Anaesthesia and intensive care
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Anaesth Intensive Care · May 2014
Long-term outcomes of minor troponin elevations in the intensive care unit.
The aim of our study is to determine the short-term and long-term outcomes of intensive care unit (ICU) patients with minor troponin elevations. The retrospective study compared ICU patients with peak troponin elevation less than 0.1 ng/ml to those with only negative tests during their hospital stay. Data were gathered from ICUs at Beth Israel Deaconess Medical Center between 2001 and 2008. ⋯ Minor elevations in troponin substantially increase one-year, all-cause mortality in a stepwise fashion; it was also independently associated with 30-day mortality. We propose that minor elevations in troponin should not be regarded as clinically unimportant, but rather be included as a prognostic element if measured. We recommend prospective ICU studies to assess prognostic value of routine troponin determination.
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Anaesth Intensive Care · May 2014
A technique of placing cuffed endotracheal tubes through in situ paediatric laryngeal mask airways.
If tracheal intubation is not possible using direct laryngoscopy, one option is to use a laryngeal mask airway (LMA) through which an endotracheal tube (ETT) can be passed. In children, however, the size of an uncuffed ETT that can pass through the lumen of an LMA is sometimes too small for the trachea, resulting in gas leakage around the ETT. Using a cuffed ETT may reduce the gas leak but withdrawal of the LMA is then prevented by the pilot balloon. ⋯ The task was easy to perform. Subsequent repair of the cuff-inflation tubing was effective and could withstand high pressures. These findings indicate that it is possible to pass cuffed ETTs through paediatric LMA lumens, which can provide ventilation without gas leaks, unlike uncuffed ETTs.
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Anaesth Intensive Care · May 2014
Randomized Controlled Trial Comparative StudyComparison of the effect of propofol and sevoflurane anaesthesia on acute and chronic postoperative pain after hysterectomy.
There is some evidence that propofol may reduce acute postoperative pain; however, the results are inconsistent. Furthermore, there is a paucity of information about the type of anaesthesia and chronic pain. This study was designed to evaluate the hypothesis that propofol reduces acute and chronic postoperative pain compared with sevoflurane. ⋯ Persistent surgical pain was observed less frequently (7 out of 40 patients in the propofol group and 21 out of 40 in the sevoflurane group at three months post-surgery, P <0.01) and pain scores were lower at one and three months in the propofol group (0.78±0.55 versus 2.23±0.73 for the sevoflurane group at three months post-surgery, P <0.01). Anxiety and depression scores were significantly lower in the propofol group at three months. In this study, general anaesthesia with propofol was associated with reduced early acute postoperative and persistent pain, compared to sevoflurane-based anaesthesia, among patients undergoing open abdominal hysterectomy.
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Anaesth Intensive Care · May 2014
Randomized Controlled TrialEffect of statins on insulin requirements during non-cardiac surgery.
Statins are thought to potentially impair glucose metabolism, increasing plasma glucose concentration. The effect of prolonged statin use on glucose metabolism among outpatients is thus well established. However, the impact of statin use on glucose concentrations and insulin requirements during surgery remains poorly characterised and may very well differ considering the substantial hyperglycaemic stress response to surgery. ⋯ While the total amount of intraoperative insulin used was not statistically different between the statin users and non-users, we observed a potentially important trend toward insulin resistance intraoperatively among statin users during major non-cardiac surgery. This result is consistent with non-operative settings and cardiac surgery. Further investigation is essential to determine whether this effect is real and, if so, determine which specific statins are more associated with insulin resistance.