30 Jan 06
Posted in Bleeding, General at 18:45 by Laci
By IJ Welsby, DM Monroe, JH. Lawson and M Hoffmann
Anaesthesia 60 (12), 1203-1212.
Recombinant activated factor VII is a safe and effective for the treatment and prevention of haemorrhage in haemophiliacs with circulating inhibitors to replacement factors, and patients with Glanzmann’s thrombasthenia refractory to platelet transfusion. By restoring thrombin generation on the surface of tissue factor bearing cells, such as activated platelets and monocytes, recombinant activated factor VII has the potential to effect haemostasis in the setting of many coagulopathic states encountered by the anaesthetist in the operating theatre or the intensive care unit. Case reports of successful rescue therapy make up the majority of the literature covering other, numerous, off-label uses of recombinant activated factor VII, although some randomised, controlled studies, mostly underpowered to address safety concerns, have been performed. However, off-label use is becoming increasingly popular judging by the number of published case reports. Additional randomised, controlled trials to determine the safe and appropriate use of this potentially valuable therapy in broader patient groups are eagerly awaited.
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Posted in General at 18:42 by Laci
By Association of Anaestehtists of Great Britain and Ireland
The majority of anaesthetists are likely to be involved with an anaesthetic catastrophe at some point in their careers. The psychological impact on staff following death or serious injuryto a patient should not be underestimated. It is vital that members of the anaesthetic department support the anaesthetist and a senior colleague or mentor should be assigned to this role. Contemporaneous records of the event must be kept. The clinical commitment of the anaesthetist concerned should be reviewed immediately by the clinical director. A team approach should be adopted to breaking bad news with relatives. This should not be done over the telephone. The task of breaking bad news should not be carried out by a trainee or staff grade or associate specialist (SAS) doctor without a consultant present. Each hospital must have a procedure for dealing with and investigating catastrophic events. Critical incident stress debriefing by trained facilitators with further psychological support may assist individuals to recover from the traumatic event. Anaesthetists are strongly advised to be a member of a medical defence organisation.
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29 Jan 06
Posted in Critical Care, General at 17:50 by Laci
I think this is an interesting background article to whom who have some interest in microbiology. An outbreak of pandemic influenza would have significant impact on critical care. Our hospital, as many of western health system, have been setting up a contingency plan how to cope with sudden increase in number of patients requiring ventilation. To have some information about influenza, epidemiology would help an intensivist to understand the situation better.
By JC. Obenauer, J Denson, PK. Mehta, X Su, S Mukatira, et al
Published online http://www.sciencemag.org/cgi/content/abstract/1121586
The spread of H5N1 avian influenza viruses (AIV) from China to Europe has raised significant global concern about their potential to infect humans and cause a pandemic. In spite of their significant threat to human health, remarkably little AIV whole genome information is available. We report here a preliminary analysis of the first large scale sequencing of AIV including 2,196 AIV genes and 169 complete genomes. We combine this new information with public AIV data to identify new gene alleles, persistent genotypes, compensatory mutations, and a potential virulence determinant.
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27 Jan 06
Posted in Critical Care, Sedation at 19:41 by Laci
By TN Evans, GR Park
Anaesthesia,1997, 52: 800-801
This is a short report appeared in the Correspondence section of Anaesthesia in 1997. Six adults receiving mechanical ventilation were given remifentanil. All patients were started on a dose of 0.25 ug/kg/min of remifentanil and the rate titrated to individual’s needs, up to a maximum of 2 ug/kg/min. For stimulating procedures such as tracheal suction, bolus doses of 1 ug/kg were also given. The duration of infusion ranged from 3 to 33 days, with a mean of 10.5 days. The modal infusion rate rangeg from 0.082 to 0.43 ug/kg. Authors have shown that remifentanil is a useful tool for sedation and analgesia in the critically ill.
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