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Anaesthesia and intensive care

Volker Gebhardt, Vera Zawierucha, Oliver Schöffski, Anke Schwarz, Christel Weiss, Marc D Schmittner
BACKGROUND: Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE: The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs...
March 7, 2018: European Journal of Anaesthesiology
D J Brewster, C P Nickson, J J Gatward, M Staples, F Hawker
This study aimed to determine whether airway education should be introduced to the continuing professional development (CPD) program for College of Intensive Care Medicine (CICM) Fellows. A random representative sample of 11 tertiary intensive care units (ICUs) was chosen from the list of 56 units accredited for 12 or 24 months of CICM training. All specialist intensive care Fellows (n=140) currently practising at the eleven ICUs were sent the questionnaire via email. Questionnaire data collection and post-collection data analysis was used to determine basic respondent demographics, frequency of certain airway procedures in the past 12 months, confidence with advanced airway practices in ICU, participation in airway education in the past three years, knowledge of can't intubate, can't oxygenate (CICO) algorithms, preference for certain airway equipment/techniques, and support for required airway education as a component of the CICM CPD program...
March 2018: Anaesthesia and Intensive Care
Despina Afroditi Lalou, Marek Czosnyka, Joseph Donnelly, Andrea Lavinio, John D Pickard, Matthew Garnett, Zofia Czosnyka
OBJECTIVES: Slow waves of intracranial pressure (ICP) are spontaneous oscillations with a frequency of 0.3-4 cycles/min. They are often associated with pathological conditions, following vasomotor activity in the cranial enclosure. This study quantifies the effects of general anaesthesia (GA) on the magnitude of B-waves compared with natural sleep and the conscious state. MATERIALS AND METHODS: Four groups of 30 patients each were formed to assess the magnitude of slow waves...
2018: Acta Neurochirurgica. Supplement
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
A Hewitt-Smith, F Bulamba, S Ttendo, K Pappenheim, I A Walker, A F Smith
The Association of Anaesthetists of Great Britain and Ireland and the then Uganda Society of Anaesthesia established the Uganda Fellowship Scheme in 2006, to provide scholarships to encourage doctors to train in anaesthesia in Uganda. We conducted an evaluation of this programme using online questionnaires and face-to-face semi-structured interviews with trainees who received scholarships, as well as with senior surgeons and anaesthetists. Focus group discussions were held to assess changes in attitudes towards anaesthesia over the last 10 years...
February 7, 2018: Anaesthesia
C A Pfortmueller, G-C Funk, C Reiterer, A Schrott, O Zotti, B Kabon, E Fleischmann, G Lindner
BACKGROUND: This double-blind randomised controlled trial investigated whether normal saline or a balanced crystalloid has distinct effects on vasopressor use in patients undergoing major abdominal surgery. METHODS: Patients received either normal saline 0.9% or an acetate-buffered crystalloid for intraoperative volume replacement in a goal-directed fashion. The primary outcome was need for vasopressors; the secondary outcomes were the total dose of catecholamines, total perioperative fluid, and unplanned intensive care admissions...
February 2018: British Journal of Anaesthesia
T Renda, A Corrado, G Iskandar, G Pelaia, K Abdalla, P Navalesi
Oxygen therapy is first-line treatment for hypoxaemic acute respiratory failure (ARF). High-flow nasal oxygen therapy (HFNO) represents an alternative to conventional oxygen therapy. HFNO provides humidified, titrated oxygen therapy matching or even exceeding the patients' inspiratory demand. The application of HFNO is becoming widespread in Intensive Care Units (ICUs), favoured by increasing evidence based on numerous studies supporting its efficacy. The mechanisms of action and physiological effects of HFNO are not yet fully understood...
