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Anaesthesia and Intensive Care
Journal Prestige (SJR): 0.597

Citation Impact (citeScore): 1
Number of Followers: 59

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ISSN (Print) 0310-057X - ISSN (Online) 1448-0271
Published by Australian Society of Anaesthetists

[1 journal]

The early history of extracorporeal membrane oxygenation
- Authors: PJ. Featherstone; CM. Ball
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
A data sharing policy for Anaesthesia and Intensive Care
- Authors: JA. Loadsman
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
The Anaesthesia and Intensive Care Jeanette Thirlwell Best Paper Award
turns 21, and our first Junior Investigator Award
- Authors: MG. Cooper; JA. Loadsman
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Mostly harmless'
- Authors: J. Sleigh
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Epinephrine (adrenaline) preventing recovery from intraoperative
anaphylactic shock complicated by systolic anterior motion of the mitral
valve with left ventricular outflow tract obstruction on transoesophageal
echocardiography
- Authors: PHM. Sadleir; RC. Clarke, BSL. Lim, PR. Platt
  Abstract: We describe a case of severe left ventricular outflow tract obstruction (LVOTO) with severe mitral incompetence due to systolic anterior motion of the anterior mitral leaflet (SAM) that was recognised thanks to the immediate availability of transoesophageal echocardiography during the resuscitation of anaphylactic shock. The patient rapidly responded to cessation of the epinephrine (adrenaline) infusion and intravascular volume expansion with intravenous crystalloid. The absence of risk factors for developing SAM/LVOTO serve as a warning to clinicians to consider this diagnosis in all cases of epinephrine non-responsive anaphylactic shock.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Adhesive arachnoiditis following inadvertent epidural injection of 2%
chlorhexidine in 70% alcohol—partial recovery over the ensuing eight
years
- Authors: I. Mohamed Iqbal; R. Morris, M. Hersch
  Abstract: We report a case of serious neurologic injury due to inadvertent epidural injection of 8 ml of the antiseptic 2% chlorhexidine in 70% alcohol during a procedure aimed to relieve the pain of labour. This resulted in immediate severe back pain, progressive tetraparesis and sphincter dysfunction caused by damage to the spinal cord and nerve roots. Subacute hydrocephalus necessitated drainage, but cranial nerve and cognitive function were spared. Magnetic resonance imaging documented marked abnormality of the spinal cord and surrounding leptomeninges. In the ensuing eight years, there has been clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Hyperinsulinaemic euglycaemic therapy use in neurogenic stunned myocardium
following subarachnoid haemorrhage
- Authors: BT. Chandler; P. Pernu
  Abstract: We present a 62-year-old female who collapsed with a subarachnoid haemorrhage. This was complicated by profound shock secondary to neurogenic stunned myocardium. As the patient demonstrated life-threatening catecholamine-resistant shock that was unresponsive to conventional treatment measures, hyperinsulinaemic euglycaemic therapy was utilised as a rescue therapy. To our knowledge this has not previously been described in the literature. The patient proceeded to stabilise and made a good recovery.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Retrieval of critically ill adults using extracorporeal membrane
oxygenation: the nine-year experience in New South Wales
- Authors: DE. Austin; B. Burns, D. Lowe, B. Cartwright, A. Clarke, M. Dennis, M. D'Souza, R. Nathan, PG. Bannon, D. Gattas, M. Connellan, P. Forrest
  Abstract: In New South Wales, a coordinated extracorporeal membrane oxygenation (ECMO) retrieval program has been in operation since 2007. This study describes the characteristics and outcomes of patients transported by this service. We performed a retrospective observational study and included patients who were transported on ECMO to either of two adult tertiary referral hospitals in Sydney, New South Wales, between February 28, 2007 and February 29, 2016. One hundred and sixty-four ECMO-facilitated transports occurred, involving 160 patients. Of these, 118 patients (74%) were treated with veno-venous (VV) ECMO and 42 patients (26%) were treated with veno-arterial ECMO. The mean (standard deviation, SD) age was 40.4 (15.0) years. Seventy-seven transports (47%) occurred within metropolitan Sydney, 52 (32%) were from rural or regional areas within NSW, 17 (10%) were interstate transfers and 18 (11%) were international