Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2025
The Bruck inhaler: An ether inhaler misattributed to Ludwig Bruck, an Australian medical publisher and supplier of medical equipment.
The acquisition of an early ether inhaler stimulated research into several inhalers classified as Bruck inhalers. Ludwig Hermann Bruck was a German migrant who arrived in Australia in 1873. He became a medical publisher, importer of medical instruments, and made unique contributions to early Australian medical publishing, most significantly as the first publisher of The Australasian Medical Gazette. ⋯ Bruck committed suicide in August 1915 before the case was heard in court. We did not find any evidence that Bruck designed the inhaler later attributed to him. The Bruck inhaler is functionally similar to the Probyn-Williams inhaler and should therefore be regarded as a glass-domed version of this inhaler.
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Anaesth Intensive Care · Jan 2025
Effects of polymyxin B haemoperfusion on septic shock caused by Gram-positive bacteria.
Polymyxin B haemoperfusion is commonly used to adsorb endotoxins in septic shock caused by Gram-negative bacterial infections. Polymyxin B haemoperfusion has been reported to improve hypotension in Gram-positive bacterial infections; however, its efficacy and mechanism in treating such cases are unclear. We hypothesised that polymyxin B haemoperfusion would be equally effective in improving haemodynamics during Gram-positive bacterial infections as in Gram-negative bacterial infections. ⋯ Although there was no significant difference in the VIS in polymyxin B haemoperfusion between patients with GNR and GPC infections, there was a significant decrease in the VIS over time, even when GPC was the causative organism. In addition, the degree of reduction in the VIS was significantly different in both the GNR and GPC groups compared with that in the non-extracorporeally treated group. Thus, polymyxin B haemoperfusion for septic shock caused by GNR reduced the VIS and could be effective even in cases of GPC infection.
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Anaesth Intensive Care · Jan 2025
The effect of type of anaesthetic on delirium after surgery for acute hip fracture: An instrumental variable analysis to assess causation.
Delirium is the most common in-hospital complication affecting older adults with acute hip fractures. Current evidence demonstrates inconsistent associations between anaesthetic type for acute hip fracture surgery and postoperative delirium. Using the Australian and New Zealand Hip Fracture Registry database, we conducted a retrospective cohort study of patients aged 50 years and over who underwent acute hip fracture surgery between 2015 and 2020. ⋯ After adjusting for known confounders, general anaesthesia patients were at slightly increased odds of developing delirium (OR 1.14, 95% CI 1.04 to 1.25, P = 0.0052). However, the instrumental variable analysis found no statistically significant difference between groups (OR 1.03, 95% CI 0.99 to 1.07, P = 0.141). Therefore, while a weak association was found between general anaesthesia exposure and postoperative delirium, an instrumental variable analysis to compensate for unmeasured confounding showed no causal association between general anaesthesia and postoperative delirium.
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Anaesth Intensive Care · Jan 2025
A feasibility study of measuring maternal anaemia and postoperative outcomes after caesarean section.
SummaryIron-deficiency anaemia (IDA) is a global health problem. The impact of IDA on outcomes in obstetric patients who undergo caesarean section (CS) is unknown. We assessed the feasibility of conducting a large study to investigate perioperative anaemia and outcomes after CS. ⋯ The prevalence of participants discharged with IDA was unquantifiable. Postoperative IDA in obstetric patients is likely to be a serious problem that is currently unrecognised. Our data suggest that a definitive study to determine associations between maternal anaemia and perioperative outcomes after CS surgery is feasible.