Anaesthesia via MedWorm.com

Advances in Anesthesia

Anaesthesia — Thu, 11 Mar 2010 00:00:00 +0100

(Source: Anaesthesia)

Hatch and Sumner's Textbook of Paediatric Anaesthesia

Anaesthesia — Wed, 03 Mar 2010 00:00:00 +0100

(Source: Anaesthesia)

The following abstracts were presented at the meeting of Association of Cardiothoracic Anaesthetists in Blackpool, November 2009

Anaesthesia — Tue, 02 Mar 2010 00:00:00 +0100

(Source: Anaesthesia)

Determination of the optimal stylet strategy for the C-MAC® videolaryngoscope

Anaesthesia — Mon, 01 Mar 2010 00:00:00 +0100

The C-MAC® videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan® manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex-It[trade]); and hockey-stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the di...

Emergency department rapid sequence intubation: do elderly patients benefit?

Anaesthesia — Fri, 26 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Testing adherence to the DAS algorithm for difficult tracheal intubation during rapid sequence induction of anaesthesia

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Change to evidence based airway practice – how easy is it?

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Mask ventilation and neuromuscular blocking drugs – a national survey

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Mouth opening and jaw protrusion measured using three-dimensional motion analysis

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Anaesthetic airway incident reporting in the National Reporting and Learning System

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Cricoid pressure and video laryngoscopy: a prospective study to evaluate the use of a video laryngoscope for effective application of cricoid pressure by anaesthetic assistants

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Many ways to skin a cat. Airway obstruction by a retrosternal thyroid mass: management and international expert opinion

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Comparison of manikin models vs live sheep in 'can't intubate can't ventilate' training

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Audit of emergency laparotomy in elderly patients

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Audit of pre-operative echocardiography requests in hip fracture patients

Anaesthesia — Thu, 25 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Multiple Choice Questions in Intensive Care Medicine

Anaesthesia — Tue, 23 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

LMA SupremeTM insertion by novices in manikins and patients

Anaesthesia — Mon, 22 Feb 2010 00:00:00 +0100

The LMA Supreme[trade] has been suggested for use in emergency situations by medical personnel with no experience in endotracheal intubation. We evaluated the LMA Supreme when inserted by non-anaesthetists, firstly in a manikin and then in patients. Fifty airway novices inserted a LMA Supreme in a manikin without any complications so we proceeded to the patient phase. Fifty airway novices inserted the LMA Supreme in anaesthetised patients undergoing elective surgery. First time insertion success rate was 86% and overall insertion success rate was 100%. Mechanical ventilation was successful in all cases. Median (IQR [range]) time to establish an airway was 34 s (26-40 [18[ndash]145] s). Median (IQR [range]) pharyngeal seal pressure was 23 cmH2O (19-28 [13[ndash]40] cmH2O). There were no imp...

The Structured Oral Examination in Clinical Anaesthesia

Anaesthesia — Mon, 22 Feb 2010 00:00:00 +0100

(Source: Anaesthesia)

Monitoring sedation in the critically ill child

Anaesthesia — Wed, 17 Feb 2010 00:00:00 +0100

Sedation is an essential part of the management of the critically ill child, and its monitoring must be individualised and continuous in order to adjust drug doses according to the clinical state. There is no ideal method for evaluating sedation in the critically ill child. Haemodynamic variables have not been found to be useful. Clinical scales are useful when sedation is moderate, but are limited by their subjective nature, the use of stimuli, and the impossibility of evaluating profoundly sedated patients or those receiving neuromuscular blocking drugs; in addition, many of these scales have not been evaluated in children. The COMFORT scale is the most appropriate, as it was designed and validated for critically ill children requiring mechanical ventilation. Electroencephalography-deriv...

Association between nitrous oxide and the incidence of postoperative nausea and vomiting in adults: a systematic review and meta-analysis

Anaesthesia — Fri, 12 Feb 2010 00:00:00 +0100

Some, but not all studies have suggested intra-operative use of nitrous oxide is correlated with postoperative nausea and vomiting. We performed a meta-analysis of randomised controlled trials to compare the incidence of nausea and vomiting in adults following general anaesthesia with or without nitrous oxide. We retrieved 30 studies (incorporating 33 separate trials) that investigated a 'nitrous oxide group' (total 2297 patients) vs a 'no-nitrous oxide group' (2301 patients). Omitting nitrous oxide significantly reduced postoperative nausea and vomiting (pooled relative risk 0.80, 95% CI 0.71[ndash]0.90, p = 0.0003). However, the absolute incidence of nausea and vomiting was high in both the nitrous oxide and no-nitrous oxide groups (33% vs 27%, respectively). In subgroup analysis, the ma...

The effects of mild induced hypothermia on the myocardium: a systematic review

Anaesthesia — Thu, 11 Feb 2010 00:00:00 +0100

Mild induced hypothermia improves neurological outcome and reduces mortality among initially comatose survivors of out-of-hospital cardiac arrest. Similar pathological processes occur in the heart and the brain, namely ischaemia followed by reperfusion injury. Animal data indicate that mild induced hypothermia results in improved myocardial salvage, reduced infarct size, reduced left ventricular remodelling and better long-term left ventricular function. Several small human studies suggest that infarct size may be reduced by mild induced hypothermia, although this has not reached significance in any human study to date. There are variable reports of harm to the myocardium caused by mild induced hypothermia, including reduced myocardial contractility and cardiac output, electrocardiographic...

Survival and length of stay following blood transfusion in octogenarians following cardiac surgery

Anaesthesia — Thu, 11 Feb 2010 00:00:00 +0100

We report the results of a cohort study of all patients aged 80 or more on the day of their emergency or elective cardiac surgery (n = 874), using routinely collected data from January 2003 to November 2007. The primary outcome was all-cause mortality in hospital. The secondary outcomes were duration of stay in the intensive care unit (ICU) and overall hospital stay. Confounding variables were used to build up a risk model using a multivariable logistic regression analysis, and blood transfusion was added to assess whether it had additional predictive value for hospital mortality. Patients were divided into three groups: (i) transfusion of 0[ndash]2 units of red blood cells; (ii) transfusion of > 2 units of red blood cells and (iii) transfusion of red blood cells plus other clotting produc...

