Anaesthesia
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The tube of the laryngeal mask airway is frequently protected by foil during ablative laser procedures. The pilot balloon, however, is often left exposed. The effect of firing seven different cutaneous lasers at the pilot balloon of a disposable laryngeal mask airway was examined to assess its susceptibility to accidental laser strikes. ⋯ The carbon dioxide and erbium YAG lasers punctured the pilot balloon in a mean (SD) of 0.07 (0.02) s and 0.7 (0.1) s, respectively, with the neodymium YAG laser the next quickest to puncture at 3.3 (1.0) s. All other lasers punctured the pilot balloon in less than 15 s. These data suggest that protection of the pilot balloon of the LMA is necessary when using carbon dioxide and erbium YAG lasers.
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Anaemia is a common problem in septic patients. We tested whether lipopolysaccharide suppressed erythropoiesis and interfered with erythropoietin. Male mice (strain C57BL/6, n = 76) were injected Escherichia coli lipopolysaccharide (serotype O127:B8; 20 mg.kg(-1) intraperitoneally) or vehicle, followed by either erythropoietin (5000 IU.kg(-1) intraperitoneally) or vehicle, and killed after 24 or 72 h. ⋯ Orthochromatic erythroblasts doubled after lipopolysaccharide exposure (p < 0.05) without any increase in reticulocytes. Lipopolysaccharide completely suppressed erythropoietin's stimulatory effects and evoked a maturation block at the late stage of erythropoiesis. Lipopolysaccharide could cause anaemia in sepsis.
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Case Reports
Respiratory arrest in an obstetric patient using remifentanil patient-controlled analgesia.
Remifentanil patient-controlled analgesia is well established in many centres and provides satisfactory pain relief for many women in labour. We describe a patient using remifentanil patient-controlled analgesia who suffered a respiratory arrest requiring a brief period of ventilation. In our institution, remifentanil patient-controlled analgesia has been offered to women in labour since 2009. Up to this point, we had not observed any critical incidents in over 130 patients using this mode of analgesia in our labour suite.
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Significant recent interest has focussed on improving outcomes after emergency laparotomy. This retrospective database analysis estimated the annual incidence and associated inpatient costs of emergency laparotomy in England. Demographic, process and outcome data were collected for all patients undergoing emergency laparotomy in Brighton for two calendar years (2009-2010). ⋯ We also found that patients > 70 years (46%) had significantly higher 30-day postoperative mortality (18% vs 6%, p < 0.0001), significantly prolonged median (IQR [range]) length of stay (15 (10-26 [1-123]) days vs 12 (7-22 [1-176]) days, p < 0.001) and incurred higher costs (median (IQR [range]) £9667 (6620-15 732 [1920-103 624]) vs £7467 (4975-14 251 [1178-118 060]), p < 0.001). Emergency laparotomy is a common procedure associated with considerable cost, particularly among elderly patients. A National Emergency Laparotomy Database will help provide an evidence base on which to improve clinical outcome and cost efficiency.
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Brain natriuretic peptide has vasodilatory properties and may thus increase splanchnic perfusion and oxygenation. We compared the effects of recombinant brain natriuretic peptide on gastric mucosal microvascular haemoglobin oxygenation (reflectance spectrophotometry) and systemic variables with those of equi-hypotensive doses of two other vasodilators (nitroglycerine and dihydralazine). Chronically instrumented, healthy dogs were randomly allocated to receive on different days, one of the three drugs (nitroglycerine and dihydralazine doses titrated to reduce mean arterial pressure by ∼20%). ⋯ In contrast, the other vasodilators either did not increase gastric mucosal microvascular haemoglobin oxygenation at all (nitroglycerine), or did so only with marked increases in other systemic haemodynamic variables (dihydralazine). Our data suggest a potential role of recombinant brain natriuretic peptide selectively for increasing microvascular mucosal oxygenation. Studies are required to extend these findings to the clinical setting.