.06 per point increment, 95% confidence interval 1.01 to 1.13; P=0.036) and a high platelet count (odds ratio 1.84 per 100x10(9)/l increment, 95% confidence interval 1.17 to 2.91; P=0.009), both in a relatively linear fashion, were independently associated with an increased risk of frequent clotting of dialysers. Optimising the position of the tip of the dialysis catheter may be particularly important for patients with a high body mass index and platelet count in order to reduce frequent clotting of dialysers during CVVHDF.
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Anaesth Intensive Care · Jan 2014
Case ReportsIntraoperative anaphylaxis to sugammadex and a protocol for intradermal skin testing.
Sugammadex is a selective binding agent for aminosteroid neuromuscular blockers whose use is increasing in anaesthetic practice. We present three cases of severe anaphylaxis coincident with sugammadex administration. ⋯ As all patients were administered sugammadex to reverse neuromuscular blockade with rocuronium, we considered that sugammadex-rocuronium complexes were a potential unique allergen. In the two patients who were additionally tested with a rocuronium-sugammadex (3.6:1 molecular ratio) mixture, the wheal-and-flare response was significantly attenuated.
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Anaesth Intensive Care · Jan 2014
Randomized Controlled TrialA randomised controlled trial of parecoxib, celecoxib and paracetamol as adjuncts to patient-controlled epidural analgesia after caesarean delivery.
The benefit of combining non-opioid analgesics with neuraxial opioids for analgesia after caesarean delivery has not been clearly established. Larger doses of paracetamol or cyclooxygenase-2 inhibitors have not been evaluated. A randomised, double blind, double-dummy, parallel group placebo-controlled clinical trial was conducted among women having elective caesarean delivery under spinal anaesthesia, followed by pethidine patient-controlled epidural analgesia. ⋯ There were no differences between groups for pethidine consumption, based on either intention-to-treat (median 365, 365, 405 and 360 mg in groups C, PC, PA and PCPA respectively, P=0.84) or per protocol analysis (17 major violations). Dynamic pain scores did not differ between groups but requirement for, and dose of, supplementary oral tramadol was least in group PCPA (incidence 23% versus 48%, 70% and 58% in groups C, PC and PA respectively, P=0.004). The addition of regular paracetamol, cyclooxygenase-2 inhibitors or both to pethidine patient-controlled epidural post-caesarean analgesia did not provide a pethidine dose-sparing effect during the first 24 hours.