January 2018: British Journal of Anaesthesia
T M Cook, N J Boniface, C Seller, J Hughes, C Damen, L MacDonald, F E Kelly
BACKGROUND: Videolaryngoscopy (VL) is increasingly used, but not yet routine practice, for tracheal intubation. Few departments formally trial equipment before adopting it into practice. We describe the decision-making and implementation processes that our department used when introducing universal VL, with the C-MAC© (Karl Storz, Germany), throughout our anaesthesia and intensive care departments. METHODS: We used a structured process to assess the feasibility of a change to universal VL...
January 2018: British Journal of Anaesthesia
Guo-Rong He, Xiao-Kun Lin, Yong-Biao Wang, Cong-De Chen
Dexmedetomidine (DEX) a type of the anaesthetic that has been widely used in anaesthesia and intensive care. However, whether DEX affects the pharmacokinetics of drugs remains elusive. As hepatic P‑glycoprotein (P‑gp) serves a critical role in the disposition of drugs, the present study aimed to address whether P‑gp function could be affected by DEX in vitro. In the present study, L02 cells (a normal human liver cell line) were exposed to DEX for 24 h and P‑gp function was evaluated by the intracellular accumulation of Rhodamine 123...
February 2, 2018: Molecular Medicine Reports
Wan Mohd Nazaruddin Wan Hassan, Yusnizah Mohd Nasir, Rhendra Hardy Mohamad Zaini, Wan Fadzlina Wan Muhd Shukeri
Background: The choice of anaesthetic techniques is important for the outcome of traumatic brain injury (TBI) emergency surgery. The objective of this study was to compare patient outcomes for target-controlled infusion (TCI) of propofol and sevoflurane anaesthesia. Methods: A total of 110 severe TBI patients, aged 18-60, who underwent emergency brain surgery were randomised into Group T (TCI) (n = 55) and Group S (sevoflurane) (n = 55). Anaesthesia was maintained in Group T with propofol target plasma concentration of 3-6 μg/mL and in Group S with minimum alveolar concentration (MAC) of sevoflurane 1...
October 2017: Malaysian Journal of Medical Sciences: MJMS
Ahmet Deniz, Ömer Lütfi Erhan, Mustafa Kemal Bayar, Ümit Karatepe, İsmail Demirel
Objective: This retrospective study aimed to evaluate the effect of a restructured anaesthesia intensive care unit (ICU) on changes in infection rates and infections. Methods: Organisational restructuring was done in the anaesthesia ICU of Firat University Hospital after it was relocated on 14 March 2012. This study was designed to investigate the effect of restructuring on infection rates through a comparison of periods encompassing one year before relocation and one year after relocation...
December 2017: Turkish Journal of Anaesthesiology and Reanimation
Stephen Mitchell, Pratik Gurung, Simon Choong, Timothy Morris, Daron Smith, Christopher Woodhouse, Timothy Philp
Background The incidence of spina bifida (SB) is approx 1:1000, and risk of stone disease is substantially raised in SB. This is the unique published study of the outcome of patients with SB undergoing percutaneous nephrolithotomy (PCNL) compared to a neurologically intact historically matched control group at the same institution. Patients and Method A series of 96 PCNLs in 13 SB and 50 non-SB control patients was analysed. The following measurements were recorded: (1) Co-morbidities; (2) Pre-operative: (renal function, American Society of Anesthesiologists (ASA) score); (3) Intra-operative: (anaesthesia time, number of tracks, stone free rate) and (4) Post-operative: (sepsis, intensive therapy unit (ITU) and total length of stay, transfusion rate, stone composition, rate of stone disease-related nephrectomy)...
January 17, 2018: Journal of Endourology
Wojciech Walas, Dawid Aleksandrowicz, Maria Borszewska-Kornacka, Tomasz Gaszyński, Ewa Helwich, Marek Migdał, Andrzej Piotrowski, Grażyna Siejka, Tomasz Szczapa, Alicja Bartkowska-Śniatkowska
Tracheal intubation may be defined as an artificial airway established in order to provide mechanical ventilation of the lungs during surgical procedures under general anaesthesia, treatment in an intensive care unit, as well as in emergency situations. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient's death. There may be unanticipated and anticipated difficult airway. Children form a specific group of patients as there are significant differences in both anatomy and physiology...