transfers. Transfers were by road (58%), fixed wing aircraft (27%) or helicopter (15%). No deaths occurred during transport. The median (interquartile range) duration of ECMO treatment was 8.9 (5.2–15.3) days. One hundred and nineteen patients (74%) were successfully weaned from ECMO and 109 (68%) survived to hospital discharge or transfer. In patients treated with VV ECMO, age, sequential organ failure assessment score, pre-existing immunosuppressive disease, pre-existing diabetes, renal failure requiring dialysis and failed prone positioning prior to ECMO were independently associated with increased mortality. ECMO-facilitated patient transport is feasible, safe, and results in acceptable short-term outcomes. The NSW ECMO Retrieval Service provides specialised support to patients with severe respiratory and cardiovascular illness, who may otherwise be too unstable to undergo inter-hospital transfer to access advanced cardiovascular and critical care services.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Vitamin D status and supplementation in adult patients receiving
extracorporeal membrane oxygenation
- Authors: P. Nair; B. Venkatesh, DJ. Hoechter, H. Buscher, S. Kerr, JR. Center, JA. Myburgh
  Abstract: The prevalence of vitamin D deficiency in critical illness is known to be high and associated with adverse clinical outcomes. Patients receiving extracorporeal membrane oxygenation (ECMO) may be at increased risk of vitamin D deficiency due to high severity of acute illness. Challenges with drug dosing in ECMO patients are recognised due to increased volume of distribution and drug absorption to circuit components. To describe the prevalence of vitamin D deficiency in ECMO patients and the effect of intramuscular dosing of cholecalciferol on levels of vitamin D metabolites, and to compare these data with intensive care unit (ICU) patients not receiving ECMO, two prospective studies were performed sequentially: an observational study of 100 consecutive ICU patients and an interventional study assessing effects of intramuscular cholecalciferol in 50 ICU patients. The subgroup of patients who required ECMO support in each of these studies was analysed and compared to patients who did not receive ECMO. Twenty-four ECMO patients, 12 from the observational study and 12 from the interventional study (who received intramuscular cholecalciferol) were studied—21/24 (88%) ECMO patients were vitamin D deficient at baseline compared to 65/126 (52%) of non-ECMO patients (P=0.006). Of the 12 ECMO patients who received cholecalciferol, six patients (50%) achieved correction of deficiency compared to 36/38 (95%) non-ECMO patients (P=0.001). The prevalence of vitamin D deficiency is higher in ECMO patients compared to other critically ill adults. Correction of deficiency with single dose cholecalciferol is not reliable; higher or repeated doses should be considered to correct deficiency.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Postoperative cognitive dysfunction after sevoflurane or propofol general
anaesthesia in combination with spinal anaesthesia for hip arthroplasty
- Authors: Y. Konishi; LA. Evered, DA. Scott, BS. Silbert
  Abstract: It is unknown if the type of general anaesthetic used for maintenance of anaesthesia affects the incidence of postoperative cognitive dysfunction (POCD). The aim of this study was to compare the incidence of POCD in patients administered either sevoflurane or propofol for maintenance of anaesthesia during total hip replacement surgery. Following administration of a spinal anaesthetic, patients received either sevoflurane (n=121) or propofol (n=171) at the discretion of the anaesthetist for maintenance of general anaesthesia to maintain the processed electroencephalogram (bispectral index, BIS) under 60. POCD was assessed postoperatively at day 7, three months, and 12 months using a neurocognitive test battery. There was no statistically significant difference between the incidence of POCD at any timepoint with sevoflurane compared to propofol. The mean BIS was significantly lower in the sevoflurane group than in the propofol group (mean BIS 44.3 [standard deviation, SD 7.5] in the sevoflurane group versus 53.7 [SD 8.1] in the propofol group, P=0.0001). However, there was no statistically significant association between intraoperative BIS level and the incidence of POCD at any timepoint. Our results suggest that the incidence of POCD is not strongly influenced by the type of anaesthesia used in elderly patients.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Peripheral tissue oxygenation and the number of organs transplanted per
donor
