Anaesthesia
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The Anaconda™ system is used to deliver inhalational sedation in the intensive care unit in mainland Europe. The new Mirus™ system also uses a reflector like the Anaconda; however, it also identifies end-tidal concentrations from the gas flow, injects anaesthetics during early inspiration, controls anaesthetic concentrations automatically, and can be used with desflurane, which is not possible using the Anaconda. We tested the Mirus with desflurane in the laboratory. ⋯ Efficiency was > 80% and was also deemed to be acceptable, but only when delivering a low concentration of desflurane (≤ 1.8%). By modifying the reflector, we improved efficiency up to a concentration of 3.6%. The Mirus appears to be a promising new device for long-term sedation with desflurane on the intensive care unit, but efficiency must be improved before routine clinical use becomes affordable.
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Sugammadex is a drug used to reverse neuromuscular blockade induced by rocuronium or vecuronium. It has not yet been approved by the Food and Drug Administration in the USA due to concerns regarding hypersensitivity. The objective of this review was to identify similarities in the presentation of hypersensitivity reactions to sugammadex. ⋯ All cases that reported exact timing (14/15) occurred in 4 min or less. Most of the patients (11/15; 73%) met World Anaphylaxis Organization criteria for anaphylaxis. Awareness must be raised for the possibility of drug-induced hypersensitivity during the critical 5-min period immediately following sugammadex administration.
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Randomized Controlled Trial
A randomised controlled trial of ultrasound-guided transversus abdominis plane block for renal transplantation.
We conducted this study to evaluate the efficacy of a transversus abdominis plane block in reducing morphine requirements in the first 24 h after renal transplant surgery. We performed transversus abdominis plane injections under ultrasound guidance in 54 patients with either 20 ml levobupivacaine 0.5% (n = 27) or 20 ml saline 0.9% (n = 27). ⋯ In the remaining 51 patients, median (IQR [range]) morphine consumption in the first 24 h was similar in both the transversus abdominis plane group (19.4 (11.7-28.6 [0.5-49.8]) mg) and the control group (16.4 (12.0-31.0 [0.0-61.7]) mg), p = 0.94. We found that use of ultrasound-guided transversus abdominis plane block for renal transplantation did not reduce 24-h morphine requirements.
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To date, postoperative quality of recovery lacks a universally accepted definition and assessment technique. Current quality of recovery assessment tools vary in their development, breadth of assessment, validation, use of continuous vs dichotomous outcomes and focus on individual vs group recovery. They have progressed from identifying pure restitution of physiological parameters to multidimensional assessments of postoperative function and patient-focused outcomes. ⋯ A literature search identified 11 unique recovery assessment tools. The Postoperative Quality of Recovery Scale assesses recovery in multiple domains, including physiological, nociceptive, emotive, activities of daily living, cognition and patient satisfaction. It addresses recovery over time and compares individual patient data with base line, thus describing resumption of capacities and is an acceptable method for identification of individual patient recovery.