Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2012
Randomized Controlled Trial Comparative StudyPostoperative plasma paracetamol levels following oral or intravenous paracetamol administration: a double-blind randomised controlled trial.
In day-case surgery paracetamol is commonly given orally preoperatively, or intravenously intraoperatively. In this double-blind randomised controlled trial we investigated which of these methods of administration achieved therapeutic plasma levels most effectively in the early postoperative period. Thirty patients undergoing day case arthroscopy of the knee were randomised to receive either 1.0 g oral paracetamol 30 to 60 minutes preoperatively (20 patients) or 1.0 g intravenous paracetamol intraoperatively (10 patients). ⋯ There was no difference in pain scores between groups. Intraoperative administration of 1.0 g of intravenous paracetamol more reliably achieved effective paracetamol levels in the early postoperative period compared to an equal dose given orally preoperatively. Only a minority of patients receiving the 1.0 g oral dose preoperatively had plasma levels in the therapeutic analgesic range.
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Anaesth Intensive Care · Jan 2012
Randomized Controlled Trial Comparative StudyVentilator versus manual hyperinflation in clearing sputum in ventilated intensive care unit patients.
The aim of hyperinflation in the ventilated intensive care unit patient is to increase oxygenation, reverse lung collapse and clear sputum. The efficacy and consistency of manual hyperventilation is well supported in the literature, but there is limited published evidence supporting hyperventilation utilising a ventilator. Despite this, a recent survey established that almost 40% of Australian tertiary intensive care units utilise ventilator hyperinflation. ⋯ The effect of techniques on the PaO2/FiO2 response ratio was dependent on time (interaction P=0.024). Physiotherapy using ventilator hyperinflation cleared a comparable amount of sputum and was as safe as manual hyperinflation. This research describes a ventilator hyperinflation protocol that will serve as a platform for continued discussion, research and development of its application in ventilated patients.
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Anaesth Intensive Care · Jan 2012
Randomized Controlled TrialL-arginine cardioplegia reduces oxidative stress and preserves diastolic function in patients with low ejection fraction undergoing coronary artery surgery.
PL-arginine cardioplegia decreases biochemical markers of myocardial damage and oxidative stress in patients with normal left ventricular function. We investigated the effects of L-arginine supplemented cardioplegic arrest in patients with reduced ejection fraction. Fifty-three adult patients with left ventricular ejection fraction <35% undergoing elective coronary artery bypass surgery were randomised to receive blood cardioplegia with or without L-arginine. ⋯ There was no difference in left ventricular systolic function. The mitral annular tissue Doppler inflow (e') velocity during early diastole improved in the L-arginine group following cardiopulmonary bypass (control 4.2 ± 1.9 cm.s(-1) to 3.6 ± 1.2 cm.s(-1) vs L-arginine 3.8 ±1.2 cm.s(-1) to 4.6 ± 1.4 cm.s(-1)) (P=0.018). In patients with reduced ejection fraction, L-arginine supplemented cardioplegic arrest did not affect postoperative cardiac troponin-I levels, but attenuated cardiac cellular peroxidation and improved early left ventricular diastolic function.
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Anaesth Intensive Care · Nov 2011
Randomized Controlled Trial Comparative StudyComparison of the Bonfils and Levitan optical stylets for tracheal intubation: a clinical study.
The Bonfils and Levitan FPS scopes are rigid fibreoptic stylets that may assist routine or difficult intubation. This study compared the effectiveness of each in patients with predicted normal airways when used by specialist anaesthetists with no prior experience using optical stylets. Twelve anaesthetists and 324 elective surgical patients participated. ⋯ Participants using the Bonfils in Phase 1 had significantly higher chance of success on first attempt (73%) compared to Levitan users during Phase 1 (57%) (P = 0.008). These differences were not significant in the second phase and ease of intubation scores were similar for both scopes (P = 0.9). This study showed the two scopes were comparable but the high failure rate amongst novice users demonstrated the importance of familiarity and skill development prior to their introduction to a difficult airway cart.
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Anaesth Intensive Care · Nov 2011
Randomized Controlled TrialA randomised controlled trial of pharmacist medication histories and supplementary prescribing on medication errors in postoperative medications.
Errors in the management of regular medications at the time of hospital admission are common. This randomised controlled three-arm parallel-group trial examined the impact of pharmacist medication history taking and pharmacist supplementary prescribing on unintentional omissions of postoperative medications in a large perioperative service. Participants included elective surgical patients taking regular medications with a postoperative hospital stay of one night or more. ⋯ The estimate marginal mean number of missed doses during a patients hospital stay was 1.07 in the pharmacist supplementary prescribing group, which was significantly less than both the pharmacist history group (3.30) and the control group (3.21) (P < 0.001). The number of medications charted at an incorrect dose or frequency was significantly reduced in the pharmacist history group and further reduced in the prescribing group (P < 0.001). We conclude that many patients miss doses of regular medication during their hospital stay and preoperative medication history taking and supplementary prescribing by a pharmacist can reduce this.