2017: Anaesthesiology Intensive Therapy
Peter C Laussen
Cardiac anesthesia and critical care provide an important continuum of care for patients with congenital heart disease. Clinicians in both areas work in complex environments in which the interactions between humans and technology is critical. Understanding our contributions to outcomes (modifiable risk) and our ability to perceive and predict an evolving clinical state (low failure-to-predict rate) are important performance metrics. Improved methods for capturing continuous physiologic signals will allow for new and interactive approaches to data visualization, and for sophisticated and iterative data modeling that will help define a patient's phenotype and response to treatment (precision physiology)...
December 2017: Cardiology in the Young
Jason Wang, Ronald Ma, Paul Eleftheriou, Leonid Churilov, David Debono, Ray Robbins, Mehrdad Nikfarjam, Chris Christophi, Laurence Weinberg
BACKGROUND: A cost analyses of complications following pancreaticoduodenectomy (PD) was performed in a high volume hepato-biliary-pancreatic service. We hypothesised that costs are increased with both severity and number of complications; we investigated the relationship between complications and specific cost centres. METHODS: 100 patients from 2011 to 2016 were included. Data relating to their perioperative course were collected. Complications were documented by the Clavien-Dindo classification and costs were inflated and converted to 2017 USD...
December 13, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Abolfazl Firouzian, Alieh Zamani Kiasari, Gholamali Godazandeh, Afshin Gholipour Baradari, Abbas Alipour, Arman Taheri, Amir Emami Zeydi, Maryam Montazemi
Background and Aims: Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC. Methods: In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min...
October 2017: Indian Journal of Anaesthesia
R-A O'Leary, S Einav, M Leone, K Madách, C Martin, I Martin-Loeches
OBJECTIVE: The global burden of invasive fungal disease is increasing. Candida albicans remains the leading cause of fungal bloodstream infections, although non-albicans candidal infections are emerging. Areas of controversy regarding diagnosis and management are hampering our ability to respond effectively to this evolving threat. The purpose of this narrative review is to address current controversies and provide recommendations to supplement guidelines. DIAGNOSIS OF INVASIVE CANDIDIASIS: Diagnosis of invasive candidiasis requires a combination of diagnostic tests and patient risk factors...
December 6, 2017: Journal of Hospital Infection
M Masud, S Yeasmeen, A K Haque, S Jahan, N C Saha, D Banik
Laparoscopic cholecystectomy is a gold standard surgical procedure for gallbladder operation. It causes altered haemodynamic responses due to pneumoperitoneum and surgical procedure also causes high incidence of postoperative nausea &vomiting. Clonidine has been shown to reduce intraoperative haemodynamic instability. This randomized prospective single blind clinical study was designed to evaluate the efficacy of oral clonidine premedication for attenuation of haemodynamic responses associated with pneumoperitoneum & also reduce the incidence of postoperative nausea & vomiting and carried out in the department of Anaesthesia Analgesia and Intensive care Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January 2010 to June 2010...
October 2017: Mymensingh Medical Journal: MMJ
Karen B Domino
No abstract text is available yet for this article.
December 2017: Anaesthesia, Critical Care & Pain Medicine
Flavia A De Orange, Rebeca Gac Andrade, Andrea Lemos, Paulo Sgn Borges, José N Figueiroa, Pete G Kovatsis
BACKGROUND: Since the introduction of endotracheal intubation in paediatrics, uncuffed endotracheal tubes (ETTs) have been the standard of care for children under eight years old, based on the presumption that complications, particularly postoperative stridor, are higher with cuffed ETTs. The major disadvantages of uncuffed ETTs cited for this shift in procedure include the difficulty in achieving tidal volumes due to leakage around an uncuffed ETT. To seal the airway adequately, uncuffed tubes may need to be exchanged for another tube with a larger diameter, which sometimes requires several attempts before the appropriate size is found...
November 17, 2017: Cochrane Database of Systematic Reviews
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