Anaesthesia and intensive care
-
Anaesth Intensive Care · Mar 2016
Randomized Controlled Trial Comparative StudyEnd-tidal sevoflurane concentration for ProSeal(TM) versus Classic(TM) laryngeal mask airway insertion in unpremedicated anaesthetised adult females.
The optimal end-tidal sevoflurane concentration for successful ProSealTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (PLMA) versus ClassicTM (Teleflex, Morrisville, NC, USA) laryngeal mask airway (CLMA) insertion in unpremedicated anaesthetised adults is unknown. We determined end-tidal sevoflurane concentrations for successful insertion in fifty percent of anaesthetised adults. This randomised, prospective, double-blind study was conducted in the operating theatre of a government tertiary care hospital. ⋯ The end-tidal sevoflurane concentration required for successful LMA insertion in fifty percent of anaesthetised adults was calculated as the mean of the crossover pairs' midpoints in each group and further confirmed by probit regression analysis. The end-tidal sevoflurane concentration (95% confidence interval) required for successful PLMA insertion in 50% of anaesthetised adults (3.15% [3.12% to 3.18%]) was significantly higher than that for CLMA insertion (2.71% [2.66% to 2.76%], P<0.001). These findings suggest that deeper anaesthesia is required for placement of a PLMA in comparison to a CLMA.
-
Anaesth Intensive Care · Jan 2016
Randomized Controlled TrialA trial of nebulised heparin to limit lung injury following cardiac surgery.
Cardiac surgery with cardiopulmonary bypass triggers an acute inflammatory response in the lungs. This response gives rise to fibrin deposition in the microvasculature and alveoli of the lungs. Fibrin deposition in the microvasculature increases alveolar dead space, while fibrin deposition in alveoli causes shunting. ⋯ Nebulised heparin was, however, associated with a lower alveolar dead space fraction (P <0.05) and lower tidal volumes at the end of surgery (P <0.01). Nebulised heparin was not associated with bleeding complications. In conclusion, prophylactic nebulised heparin did not improve oxygenation, but was associated with evidence of better alveolar perfusion and CO₂elimination at the end of surgery.
-
Anaesth Intensive Care · Nov 2015
Randomized Controlled TrialEffects of dialysis modality on blood loss, bleeding complications and transfusion requirements in critically ill patients with dialysis-dependent acute renal failure.
Blood loss and bleeding complications may often be observed in critically ill patients on renal replacement therapies (RRT). Here we investigate procedural (i.e. RRT-related) and non-procedural blood loss as well as transfusion requirements in regard to the chosen mode of dialysis (i.e. intermittent haemodialysis [IHD] versus continuous veno-venous haemofiltration [CVVH]). ⋯ In conclusion, procedural and non-procedural blood loss may often be observed in critically ill patients on RRT. In CVVH-treated patients, procedural blood loss was increased but overall transfusion rates remained unchanged. Our data show that IHD and CVVH may be regarded as equivalent approaches in critically ill patients with dialysis-dependent acute renal failure in this regard.
-
Anaesth Intensive Care · Jul 2015
Randomized Controlled Trial Comparative StudySpinal anaesthesia with adjunctive intrathecal morphine versus continuous lumbar plexus blockade: a randomised comparison for analgesia after hip replacement.
Following elective total hip replacement, both continuous lumbar plexus blockade and spinal anaesthesia (with adjunctive intrathecal morphine) have shown early outcome benefits over opioid analgesia and single-injection nerve block. However, the two techniques have not been compared in a prospective randomised manner. Our study examined 50 patients undergoing elective hip joint replacement who were randomised to receive spinal anaesthesia (with adjunctive intrathecal morphine 0.1 mg) or patient-controlled continuous lumbar plexus blockade. ⋯ Postoperative symptoms suggestive of neurological irritation or injury did not differ between groups. We found that following elective hip joint replacement, compared to continuous lumbar plexus blockade, spinal anaesthesia incorporating adjunctive intrathecal morphine did not result in a statistically significant difference in worst pain on movement/mobilisation during the first 24 hours, although it was associated with better analgesia in the post-anaesthesia care unit. Subsequently, however, these patients appeared to require more rescue morphine and more of them reported pruritus.
-
Anaesth Intensive Care · Jul 2015
Randomized Controlled TrialThe effect of routine reversal of neuromuscular blockade on adequacy of recurrent laryngeal nerve stimulation during thyroid surgery.
Testing of the integrity of the recurrent laryngeal nerve during thyroid surgery has become routine practice for many surgeons to aid dissection and minimise the chance of inadvertent nerve injury. We hypothesised that routine reversal of an intermediate-acting, non-depolarising neuromuscular blocking agent would improve conditions for stimulation of the recurrent laryngeal nerve. We conducted a single-centre, randomised, double-blind placebo-controlled trial of patients undergoing thyroid surgery by the same surgeon. ⋯ Three of the ten patients (30%) with inadequate reversal showed no evidence of residual blockade assessed peripherally. The routine reversal of neuromuscular blockade at 30 minutes post induction appears to result in adequate surgical conditions for safe stimulation of the recurrent laryngeal nerve. Return of neuromuscular function at a peripheral site does not guarantee adequate laryngeal muscle function for use of the NIM.