Modification of Tp-e and QTc intervals during caesarean section under spinal anaesthesia

Anaesthesia — Sat, 06 Feb 2010 00:00:00 +0100

There are no guidelines for the anaesthetic management of caesarean section in women with long QT syndrome; the description of myocardial ventricular repolarisation in healthy women during caesarean delivery could be a first step. The aim of this study was to describe modification of the QT interval, corrected for heart rate, and the interval between the peak and the end of the T-wave (Tpeak[ndash]Tend interval) during caesarean section under spinal anaesthesia. We studied 40 patients scheduled for caesarean section under spinal anaesthesia. Patients were randomly assigned to receive either ephedrine or phenylephrine to prevent hypotension. We injected 5 IU oxytocin after delivery. Corrected QT and Tpeak[ndash]Tend intervals were unchanged from pre-operative values after induction of spina...

Anaesthetics and postoperative cognitive dysfunction: a pathological mechanism mimicking Alzheimer's disease

Anaesthesia — Fri, 05 Feb 2010 00:00:00 +0100

With longevity, postoperative cognitive decline in the elderly has emerged as a major health concern for which several factors have been implicated, one of the most recent being the role of anaesthetics. Interactions of anaesthetic agents and different targets have been studied at the molecular, cellular and structural anatomical levels. Recent in vitro nuclear magnetic resonance spectroscopy studies have shown that several anaesthetics act on the oligomerisation of amyloid [beta] peptide. Uncontrolled production, oligomerisation and deposition of amyloid [beta] peptide, with subsequent development of amyloid plaques, are fundamental steps in the generation of Alzheimer's disease. Amyloid [beta] peptide is naturally present in the central nervous system, and is found at higher tissue conce...

Effect of informational internet web pages on patients' decision-making: randomised controlled trial regarding choice of spinal or general anaesthesia for orthopaedic surgery

Anaesthesia — Thu, 04 Feb 2010 00:00:00 +0100

This study explored whether patients' preference for particular types of anaesthesia could be influenced pre-operatively by giving them the addresses of various relevant websites. Patients at an orthopaedic pre-assessment education clinic completed a questionnaire, which included a short multiple-choice general knowledge quiz about anaesthesia, and also questioned them as to their choice of anaesthesia (general or neuraxial). Patients were randomly assigned to intervention or control groups. Intervention group members were given the addresses of three relevant anaesthesia and health related websites to access at home. All patients were asked to complete the questionnaires on a second occasion, before surgery. Initially, most patients stated a preference for general anaesthesia. Subsequentl...

Ultrasonographic guided axillary plexus blocks with low volumes of local anaesthetics: a crossover volunteer study

Anaesthesia — Sat, 30 Jan 2010 00:00:00 +0100

This study confirms our previous published ED95 volume for mepivacaine 1% to block peripheral nerves. The volume of local anaesthetic has some influence on the sensory onset time. (Source: Anaesthesia)

The use of sugammadex in a patient with myasthenia gravis

Anaesthesia — Tue, 26 Jan 2010 00:00:00 +0100

We report the successful use of the modified [mu]-cyclodextrin sugammadex in a myasthenic patient to reverse a rocuronium-induced deep level of neuromuscular block. After spontaneous neuromuscular recovery of T2 (second twitch of the train-of-four series), we administered 2 mg.kg[minus]1 of sugammadex intravenously, reversing neuromuscular blockade to a train-of-four ratio (T4/T1) > 90% within 210 s. Sugammadex, in combination with objective neuromuscular monitoring, can be used to reverse rocuronium-induced neuromuscular blockade in patients with myasthenia gravis, thereby avoiding the need for reversal with acetylcholinesterase inhibitors. (Source: Anaesthesia)

A comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotracheal intubation

Anaesthesia — Mon, 25 Jan 2010 00:00:00 +0100

This study aimed to compare the effectiveness of dexmedetomidine vs target controlled propofol infusion in providing sedation during fibreoptic intubation. Forty patients with anticipated difficult airways and due to undergo tracheal intubation for elective surgery were enrolled and randomly allocated into the dexmedetomidine group (1.0 [mu]g.kg[minus]1 over 10 min) (n = 20) or the propofol target controlled infusion group (n = 20). Intubating conditions and patient tolerance as graded by a scoring system were evaluated as primary outcomes. Intubation was successful in all patients. Satisfactory intubating conditions were found in both groups (19/20 in each group). The median (IOR [range]) comfort score was 2 (1[ndash]2 [1[ndash]4]) in the dexmedetomidine group and 3 (2[ndash]4 [2[ndash]5]...

Effects of head rotation on the right internal jugular vein in infants and young children

Anaesthesia — Mon, 25 Jan 2010 00:00:00 +0100

We investigated the effects of head rotation on the cross-sectional area of the right internal jugular vein and its relative position to the carotid artery. Eighty-eight subjects were divided into infants and children groups. The cross-sectional area of the right internal jugular vein and the degree of the carotid artery overlap were measured at 0° (neutral), 40° and 80° of head rotation. The cross-sectional area of the right internal jugular vein was significantly larger at 40° and 80° head rotation compared with the neutral position in both infants and children (p < 0.001). As the head was rotated, the percentage overlap of the carotid artery increased significantly (p < 0.001). We suggest that 40° head rotation appears to be optimal for right internal jugular vein cannulation in p...

Benefits and risks of furosemide in acute kidney injury

Anaesthesia — Wed, 20 Jan 2010 00:00:00 +0100

Furosemide, a potent loop diuretic, is frequently used in different stages of acute kidney injury, but its clinical roles remain uncertain. This review summarises the pharmacology of furosemide, its potential uses and side effects, and the evidence of its efficacy. Furosemide is actively secreted by the proximal tubules into the urine before reaching its site of action at the ascending limb of loop of Henle. It is the urinary concentrations of furosemide that determine its diuretic effect. The severity of acute kidney injury has a significant effect on the diuretic response to furosemide; a good 'urinary response' may be considered as a 'proxy' for having some residual renal function. The current evidence does not suggest that furosemide can reduce mortality in patients with acute kidney i...

Therapeutic hypothermia after cardiac arrest – implementation in UK intensive care units*

Anaesthesia — Tue, 19 Jan 2010 00:00:00 +0100

A telephone survey was carried out to determine how many United Kingdom intensive care units were using therapeutic hypothermia as part of their management of unconscious patients admitted after cardiac arrest. All 247 intensive care units listed in the 2008 Directory of Critical Care Services were contacted to determine how many units were using hypothermia as part of their post-cardiac arrest management and how it was implemented. We obtained information from 243 (98.4%) of the intensive care units. At the time of the study, 208 (85.6%) were using hypothermia as part of post-cardiac arrest management. There has been a steady increase annually in the number of units performing therapeutic cooling from 2003 to date, with the majority of units starting in 2007 or 2008. The International Lia...

