Anaesthesia and intensive care
-
Anaesth Intensive Care · Mar 2014
Glycaemic control and long-term outcomes following transition from modified intensive insulin therapy to conventional glycaemic control.
This retrospective observational cohort study compared glycaemic control and long-term outcomes following transition from a modified intensive insulin therapy (mIIT) regimen to conventional glycaemic control (CGC) in adult patients admitted to a tertiary adult general intensive care unit, during two 24-month periods, before and after the publication of the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial. The before NICE-SUGAR cohort received mIIT (target glycaemic ranges 4.4 to 7.0 mmol/l), while the after NICE-SUGAR cohort received CGC (target glycaemic range 7.1 to 9.0 mmol/l). A total of 5202 patients were included in the study. ⋯ Changes in recommended glycaemic control were translated into practice, with increased glycaemic indices and decreased rates of severe and moderate hypoglycaemia after the introduction of CGC. The associated decrease in 90-day mortality suggests mIIT was not superior to CGC, despite a lower hypoglycaemia rate than in previous IIT trials. Our findings support the continued use of CGC.
-
Anaesth Intensive Care · Mar 2014
Randomized Controlled TrialEffects of different general anaesthetic techniques on immune responses in patients undergoing surgery for tongue cancer.
The aim of this study was to investigate the effects of different general anaesthesia techniques on immune responses in patients undergoing surgery for tongue cancer. Sixty American Society of Anesthesiologists physical status 1 or 2 patients undergoing elective reconstructive surgery for tongue cancer were randomised to three groups. Group 1 received propofol induction and maintenance (TIVA), group 2 received propofol induction and sevoflurane maintenance (MIXED) and group 3 received sevoflurane induction and maintenance (SEVO). ⋯ The percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios were significantly lower in the MIXED groups and SEVO groups but not the TIVA group at T6 as compared with T0 (P <0.05). There were minor but statistically significant differences in the percentages of CD3(+) cells, CD3(+)CD4(+) cells and natural killer cells, and the CD4(+)/CD8(+) ratios between the SEVO group and the TIVA group at T2approxT6 (P <0.05). These findings suggest that propofol has slightly less effect on cellular immune responses than sevoflurane.
-
Anaesth Intensive Care · Mar 2014
The effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing subsequent simulated 'Can't Intubate, Can't Oxygenate' scenarios.
The decision to attempt a percutaneous airway in a recognised 'Can't Intubate, Can't Oxygenate' (CICO) situation may occur too late to avoid a poor outcome. Our study was designed to investigate the effect of high-fidelity simulation on the confidence and decision-making ability of anaesthesia trainees in managing CICO scenarios in subsequent simulation. Nine anaesthesia trainees from Logan Hospital participated. ⋯ The median number of deviations from the Difficult Airway Society algorithm was 0 for the simulation group compared to 1 for the non-simulation group. This small study suggests that high-fidelity simulation shortens the decision-making time of anaesthesia trainees in subsequent simulated CICO scenarios. This observation warrants follow-up in larger prospective trials.