Anaesthesia
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We describe the initial management and subsequent recovery of a 61 year-old male patient following attempted suicide by oral ingestion of a potentially fatal overdose of quetiapine and sertraline. Intravenous Intralipid was given soon after initiation of basic resuscitation. ⋯ No other clinical signs of drug toxicity were observed. Intralipid may have reversed the deep coma associated with ingestion and prevented other manifestations of drug toxicity occurring, thus expediting this patient's recovery.
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Comparative Study
The TEG vs the ROTEM thromboelastography/thromboelastometry systems.
We have evaluated the TEG thromboelastograph and the ROTEM thromboelastometer, two point-of-care devices that measure blood coagulation. During a one-week period, seven consultant anaesthetists, one consultant haematologist, one associate specialist anaesthetist and two senior trainee anaesthetists were trained by the manufacturers and set up, calibrated and used both systems, after which their views were obtained and specific technical/support information was sought from the manufacturers using a questionnaire. Although the devices shared common features, they differed in complexity and aspects of ease of use, and in their purchase and running costs.
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Review
B type natriuretic peptide--a diagnostic breakthrough in peri-operative cardiac risk assessment?
The B-type natriuretic peptides; B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, are increasing being used as biomarkers for the diagnosis, management and prognostication of cardiac failure, but their application in the peri-operative period is unclear. This review examines the current understanding of the role of B-type natriuretic peptides in both the operative and non-operative settings. ⋯ Using this as a background, the role of B-type natriuretic peptides in the prediction of peri-operative mortality and morbidity is examined and potential confounders, such as renal failure and body mass index, which may impact significantly on the utility of the biomarkers, are discussed. Clinical recommendations with regard to its use are made and a research agenda is proposed for future peri-operative studies.
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Randomized Controlled Trial Comparative Study
Tramadol for prevention of postanaesthetic shivering: a randomised double-blind comparison with pethidine.
The present study was conducted with the aims of comparing intravenous tramadol 1, 2 and 3 mg.kg(-1) with pethidine 0.5 mg.kg(-1) for prophylaxis of postanaesthetic shivering and to find a dose of tramadol that could provide the dual advantage of antishivering and analgesic effect in the postoperative period. The study included 165 patients, randomly allocated to five groups of 33 each. ⋯ All three doses of tramadol were effective and comparable to pethidine in preventing postanaesthetic shivering. Tramadol 2 mg.kg(-1) had the best combination of antishivering and analgesic efficacy without excessive sedation and thus appeared to be a good choice to be administered at the time of wound closure to provide antishivering effect and analgesia without significant side effects in the postoperative period.