The following abstracts were presented at the Annual Scientific Symposium of the Resuscitation Council (UK) in London, September 2009

Anaesthesia — Mon, 18 Jan 2010 00:00:00 +0100

(Source: Anaesthesia)

A low oxygen consumption pneumatic ventilator for emergency construction during a respiratory failure pandemic*

Anaesthesia — Fri, 08 Jan 2010 00:00:00 +0100

The UK influenza pandemic plan predicts up to 750 000 additional deaths with hospitals prioritising patients against inadequate resources. We investigated three prototype low-cost, gas-efficient, pneumatic ventilators in a test lung model at different compliance and rate settings. Mean (SD) oxygen consumption was 0.913 (0.198) and 1.119 (0.267) l.min[minus]1 at tidal volumes of 500 ml and 700 ml respectively. Values of FIo2 increased marginally as lung compliance reduced, reflecting the increased ventilator workload and consequent increased enrichment of breathing gas by waste oxygen from the pneumatic mechanism. We also demonstrated that a stable nitric oxide concentration could be delivered by this design following volumetric principles. It is possible to make a gas-efficient ventilator ...

Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia

Anaesthesia — Thu, 24 Dec 2009 00:00:00 +0100

(Source: Anaesthesia)

The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery

Anaesthesia — Wed, 23 Dec 2009 00:00:00 +0100

The purpose of this study was to evaluate peri-operative outcome after vitreoretinal surgery when peribulbar anaesthesia is combined with general anaesthesia. Sixty adult patients undergoing elective primary retinal detachment surgery with scleral buckling or an encircling procedure received either peribulbar anaesthesia in conjunction with general anaesthesia or general anaesthesia alone. For peribulbar anaesthesia a single percutaneous injection of 5[ndash]7 ml of local anaesthetic solution (0.75% ropivacaine with hyaluronidase 15 iu.ml[minus]1) was used. The incidence of intra-operative oculocardiac reflex and surgical bleeding interfering with the surgical field, postoperative pain and analgesia requirements, and postoperative nausea and vomiting were recorded. In the block group there...

Anaesthesia for proximal femoral fracture in the UK: first report from the NHS Hip Fracture Anaesthesia Network*

Anaesthesia — Sat, 19 Dec 2009 00:00:00 +0100

The aim of this audit was to investigate process, personnel and anaesthetic factors in relation to mortality among patients with proximal femoral fractures. A questionnaire was used to record standardised data about 1195 patients with proximal femoral fracture admitted to 22 hospitals contributing to the Hip Fracture Anaesthesia Network over a 2-month winter period. Patients were demographically similar between hospitals (mean age 81 years, 73% female, median ASA grade 3). However, there was wide variation in time from admission to operation (24[ndash]108 h) and 30-day postoperative mortality (2[ndash]25%). Fifty percent of hospitals had a mean admission to operation time < 48 h. Forty-two percent of operations were delayed: 51% for organisational; 44% for medical; and 4% for 'anaesthetic'...

The value of lung ultrasound monitoring in H1N1 acute respiratory distress syndrome

Anaesthesia — Sat, 12 Dec 2009 00:00:00 +0100

We present the case of a healthy young male who developed acute respiratory failure as a result of infection with influenza A/H1N1 of swine-origin and in whom ventilatory support was optimised and recovery of lung function was monitored by the use of sequential chest ultrasound examinations. The potential pivotal role of bedside lung ultrasonography in H1N1-induced respiratory failure is discussed. (Source: Anaesthesia)

Strongyloides stercoralis hyperinfection: difficulties in diagnosis and treatment

Anaesthesia — Fri, 11 Dec 2009 00:00:00 +0100

We present the case of one such patient who underwent a negative laparotomy for a presumed intra-abdominal surgical catastrophe with a subsequent protracted stay on the intensive care unit. Once the diagnosis of strongyloidiasis was made, the patient was successfully treated with subcutaneous antihelminthic drugs. With appropriate screening for and eradication of strongyloides in those with immune compromise, or in those about to start immunosuppressive therapy, potentially fatal episodes of hyperinfection could be avoided. In the absence of screening, severe strongyloidiasis should be suspected in immunosuppressed individuals who have travelled to or resided in an endemic area and present with the characteristic features. Awareness of the signs of hyperinfection amongst those involved in ...

Beyond competence: defining and promoting excellence in anaesthesia

Anaesthesia — Fri, 11 Dec 2009 00:00:00 +0100

This article reviews published literature and relevant concepts relating to excellence and professionalism from within anaesthesia, from medicine more generally and from outside the profession. A number of conceptual frameworks are presented that could be adapted for the promotion of excellence, and some of the necessary prerequisites for this promotion discussed. (Source: Anaesthesia)

Elective peri-operative intra-aortic balloon counterpulsation during maxillofacial free flap reconstructive surgery in a patient with severe cardiomyopathy

Anaesthesia — Fri, 11 Dec 2009 00:00:00 +0100

We describe the use of intra-aortic balloon counterpulsation in a patient with severe cardiac dysfunction, in whom surgery was initially felt to be contraindicated. (Source: Anaesthesia)

Effect of an episode of critical illness on subsequent hospitalisation: a linked data study

Anaesthesia — Thu, 10 Dec 2009 00:00:00 +0100

Healthcare utilisation can affect quality of life and is important in assessing the cost-effectiveness of medical interventions. A clinical database was linked to two Australian state administrative databases to assess the difference in incidence of healthcare utilisation of 19 921 patients who survived their first episode of critical illness. The number of hospital admissions and days of hospitalisation per patient-year was respectively 150% and 220% greater after than before an episode of critical illness (assessed over the same time period). This was the case regardless of age or type of surgery (i.e. cardiac vs non-cardiac). After adjusting for the ageing effect of the cohort as a whole, there was still an unexplained two to four-fold increase in hospital admissions per patient-year af...

