Anaesthesia
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This study aimed to compare the haemodynamics in healthy pregnant women with the haemodynamics in women with untreated pre-eclampsia, to determine the cardiovascular reason for hypertension in pre-eclampsia. 40 women with untreated pre-eclampsia, 40 matched healthy pregnant women and 20 non-pregnant women were studied using transthoracic echocardiography. Untreated pre-eclampsia demonstrated (mean (SD), healthy non-pregnant vs healthy pregnant vs untreated pre-eclampsia) increased cardiac output (3400 (752) vs 4109 (595) vs 4789 (1416) ml.min(-1), p=0.002), increased stroke volume (53 (10) vs 53 (8) vs 59 (13) ml, p=0.04), increased fractional shortening (35 (5) vs 35 (7) vs 41 (8) %, p=0.006), increased fractional area change (57 (7) vs 57 (9) vs 65 (9)%, p=0.002) and increased systemic vascular resistance (2116 (457) vs 1613 (315) vs 2016 (625) dyne.s.cm(-5), p=0.001). Mitral E/septal e' was higher (6.0 (1.1) vs 6.7 (1.3) vs 10.4 (2.4), p=0.002) and left atrial size increased (3.2 (0.3) vs 3.8 (0.4) vs 4.0 (0.4) cm, p=0.002). Hypertension in untreated pre-eclampsia is due to increased cardiac output and mild vasoconstriction, with increased inotropy and reduced diastolic function.
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Case Reports
Catastrophic complication of an interscalene catheter for continuous peripheral nerve block analgesia.
We report a catastrophic postoperative complication of a prolonged interscalene block performed under general anaesthesia. The course of the anaesthetic was uneventful and the patient remained stable during his stay in the recovery area with the operative extremity paralysed and insensate. ⋯ The patient was next assessed 6.5 h later when he was found dead in his bed. A postmortem CT scan revealed the catheter to be sited intrathecally, presumably the result of dural sleeve penetration.
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Comparative Study
Epidural catheter connectors: a laboratory-based comparison of the Portex Tuohy-Borst and EpiFuse™ designs.
Disconnection of an epidural catheter from its connector may result in patient harm and commonly requires resiting of the epidural. Clamp-connector designs such as the novel Portex EpiFuse™ potentially offer an improved safety profile over screw-cap designs such as the Tuohy-Borst, but comparative studies are limited. We therefore compared the tensile strength of EpiFuse and Tuohy-Borst connectors in a laboratory setting. ⋯ The Tuohy-Borst was also less likely to meet British Standard requirements (13/20 sets vs 19/20 and 20/20, p=0.002). Modification of the EpiFuse did not affect lumen patency or connection strength. We conclude that under controlled conditions, EpiFuse connectors are superior to Tuohy-Borst connectors.
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Alcohol-related disease adversely affects the outcome of critically ill patients. The burden of this in Scotland is higher than elsewhere in the United Kingdom. In a prospective observational study of all patients admitted to the 24 intensive care units in Scotland we assessed the proportion of admissions in which alcohol-related disease was implicated. ⋯ The alcohol-related group had a significantly longer period of ventilation with a median (IQR [range]) of 2 (1-6 [0-176]) vs 1 (0-4 [0-136]) days (p<0.005). Admissions from an area of deprivation were more likely to be related to alcohol. Alcohol-related admissions have a significant impact on Scottish intensive care services, with an extrapolated cost of £8.9 million per year.