Anaesthesia and intensive care
-
Anaesth Intensive Care · Jul 2013
ReviewOverview of the introduction of neuromuscular monitoring to clinical anaesthesia.
Muscle relaxants were introduced into clinical practice in the early 1940s. From 1949, assessments were being made of the efficacy of various agents in awake volunteers, usually the researchers themselves. From the early to mid 1950s, while interest in using muscle relaxants was keen, concern emerged in the surgical literature that there was a higher mortality rate seen in patients receiving muscle relaxants. ⋯ These were measured responses to single twitch stimulus or tetanic stimulation. In 1970, train-of-four ratio was introduced, then in 1981 post-tetanic count, and in 1989 double burst stimulation. This article reviews the introduction of these techniques.
-
Anaesth Intensive Care · Mar 2013
ReviewIs suppression of apoptosis a new therapeutic target in sepsis?
Sepsis remains as a leading cause of death in critically ill patients. Unfortunately, there have been very few successful specific therapeutic agents that can significantly reduce the attributable mortality and morbidity of sepsis. ⋯ In this review article, we summarise the critical role of apoptosis of the immune cells in the pathophysiology of sepsis and propose that blocking cell-signaling pathways leading to apoptosis may present a promising specific therapy for sepsis. Various methods to inhibit apoptosis including the cell surface Fas receptor pathway inhibitors, caspase inhibitors, over-expression of anti-apoptotic genes and small interfering ribonucleic acid therapy are discussed.
-
Lung protective ventilation limiting tidal volumes and airway pressures were proven to reduce mortality in patients with acute severe respiratory failure. Hypercapnia and hypercapnic acidosis is often noted with lung protective ventilation. ⋯ To the contrary, some clinicians do not tolerate hypercapnic acidosis and use various techniques including extracorporeal carbon dioxide elimination to treat hypercapnia and acidosis. This review aims at defining the effects of hypercapnia and hypercapnic acidosis with a focus on the pros and cons of clearing carbon dioxide and the modalities that may enhance carbon dioxide clearance.
-
Anaesth Intensive Care · Mar 2013
ReviewInterventional neuroradiological procedures-a review for anaesthetists.
Interventional neuroradiology is a rapidly expanding field, and the complexity and duration of these procedures makes anaesthetic support essential to their success. Such has been the development in this area, that the American Heart Association has published a scientific statement on the indications for these procedures. ⋯ This article will cover the management of intracranial aneurysms, cerebral vasospasm following intracranial haemorrhage, intracranial and spinal arteriovenous malformations, idiopathic intracranial hypertension, carotid artery stenting, intra-arterial thrombolysis for stroke and endovascular treatment of intracranial atherosclerosis. Protection from ionising radiation and acute kidney injury are also discussed.
-
Anaesth Intensive Care · Jan 2013
ReviewThe clinical role of glutamine supplementation in patients with multiple trauma: a narrative review.
Glutamine is considered an essential amino acid during stress and critical illness. Parenteral glutamine supplementation in critically ill patients has been shown to improve survival rate and minimise infectious complications, costs and hospital length-of-stay. However, glutamine supplementation in patients receiving enteral nutrition and the best method of administration are still controversial. ⋯ A search in PubMed and EMBASE was conducted and relevant papers that investigated the effect of enteral or parenteral glutamine supplementation in patients with multiple trauma were reviewed. Although recent nutritional guidelines recommend that glutamine supplementation should be considered in these patients, further well-designed trials are required to provide a confirmed conclusion. Due to the inconclusive results of enteral glutamine supplementation trials in patients receiving enteral nutrition, future trials should focus on intravenous glutamine supplementation in patients requiring enteral nutrition and on major clinical outcome measures (e.g. mortality rate, infectious complications).