Acute hypotension associated with leucocyte depletion filters during cell salvaged blood transfusion

Anaesthesia — Wed, 09 Dec 2009 00:00:00 +0100

We report a case of acute hypotension during reinfusion of cell salvaged blood through a leucocyte depletion filter that occurred during a caesarean section. We review the literature of hypotension associated with the use of bedside leucocyte depletion filters. (Source: Anaesthesia)

Association of human μ-opioid receptor gene polymorphism A118G with fentanyl analgesia consumption in Chinese gynaecological patients

Anaesthesia — Wed, 09 Dec 2009 00:00:00 +0100

One hundred and seventy-four Chinese gynaecology patients were studied for the impact of A118G polymorphism in the [mu]-opioid receptor gene (OPRM1) on pain sensitivity and postoperative fentanyl consumption. Pre-operatively, the pain threshold and pain tolerance threshold were measured using electrical stimulation. A118G polymorphism was genotyped using the polymerase chain reaction[ndash]restriction fragment length polymorphism method. Intravenous fentanyl patient-controlled analgesia provided postoperative pain management, assessed using a visual analogue scale and fentanyl consumed in the first 24 h after surgery was noted. We found the prevalence of G118 allele was 31.3%. The A118G polymorphism had a gene-dose-dependent effect on electrical pain tolerance threshold. Fentanyl consumpti...

The acute hypoxic ventilatory response under halothane, isoflurane, and sevoflurane anaesthesia in rats*

Anaesthesia — Wed, 09 Dec 2009 00:00:00 +0100

We examined the effects of 1.4, 1.6, 1.8, and 2.0 MAC halothane, isoflurane, and sevoflurane on phrenic nerve activity in euoxia (baseline) and during acute normocapnic hypoxia (inspired oxygen fraction 0.09) in adult male Sprague-Dawley rats. With halothane, all animals became apnoeic even in euoxia, and the hypoxic response was completely abolished at all anaesthetic levels. With isoflurane, 5 of 14 animals exhibited phrenic nerve activity in euoxia at 1.4 MAC and demonstrated a hypoxic response (302% of baseline activity), but all became apnoeic and lost the hypoxic response at higher doses. With sevoflurane, phrenic nerve activity and a hypoxic response was preserved in at least some animals at all doses (i.e. even the highest dose of 2.0 MAC). Similar to the rank order of potency prev...

The cardiovascular effects of normobaric hyperoxia in patients with heart rate fixed by permanent pacemaker

Anaesthesia — Wed, 09 Dec 2009 00:00:00 +0100

To investigate whether the established reductions in heart rate and cardiac output with hyperoxia in humans are primary effects or secondary to increases in systemic vascular resistance, we paced the hearts of nine patients with permanent pacemakers at a fixed rate when breathing either medical air (inspired O2 fraction 0.21) or oxygen (inspired O2 fraction 0.80) in a randomised, double-blind fashion. A thoracic bio-impedance machine was used to measure heart rate, stroke volume and blood pressure and calculate cardiac index and systemic vascular resistance index. Oxygen caused no change in cardiac index (p = 0.18), stroke index (p = 0.44) or blood pressure (p = 0.52) but caused a small (5.5%) increase in systemic vascular resistance index (p = 0.03). This suggests that hyperoxia has no di...

Effect of intra-operative pressure support vs pressure controlled ventilation on oxygenation and lung function in moderately obese adults*

Anaesthesia — Fri, 04 Dec 2009 00:00:00 +0100

Obesity impairs peri-operative lung function. To evaluate the impact of pressure support ventilation vs pressure controlled ventilation in moderately obese adults upon early postoperative lung function, we randomly assigned 68 moderately obese patients (body mass index 25[ndash]35 kg.m[minus]2) undergoing minor surgery to receive intra-operative ventilation either with pressure support or pressure controlled ventilation. We performed intra-operative blood gas analysis and measured pulse oximetry saturation, spirometry values at pre-operative assessment (baseline) and at 10 min, 30 min, 2 h and 24 h after extubation. The intra-operative oxygenation index (arterial partial pressure of oxygen/fraction of inspired oxygen) in the pressure support ventilation group was significantly improved ove...

Handbook of Ambulatory Anesthesia

Anaesthesia — Wed, 02 Dec 2009 00:00:00 +0100

(Source: Anaesthesia)

Obstetric Anaesthesia

Anaesthesia — Wed, 02 Dec 2009 00:00:00 +0100

(Source: Anaesthesia)

Inter-hospital transfers of acutely ill adults in Scotland*

Anaesthesia — Tue, 01 Dec 2009 00:00:00 +0100

The transfer of acutely ill adults who were transported between hospitals by the Scottish Ambulance Service was audited in order to determine the number of transfers and to quantify the incidence of adverse events. Patients over 16 years of age requiring intervention/vital signs monitoring during transfer or a nursing/medical escort from the outset were defined as acutely ill adults. Three thousand and forty-eight audit forms were received, of which 2396 were suitable for inclusion in the audit. Transfers primarily occurred for specialist management (1580; 66%) or specialist investigation (550; 23%). Clinicians escorted 825 (34%) patients and were away from their hospital a median (IQR [range]) of 2 h (01:24[ndash]3:30 [00:05[ndash]17:33]) h:min Clinical intervention was required in 84 tra...

Use of rotation thromboelastometry (ROTEM®) to achieve successful treatment of polytrauma with fibrinogen concentrate and prothrombin complex concentrate

Anaesthesia — Tue, 01 Dec 2009 00:00:00 +0100

We report a severely injured multiple trauma patient who received haemostatic therapy with coagulation factor concentrates, guided by rotational thromboelastometry (ROTEM®). Initial therapy consisted of fibrinogen concentrate (Haemocomplettan® P), as maximum clot firmness in the ROTEM analyses was low, whereas clotting time was normal. Later on, prothrombin complex concentrate was given to optimise thrombin generation. This approach enabled extended emergency hemihepatectomy to be performed without using fresh frozen plasma. As the EXTEM maximum clot firmness showed good clot quality, no platelets were transfused despite low platelet counts. This case shows the potential success of treatment using both fibrinogen concentrate and prothrombin complex concentrate, not only in restoring haem...

NFKB1-94ins/del polymorphism is not associated with lung injury after cardiopulmonary bypass

Anaesthesia — Thu, 26 Nov 2009 00:00:00 +0100

Nuclear factor (NF)-[kappa]B (NFKB1)-94ins/del is an important polymorphism that affects promoter activity of the NFKB1 gene and is potentially associated with several inflammatory diseases. We investigated the association of this polymorphism with lung injury after cardiac surgery and cardiopulmonary bypass in a prospective cohort study of 283 patients. Genotyping was performed by high resolution melting analysis; analysis indicated no association of NFKB1 with postoperative lung injury (p = 0.064). Relative risks of the del allele and the del/del genotype were 1.34 (95% CI 1.02[ndash]1.75) and 1.74 (95% CI 1.00[ndash]3.05) respectively. Logistic regression analysis (with factors including age, peripheral vascular disease and surgical duration as risk factors of lung injury after cardiac ...

