Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2007
Patterns of sevoflurane use in a children's hospital: the effects of a simple educational intervention.
We conducted a prospective observational study of sevoflurane use over a four-week period at our tertiary referral children's hospital. Sevoflurane vaporisers were weighed before and after all general anaesthesia sessions and anaesthesia time intervals recorded. Midway through the audit, the initial findings were presented to the department with a brief reminder of ways to reduce sevoflurane use. ⋯ Clinicians can be relatively complacent about financial accountability. In this study, a simple educational reminder halved sevoflurane use in the short term. This study suggests that specific reminders or recommendations about anaesthetic technique in the induction rooms may be indicated.
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Anaesth Intensive Care · Aug 2007
The effects of acidosis and hypothermia on blood transfusion requirements following factor VII administration.
While there is laboratory evidence that the activity of recombinant activated factor VII (rFVIIa) is reduced by the presence of acidosis and hypothermia, there is limited clinical data to support this observation. Recombinant FVIIa may be used as rescue therapy in surgical patients who have bleeding that is refractory to conventional therapy. However, these patients are also frequently acidotic and hypothermic at the time the drug is administered. ⋯ The implication of this study is that rFVIIa may be less effective when administered to severely acidotic patients. Further studies are required to examine whether this is related to the acidosis directly, or is secondary to other intraoperative variables affecting acidosis. The clinical utility of rFVIIa in acidotic patients also requires further investigation.
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Anaesth Intensive Care · Aug 2007
Continuous venovenous haemofiltration using a citrate buffered substitution fluid.
Different methods of regional anticoagulation using citrate in continuous renal replacement therapy have been described in the past. However, these procedures were usually very complex or did not reach modem requirements for effective continuous renal replacement therapy. Furthermore, little is known about long-term acid-base stability and citrate levels during the treatment. ⋯ Predilution, citrate-based substitution fluid provides both anticoagulation within the extracorporeal circuit and control of acid-base balance in critically ill patients at risk of bleeding in acute renal failure. It is easy to apply and safe. Clearance can be varied as long as a constant ratio between blood and substitution flow is maintained.
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Anaesth Intensive Care · Aug 2007
The shoulder block: a new alternative to interscalene brachial plexus blockade for the control of postoperative shoulder pain.
This report describes the development of the shoulder block, an alternative to interscalene brachial plexus blockade for the control of postoperative pain following shoulder surgery. Included is a review of the relevant anatomy of the shoulder joint and its associated structures. ⋯ The technique of Meier is used to block the suprascapular nerve in the supraspinous fossa. No descriptions of axillary nerve block were available in the literature, so a technique for blocking this nerve as it travels across the posterior surface of the humerus was developed and is described, along with a discussion of the author's initial clinical experience.