04 Jul 09
Posted in Anesthesia at 6:50 by Laci
By R Chapman and F Plaat
Cont Edu Anaesth Crit Care & Pain 2009;9:10-13
Two-thirds of adults in England drink alcohol on a weekly basis, and 30% drink more than the recommended daily level. Among children, 46% of 15 yr olds and 3% of 11 yr olds admit to drinking periodically
Alcohol misuse is estimated to cost the NHS £3 billion per year. Alcohol-related disease was the primary or secondary diagnosis for over 180 000 NHS hospital admissions in 2004/2005. This includes a doubling in the number of admissions for alcoholic liver disease over the past 10 yr. Casualties in road traffic accidents involving a driver over the legal limit for alcohol numbered 17 000 in 2004, representing 6% of the total and including 590 fatalities. Twelve per cent of A&E attendances are for alcohol-related problems, and 22% of attendees have recently consumed alcohol. Risk of injury is greatest with episodic, heavy drinking, a pattern that is increasing in Britain.
The high prevalence of alcohol-related disease means that the anaesthetist will frequently encounter such patients and must consider both the acute and chronic effects of alcohol consumption.
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03 Jul 09
Posted in Anesthesia at 16:49 by Laci
By B Patel and R Bingham
Cont Edu Anaesth Crit Care & Pain 2009;9:6-9
Since its introduction into paediatric anaesthesia in the late 1980s, the laryngeal mask airway (LMA) has been used increasingly to provide hands-free airway management in paediatric patients. However, several disadvantages of the LMA, notably compressibility of the breathing tube and a low cuff leak pressure, have led to the development of alternative supraglottic airway devices. The present article describes the current uses and limitations of the paediatric LMA and initial experiences with some of the newer supraglottic airways in paediatric patients.
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30 Jun 09
Posted in Anesthesia at 22:14 by Laci
By C Lee, J Jahr, K Candiotti, B Warriner, M Zornow, M Naguib
Anesthesiology 2009;110:1020-1025
Rocuronium in intubation doses provides similar intubation conditions as succinylcholine, but has a longer duration of action. This study compared time to sugammadex reversal of profound rocuronium-induced neuromuscular block with time to spontaneous recovery from succinylcholine.
Methods
One hundred and fifteen adult American Society of Anesthesiologists Class I-II surgical patients were randomized to this multicenter, safety-assessor-blinded, parallel group, active-controlled, Phase IIIa trial. Anesthesia was induced and maintained with propofol and an opioid. Neuromuscular transmission was blocked and tracheal intubation facilitated with 1.2 mg/kg rocuronium or 1 mg/kg succinylcholine. Sugammadex (16 mg/kg) was administered 3 min after rocuronium administration. Neuromuscular function was monitored by acceleromyography. The primary efficacy endpoint was the time from the start of relaxant administration to recovery of the first train-of-four twitch (T1) to 10%.
Results
One hundred and ten patients received study treatment. Mean times to recovery of T1 to 10% and T1 to 90% were significantly faster in the rocuronium-sugammadex group (4.4 and 6.2 min, respectively), as compared with the succinylcholine group (7.1 and 10.9 min, respectively; all P < 0.001). Timed from sugammadex administration, the mean time to recovery of T1 to 10%, T1 to 90%, and the train-of-four (T4/T1) ratio to 0.9 was 1.2, 2.9, and 2.2 min, respectively. Reoccurrence of the block was not observed. There were no serious adverse events related to study treatments.
Conclusion
Reversal of profound high-dose rocuronium-induced neuromuscular block (1.2 mg/kg) with 16 mg/kg sugammadex was significantly faster than spontaneous recovery from 1 mg/kg succinylcholine.
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27 Jun 09
Posted in Infection, Procalcitonin at 11:01 by Laci
By M Hochreiter, T Köhler, A Schweiger, F Sixtus Keck, B Bein, T von Spiegel and S Schroeder
Critical Care 2009, 13:R83
The development of resistance by bacterial species is a compelling issue to reconsider indications and administration of antibiotic treatment. Adequate indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care setting. Until recently, no laboratory marker has been available to differentiate bacterial infection from viral or non-infectious inflammatory reaction; however, over the past years, procalcitonin (PCT) is the first among a large array of inflammatory variables that offers this possibility. The present study aimed to investigate the clinical usefulness of PCT for guiding antibiotic therapy in surgical intensive care patients.
Methods
All patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections and at least two concomitant systemic inflammatory response syndrome criteria were eligible. Patients were randomly assigned to either a PCT-guided (study group) or a standard (control group) antibiotic regimen. Antibiotic therapy in the PCT-guided group was discontinued, if clinical signs and symptoms of infection improved and PCT decreased to <1 ng/ml or the PCT value was >1 ng/ml, but had dropped to 25 to 35% of the initial value over three days. In the control group antibiotic treatment was applied as standard regimen over eight days.
Results
A total of 110 surgical intensive care patients receiving antibiotic therapy after confirmed or high-grade suspected infections were enrolled in this study. In 57 patients antibiotic therapy was guided by daily PCT and clinical assessment and adjusted accordingly. The control group comprised 53 patients with a standardized duration of antibiotic therapy over eight days. Demographic and clinical data were comparable in both groups. However, in the PCT group the duration of antibiotic therapy was significantly shorter than compared to controls (5.9 +/- 1.7 versus 7.9 +/- 0.5 days, P < 0.001) without negative effects on clinical outcome.
Conclusions
Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistance and costs in intensive care medicine.
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