Cocaine-related admissions to an intensive care unit: a five-year study of incidence and outcomes

Anaesthesia — Tue, 24 Nov 2009 00:00:00 +0100

Cocaine misuse is increasing and it is evidently considered a relatively safe drug of abuse in Ireland. To address this perception, we reviewed the database of an 18-bed Dublin intensive care unit, covering all admissions from 2003 to 2007. We identified cocaine-related cases, measuring hospital mortality and long-term survival in early 2009. Cocaine-related admissions increased from around one annually in 2003[ndash]05 to 10 in 2007. Their median (IQR [range]) age was 25 (21[ndash]35 [17[ndash]47]) years and 78% were male. The median (IQR [range]) APACHE II score was 16 (11[ndash]27 [5[ndash]36]) and length of intensive care stay was 5 (3[ndash]9 [1[ndash]16]) days. Ten patients died during their hospital stay. A further five had died by the time of follow-up, a median of 24 months later....

Insertion and use of the LMA Supreme™ in the prone position*

Anaesthesia — Mon, 23 Nov 2009 00:00:00 +0100

We investigated whether insertion of an LMA Supreme[trade] and its use for maintenance of anaesthesia is feasible in the prone position. Forty adult patients positioned themselves prone and were given propofol until the Bispectral Index was < 50. A size-4 LMA Supreme was inserted by experienced anaesthetists. Ease of insertion, ease of ventilation, efficacy of seal, ease of gastric tube insertion, blood staining, postoperative sore throat, and other complications were recorded. Insertion was successful at the first and second attempt in 37 (92.5%) and 3 (7.5%) patients, respectively. The mean (SD) insertion time was 21 (15) s. Oropharyngeal leak pressure was greater in females than males (29 (4) vs 25 (4) cmH2O, respectively, p = 0.01). Adequate ventilation was achieved in all patients. Ga...

The prevalence of anatomical variations that can cause inadvertent dural puncture when performing caudal block in Koreans: a study using magnetic resonance imaging

Anaesthesia — Wed, 18 Nov 2009 00:00:00 +0100

The purpose of this study was to investigate the prevalence of the anatomical abnormalities that can induce inadvertent dural puncture when performing caudal block. The anatomy of the lumbo-sacral area was evaluated using magnetic resonance imaging. In 2462 of the 2669 patients imaged, the dural sac terminal was located between the upper half of the 1st sacral vertebra and the lower half of the 2nd sacral vertebra. In 22 cases (0.8%), the dural sac terminal and the spinal canal were located at or below the 3rd sacral vertebra, and these were cases of simple anatomical variations. As regards pathologic conditions, there was one case of sacral meningocoele and 46 cases of sacral perineural cyst. In 21 cases (0.8%) out of the 46 perineural cyst cases, the cyst could be found at or below the 3...

Appropriate laryngeal mask airway size for overweight and underweight children

Anaesthesia — Tue, 17 Nov 2009 00:00:00 +0100

In conclusion, laryngeal mask airway sizing according to the manufacturer's weight-based recommendation is to be preferred in overweight children, but laryngeal mask airway size by an ideal weight estimated from the patient's age is a better choice in underweight children. (Source: Anaesthesia)

Radiation exposure to anaesthetists during interventional radiology*

Anaesthesia — Tue, 17 Nov 2009 00:00:00 +0100

This prospective study determined the level of radiation exposure of anaesthetists during interventional radiological procedures performed in the endoscopic retrograde cholangiopancreatography suite and cardiac catheterisation laboratory and compared it with the current safety guidelines. Anaesthetists wore area-specific lithium fluoride thermo-luminescent dosimeter badges at standardised positions. A total of 1344 procedures were performed over a 6-month period. Anaesthetists were involved in 39/645 (6.0%) procedures associated with ionisation radiation in the endoscopic retrograde cholangiopancreatography suite and 86/699 (12.3%) in the cardiac catheterisation laboratory. The mean (SD) duration of endoscopic retrograde cholangiopancreatography was 54.8 (29.1) min compared with 67.9 (42.8...

Epidural analgesia and breastfeeding: a randomised controlled trial of epidural techniques with and without fentanyl and a non-epidural comparison group

Anaesthesia — Fri, 13 Nov 2009 00:00:00 +0100

We compared breastfeeding initiation and duration in 1054 nulliaparae randomised to bupivacaine Control epidural, Combined Spinal Epidural or Low Dose Infusion and 351 matched non-epidural comparisons. Women were interviewed after delivery and completed a postal questionnaire at 12 months. Regression analysis determined factors which independently predicted breastfeeding initiation. Breastfeeding duration was subjected to Kaplan[ndash]Meier analysis. A similar proportion of women in each epidural group initiated breastfeeding. Women with no epidural did not report a higher initiation rate relative to epidural groups and those who received pethidine reported a lower initiation rate than control epidural (p = 0.002). Older age groups (p < 0.001) and non-white ethnicity (p < 0.026) were predi...

Validation of a novel fibreoptic intubation trainer

Anaesthesia — Sun, 08 Nov 2009 00:00:00 +0100

This study supports the use of such a device in training and assessment although further studies will be required to determine whether the skills learned on the device can be transferred to the clinical environment. (Source: Anaesthesia)

Atomised lidocaine for airway topical anaesthesia in the morbidly obese: 1% compared with 2%*

Anaesthesia — Fri, 06 Nov 2009 00:00:00 +0100

Airway anaesthesia using atomised lidocaine for awake oral fibreoptic intubation in morbidly obese patients was evaluated using two doses of local anaesthetic. In this randomised, blinded prospective study, 40 ml of atomised 1% (n = 11) or 2% (n = 10) lidocaine was administered with high oxygen flow as carrier. Outcomes included time for intubation, patient tolerance to airway manipulation, haemodynamic parameters, the bronchoscopist's overall satisfaction, and serial serum lidocaine concentrations. Patients receiving lidocaine 1% had a longer mean (SD) time from the start of topicalisation to tracheal tube cuff inflation than those receiving lidocaine 2% (8.6 (0.9) min vs 6.9 (0.5) min, respectively; p < 0.05). Patients in the 1% cohort demonstrated increased responses to airway manipulat...

