Anaesthesia
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Randomized Controlled Trial Clinical Trial
A partially blinded randomised controlled trial of patient-maintained propofol sedation and operator controlled midazolam sedation in third molar extractions.
Patient-maintained sedation using propofol has recently been shown to be effective for dental surgery. We compared this new technique to the established technique of operator administered midazolam. The two groups were compared before, during and after sedation. ⋯ Propofol patients had a smaller reduction in arterial oxygen saturation (mean difference 0.8 (SD 0.3)%; p = 0.030), and a reduced increase in heart rate (mean difference 9 (SD 2) beats.min(-1); p < 0.001). Both techniques were well tolerated and safe. Propofol sedation offered superior anxiolysis, quicker recovery, less amnesia and less depression of simple psychomotor function.
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Multicenter Study
Antibiotic-treated infections in intensive care patients in the UK.
The purpose of this audit was to study reasons for starting antibiotic therapy, duration of antibiotic treatment, reasons for changing antibiotics and the agreement between clinical suspicion and microbiological results in intensive care practice. We conducted a multicentre observational audit of 316 patients. Data on demographic details, site, treatment and nature of infection were collected. ⋯ Gram-negative organisms were the most common cause of proven infections (n = 90 (50%)). The antibiotic spectrum was narrowed in light of microbiology results in 78 patients (43%) and changed due to antibiotic resistance in 38 patients (21%). We conclude that the mean duration of treatment contrasts with existing published guidelines, highlighting the need for further studies on duration and efficacy of treatment in intensive care.
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We report the use of intracranial pressure monitoring, mild hypothermia and barbiturate coma in a patient with meningococcal meningitis complicated by raised intracranial pressure.
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Case Reports
Accidental tenfold overdose of propofol in a 6-month old infant undergoing elective craniosynostosis repair.
We report a 6-month-old male infant undergoing elective craniosynostosis repair who accidentally received a tenfold dose of propofol over a 4-h operative period. Myocardial dysfunction was observed after nearly 3 h of infusion; this could not solely be explained by the propofol overdose.