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i-gel in a manikin*

Anaesthesia — Fri, 06 Nov 2009 00:00:00 +0100

We compared the classic laryngeal mask airway and i-gel as adjuncts to fibrescope guided intubation in a manikin. Two methods of intubation were compared with each device: the tracheal tube directly over the fibrescope; and the tracheal tube over an Aintree Intubation Catheter. Thirty-two anaesthetists took part in this randomised crossover study. Each anaesthetist performed two intubations with each method via each device. The mean (SD) time for the first intubation using the tracheal tube over the fibrescope was 43 (24) s with the classic laryngeal mask airway and 22 (9) s with the i-gel (95% CI for the difference 12[ndash]30 s, p < 0.0001). The mean (SD) times for the first intubation when using the Aintree Intubation Catheter was 46 (24) s with the classic laryngeal mask airway and 37 ...

Bispectral index during cardiopulmonary resuscitation: a poor indicator of recovery. Two very different cases

Anaesthesia — Thu, 05 Nov 2009 00:00:00 +0100

We report two cases of massive intra-operative bleeding during lung transplantation requiring emergency cardiopulmonary bypass. In both cases the bispectral index dropped to 0, remained low for around 30 and 90 min respectively, and then returned to values consistent with a usual anaesthetic state (around 40). At the time bispectral monitoring provided some reassurance to the medical team about the adequacy of the resuscitation. However, this proved misleading since postoperative neurological recovery was favourable in one case but not in the other. (Source: Anaesthesia)

The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

We performed a randomised, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous fentanyl (25 [mu]g) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Six hundred patients were randomly assigned to one of three groups to receive either 0.5 ml saline 0.9% 1 min before administration of fentanyl 150 [mu]g (3 ml), or pre-emptive fentanyl 25 [mu]g (0.5 ml) 1 min before administration of fentanyl 125 [mu]g or 150 [mu]g. The incidence of fentanyl-induced cough was significantly lower in both pre-emptive groups (7 (3.5%) for 125 [mu]g fentanyl and 15 (7.5%) for 150 [mu]g fentanyl) than in the saline group (37 (18.5%); p = 0.001). We conclude that pre-emptive use of fentanyl 25 [mu]g, administered 1 min before bolus injection of fent...

The impact of computerised physician order entry on prescribing practices in a cardiothoracic intensive care unit*

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

This prospective, time series, cross-sectional study was designed to compare the quality of handwritten vs computerised prescriptions in a tertiary 25-bedded cardiothoracic intensive care unit. A total of 14 721 prescriptions for 613 patients were analysed over three periods of investigation: 7 months before; and 5 and 12 months after implementation of a clinical information system with computerised physician order entry capability. Errors in prescribing were common. Only (53%) of handwritten charts analysed had all immediate administration drugs prescribed correctly. Errors included omission of route 81 (8.0%), date of prescription 78 (7.7%), and time to be given 255 (25.2%), and 119 (11.7%) had no dose or an incorrect dose prescribed. All errors of completeness were abolished following i...

Monitoring of haemostasis in liver transplantation: comparison of laboratory based and point of care tests

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

During orthotopic liver transplanatation haemostasis is often disturbed and coagulation monitoring is mandatory. We compared the results obtained by whole blood prothrombin time and activated partial thromboplastin time assays (Hemochron®) and thrombelastometry (ROTEM® 05) with laboratory coagulation assays (prothrombin time, activated partial prothrombin time, fibrinogen, and platelet count) in samples obtained during orthotopic liver transplantations. Determination of prothrombin time and activated partial prothrombin time using the Hemochron device showed good correlation with laboratory coagulation assays (r = 0.912, p < 0.001, and r = 0.794, p < 0.001). Maximum clot firmness as determined by thrombelastometry correlated well with platelet count (r = 0.779, p < 0.001) and, to a lesse...

HLA-DR expression and differential trafficking of monocyte subsets following low to intermediate risk surgery*

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

Reduced HLA-DR expression on monocytes has been suggested as a predictive marker of immunosuppression following very high risk surgery, but there are few reports in lower risk surgery. In 32 patients undergoing low to intermediate risk surgery, blood samples were analysed by flow cytometry for HLA-DR expression and numbers in both CD14high and CD14lowCD16+ monocyte subsets. The numbers of CD14high monocytes increased at 24 h (mean (SD), 5.0 (2.2) vs 7.6 (3.9) × 105 cells.ml[minus]1; p < 0.01) while CD14lowCD16+ monocytes decreased (0.68 (0.36) vs 0.44 (0.36) × 105 cells.ml[minus]1; p < 0.01). HLA-DR expression was significantly reduced in both subsets by 24 h (mean (SD) fluorescent intensity 440 (310) vs 160 (130) for CD14high and 1000 (410) vs 560 (380) for CD14lowCD16+ subsets; p < 0.0...

An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic

Anaesthesia — Fri, 23 Oct 2009 23:00:00 +0100

Sequential Organ Failure Assessment (SOFA) score based triage of influenza A H1N1 critically ill patients has been proposed for surge capacity management as a guide for clinical decision making. We conducted a retrospective records review and SOFA scoring of critically ill patients with influenza A H1N1 in a mixed medical-surgical intensive care unit in an urban hospital. Eight critically ill patients with influenza A H1N1 were admitted to the intensive care unit. Their mean (range) age was 39 (26[ndash]52) years with a length of stay of 11 (3[ndash]17) days. All patients met SOFA score based triage admission criteria with a modal SOFA score of five. Five patients required invasive ventilation for a mean (range) of 5 (4[ndash]11) days. Five patients would have been considered for withdrawa...

Risk of pulmonary aspiration with laryngeal mask airway and tracheal tube: analysis on 65 712 procedures with positive pressure ventilation

Anaesthesia — Thu, 22 Oct 2009 23:00:00 +0100

We compared the risk of pulmonary aspiration in patients whose lungs were mechanically ventilated through a laryngeal mask airway (35 630 procedures) or tracheal tube (30 082 procedures). Three cases of pulmonary aspiration occurred with the laryngeal mask airway and seven with the tracheal tube. There were no deaths related to pulmonary aspiration. The incidence and outcome of pulmonary aspiration detected in this study were similar to those previously reported. The adjusted odds ratio (OR) for pulmonary aspiration with the laryngeal mask airway was 1.06 (95% CI 0.20[ndash]5.62). Unplanned surgery (OR 30.5, 95% CI 8.6[ndash]108.9) and male sex (OR 8.6, 95% CI 1.1[ndash]68) were associated with an increased risk of aspiration and age < 14 years with a reduced risk (OR 0.21, 95% CI 0.07[nda...

Use of remifentanil as a sedative agent in critically ill adult patients: a meta-analysis

Anaesthesia — Thu, 22 Oct 2009 23:00:00 +0100

This meta-analysis examined the benefits of using remifentanil as a sedative agent in critically ill patients. A total of 11 randomised controlled trials, comparing remifentanil with another opioid or hypnotic agent in 1067 critically ill adult patients, were identified from the Cochrane controlled trials register and EMBASE and MEDLINE databases, and subjected to meta-analysis. Remifentanil was associated with a reduction in the time to tracheal extubation after cessation of sedation (weighted-mean-difference [minus]2.04 h (95% CI [minus]0.39 to [minus]3.69 h); p = 0.02). Remifentanil was, however, not associated with a significant reduction in mortality (relative risk 1.01 (95% CI 0.67[ndash]1.52); p = 0.96), duration of mechanical ventilation, length of intensive care unit stay, and ris...

Profound hypocalcaemia in a patient being anticoagulated with citrate for continuous renal replacement therapy

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

We report a case of severe systemic hypocalcaemia during continuous renal replacement therapy with citrate anticoagulation resulting from relentless sequestration of calcium due to undiagnosed evolving rhabdomyolysis. Although excessive systemic citrate accumulation can also cause hypocalcaemia, this complication was not observed in our patient. While an acceptable lower limit of ionised calcium remains unknown, severe rhabdomyolysis needs to be considered when a patient's ionised calcium levels are not responsive to standard calcium replacement therapy during continuous renal replacement therapy using citrate anticoagulation in critically ill patients. (Source: Anaesthesia)

Dental implant removal to facilitate suspension laryngoscopy and laser treatment of an obstructed airway

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

A 29-year-old patient presented with dysphonia, dysphagia and a progressive history of stridor over 6 weeks. His past medical history included childhood nasolabial rhabdomyosarcoma treated by surgery, chemotherapy and radiotherapy. This had resulted in marked abnormalities of the facial skeleton, limited neck extension and restricted mouth opening of 1 cm, in part due to dental implants. After careful discussion and planning within a multidisciplinary team, the airway was optimised by temporary removal of the dental implants. This enabled a suspension laryngoscope to be passed, permitting carbon dioxide laser treatment to an obstruction at the laryngeal inlet and eliminating the need for a tracheostomy. (Source: Anaesthesia)

Litigation related to drug errors in anaesthesia: an analysis of claims against the NHS in England 1995–2007

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

Ninety-three claims (total cost £4 915 450) filed under 'anaesthesia' in the NHS Litigation Authority database between 1995 and 2007, alleging patient harm directly by drug administration error or by an allergic reaction, were analysed. Alleged errors were categorised using systems employed by the National Coordinating Council for Medication Error Reporting and Prevention, the American Society of Anesthesiologists Closed Claims Project and the UK Health and Safety Executive. The severity of outcome in each claim was categorised using adapted National Patient Safety Agency definitions. Sixty-two claims involved alleged drug administration errors (total cost £4 283 677) and 15 resulted in severe harm or death. Half alleged the administration of the wrong drug, in most (16) a neuromuscular ...

The Parker Flex-Tip™ tube for nasotracheal intubation: the influence on nasal mucosal trauma

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

We tested our hypothesis that use of the Parker Flex-Tip[trade] tracheal tube could reduce the incidence of nasal mucosal trauma during nasotracheal intubation when compared with a conventional tip tracheal tube. One hundred and two patients, who were scheduled for elective oral surgery in which nasotracheal intubation was indicated to optimise the surgical approach, were recruited into this study. Either a Flex-Tip tracheal tube or a conventional tip tracheal tube was chosen randomly for each nasotracheal intubation. The incidence of epistaxis using the Flex-Tip tracheal tube (6 (11.8%)) was significantly lower than that with the conventional tip tracheal tube (18 (35.3%); p = 0.009). Nasal pain due to intubation, rated on a 100-mm visual analogue scale, was less intense with the Flex-Tip...

The Scottish Audit of Surgical Mortality: a review of areas of concern related to anaesthesia over 10 years

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

The Scottish Audit of Surgical Mortality is a voluntary, peer reviewed, critical event analysis of patients who die under the care of consultant surgeons in acute hospitals in Scotland. The anaesthetic contribution to surgical mortality over a 10-year period from 1996 was reviewed. The total number of deaths was 44 230 or 1.5% of all admissions. Forty thousand, eight hundred and ninety-six deaths (92%) were audited. Deaths after elective surgery declined over 10 years. Over 80% of deaths followed emergency admission. The number of deaths where an anaesthetist was present was 16 981 or 0.6% of all admissions. Anaesthetic areas of concern were identified in 8% of deaths. Of these, 43% were related to pre-operative assessment. Anaesthesia also played a part in a further 18% of deaths where de...

Peri-operative management of a patient with hereditary angioedema undergoing laparoscopic cholecystectomy

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

We describe the peri-operative care of a woman with hereditary angioedema undergoing laparoscopic cholecystectomy with emphasis on the role of anaesthetists as peri-operative physicians. (Source: Anaesthesia)

Lipid resuscitation in a carnitine deficient child following intravascular migration of an epidural catheter*

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

A child with cerebral palsy and carnitine deficiency developed ventricular arrhythmias with loss of cardiac output during elective surgery under general anaesthesia with concomitant epidural analgesia. Sinus rhythm was restored on administration of adrenaline, but hypotension persisted despite resuscitation. Bolus administration of 0.8 ml.kg[minus]1 (20 ml) lipid emulsion resulted in rapid improvement in cardiac output. Blood samples taken before and after the lipid bolus did not demonstrate toxic concentrations of bupivacaine. This case suggests that carnitine deficiency may increase susceptibility to bupivacaine cardiotoxicity. (Source: Anaesthesia)

Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq® and LMA CTrach™ devices*

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

The aim of this study was to evaluate the effectiveness of the Airtraq® and CTrach[trade] in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 [mu]g.kg[minus]1 fentanyl, 3 mg.kg[minus]1 propofol and 0.6 mg.kg[minus]1 rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p < 0.001). The mean (SD) time taken for tr...

Anosmia after general anaesthesia: a case report

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

We present the case of a 60-year-old female patient with a 3-month history of altered smell and taste immediately after recovery from general anaesthesia for a urological operation. The anaesthetic drugs used were fentanyl, propofol and sevoflurane. Clinical examination and a computed tomography brain scan did not reveal any pathology. Psychophysical testing showed anosmia and normal taste function. Imaging studies using single photon emission computed tomography of the brain were performed twice: as a baseline examination; and after odour stimulation with phenyl ethyl alcohol. Normal brain activity without reaction to odorous stimuli suggested peripheral dysfunction or stimuli transmission problems. The patient, after four months of olfactory retraining, demonstrated significant improveme...

A comparison of the laryngeal mask airway with the facemask and oropharyngeal airway for manual ventilation by first responders in children

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

In adults, first responders to a cardiopulmonary arrest provide better ventilation using a laryngeal mask airway than a facemask. It is unclear if the same is true in children. We investigated this by comparing the ability of 36 paediatric ward nurses to ventilate the lungs of 99 anaesthetised children (a model for cardiopulmonary arrest) using a laryngeal mask airway and using a facemask with an oropharyngeal airway. Anteroposterior chest wall displacement was measured using an ultrasonic detector. Nurses achieved successful ventilation in 74 (75%) of cases with the laryngeal mask airway and 76 (77%) with facemask and oropharyngeal airway (p = 0.89). Median (IQR [range]) time to first breath was longer for the laryngeal mask airway (48 (39[ndash]65 [8[ndash]149])) s than the facemask/airw...

Unrecognised dural puncture resulting in subdural hygroma and cortical vein thrombosis

Anaesthesia — Wed, 21 Oct 2009 23:00:00 +0100

Unrecognised dural punctures are difficult to diagnose early. Failure of recognition may lead to sinister consequences. A case of unrecognised dural puncture in a young female leading to the development of subdural hygroma and cortical vein thrombosis is presented. The dilemma in the diagnosis of headache in such patients along with the significance of follow-up of all, including attempted, epidurals is also discussed. (Source: Anaesthesia)

Naloxone-responsive acute dystonia and parkinsonism following general anaesthesia

Anaesthesia — Thu, 15 Oct 2009 23:00:00 +0100

We report an acute, severe and generalised dystonic reaction in an otherwise healthy woman at emergence from general anaesthesia, dramatically reversed by the administration of naloxone, pointing to a potential role of the fentanyl and morphine that the patient had received. Recent literature on the mechanisms of abnormal movements induced by opioids are discussed. The severity of the reaction with usual doses of opioids, in a patient with no prior history of parkinsonism, led to further investigation that demonstrated the possibility of an enhanced susceptibility to opioids, involving a genetically determined abnormal function of glycoproteine-P and catechol-O-methyltransferase. (Source: Anaesthesia)

The effect of intrathecal fentanyl on Cerebral State Index-guided sedation during spinal anaesthesia*

Anaesthesia — Tue, 13 Oct 2009 23:00:00 +0100

In conclusion, adding intrathecal fentanyl 25 [mu]g during spinal anaesthesia significantly reduced the dose of propofol required for sedation and prolonged the subsequent recovery time. (Source: Anaesthesia)

A bench study of ventilation via two self-assembled jet devices and the Oxygen Flow Modulator in simulated upper airway obstruction

Anaesthesia — Mon, 12 Oct 2009 23:00:00 +0100

In managing an obstructed upper airway, an emergency transtracheal ventilation device needs to function as a bidirectional airway, allowing both insufflation of oxygen and egress of gas. The aim of the present study was to determine the capability of two self-assembled, three-way stopcock based jet devices and the Oxygen Flow Modulator to function as a bidirectional airway in conjunction with a small lumen catheter. For each device the effective pressures at the catheter's tip during the expiratory phase and the achievable minute volumes were determined in a laboratory set-up. Using the three-way stopcock based jet devices, changing the connection position of the transtracheal catheter from the in-line port to the side port of the three-way stopcock resulted in a decrease of expiratory pre...

A comparison of a flexometallic tracheal tube with the intubating laryngeal mask tracheal tube for nasotracheal fibreoptic intubation using the two-scope technique*

Anaesthesia — Fri, 09 Oct 2009 23:00:00 +0100

We compared the incidence and site of impingement of a flexometallic tracheal tube with those of the re-usable intubating laryngeal mask (ILMA) tube in 60 anaesthetised patients undergoing nasotracheal fibreoptic intubation for oral surgery. A two-scope technique was used, observing the site of impingement with one scope whilst intubating with the other. The tubes were 6.0-mm in females and 6.5-mm in males. Impingement occurred with 10 (33%) flexometallic and 2 (7%) ILMA tubes (p < 0.032). In all but one case, the impingement was posterior to the right arytenoid cartilage. When impingement was observed, a single disempaction with a 90° anticlockwise rotational manoeuvre overcame impingement in every case except one, allowing successful intubation. We conclude that the incidence of impinge...

An audit of intensive care unit recyclable waste

Anaesthesia — Sun, 04 Oct 2009 23:00:00 +0100

There is little known about recyclable intensive care unit waste. We tested the hypotheses that the intensive care unit produces a small proportion (< 10%) of hospital waste, that much waste (> 30%) is recyclable and that there is little (< 10%) cross-contamination of non-infectious with infectious waste. For seven consecutive days in an Australian 10-bedded intensive care unit, we prospectively sorted all waste. The total intensive care unit waste for the week was 540 kg, representing 5% of hospital waste. Of the 401 kg of intensive care unit general waste, recyclables were 230 kg (57%; 95% CI 53[ndash]61%), mainly plastics, cardboard and paper. There were 0.4 kg of infectious cross-contamination in the 401 kg of general waste. Intensive care unit waste was a small proportion of all hospi...

High frequency jet ventilation through a supraglottic airway device: a case series of patients undergoing extra-corporeal shock wave lithotripsy

Anaesthesia — Thu, 27 Aug 2009 23:00:00 +0100

In this study, a simple method using supraglottic jet ventilation through a laryngeal mask attached to a circle absorber anaesthetic breathing system is described. The technique avoids the need for dense neuromuscular blockade for laryngoscopy and the potential complications associated with sub-glottic instrumentation and sub-glottic jet ventilation. The technique was successfully employed in a series of patients undergoing lithotripsy under general anaesthesia as an outpatient procedure. (Source: Anaesthesia)

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