- Authors: SE. Perez-Protto; JD. Reynolds, R. Nazemian, J. You, JS. Hata, SQ. Latifi, DJ. Lebovitz
  Abstract: Current donor management practices target macrohaemodynamic parameters, but it is unclear if this leads to improvements in microvascular perfusion and tissue oxygenation; the latter may have more impact on organ status. In a recent preclinical study we determined that brain death impaired tissue perfusion and oxygen utilisation in swine while pharmacologic correction of these deficits improved organ function and reduced markers of tissue injury. As a first step in translating the preclinical findings, we conducted a prospective observational study to determine if there was an association between peripheral tissue oxygenation (measured by near-infrared spectroscopy) in deceased by neurological criteria human donors and the number of organs transplanted. In 60 donors, the mean time-weighted average of tissue oxygenation was 87.5% (standard deviation, SD, 5.2%) and the average number of organs transplanted was 3.5 (SD 2); there was a positive linear relationship between these two parameters. A 5% rise in tissue oxygenation was associated with an increase of 0.47 organs transplanted (95% confidence intervals 0.16 to 0.78) after adjusting for age (P=0.004). No such correlations were observed for the macrohaemodynamic or macro-oxygenation parameters (including arterial blood oxygenation). The results of this clinical trial are consistent with our preclinical work and support the postulate that targeting the microvasculature to improve tissue perfusion and tissue oxygen delivery in human donors has the potential to increase the quantity of organs suitable for transplant.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Preoperative gastric residual volumes in fasted patients measured by
bedside ultrasound: a prospective observational study
- Authors: Y. Ohashi; JC. Walker, F. Zhang, FE. Prindiville, JP. Hanrahan, R. Mendelson, T. Corcoran
  Abstract: The purpose of this prospective observational study was to measure gastric volumes in fasted patients using bedside gastric ultrasound. Patients presenting for non-emergency surgery underwent a gastric antrum assessment, using the two-diameter and free-trace methods to determine antral cross-sectional area (CSA). Gastric residual volume (GRV) was calculated using a validated formula. Univariate and multivariable analyses were performed to examine any potential relationships between ‘at risk’ GRVs (>100 ml) and patient factors. Two hundred and twenty-two successful scans were performed; of these 110 patients (49.5%) had an empty stomach, nine patients (4.1%) had a GRV>100 ml, and a further six patients (2.7%) had a GRV>1.5 ml/kg. There was no significant relationship between at risk GRV and obesity, diabetes mellitus, gastro-oesophageal reflux disease or opioid use, although our study had insufficient power to exclude an influence of one or more of these factors. Our results indicate that despite compliance with fasting guidelines, a small percentage of patients still have GRVs that pose a pulmonary aspiration risk. Anaesthetists should consider this background incidence when choosing anaesthesia techniques for their patients. While future observational studies are required to determine the role of preoperative bedside gastric ultrasound, it is possible that this technique may assist anaesthetists in identifying patients with ‘at risk’ GRVs.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
The effect of preload on electromyographic train-of-four ratio at the
first dorsal interosseous muscle during spontaneous recovery from
neuromuscular blockade
- Authors: A. Bansal; PA. Stewart, S. Phillips, S. Liang, X. Wang
  Abstract: Accurate and reliable quantitative neuromuscular function monitoring is desirable for the optimal management of neuromuscular blockade, selection of the most appropriate reversal agent and dosage, and assessing the completeness of reversal to exclude residual neuromuscular blockade. Applying preload to the thumb may affect the precision of electromyography. This study compared the precision and agreement of electromyography with and without preload during recovery from non-depolarising neuromuscular blockade. After induction of anaesthesia and before neuromuscular blockade, the supramaximal current required at the first dorsal interosseous muscle with and without preload was determined. During recovery, train-of-four ratios were recorded using electromyography every 20 seconds. Alternating pairs of measurements (with and without preload) were obtained until spontaneous recovery was achieved. The preload device applied a resting tension of 75–150 g to the thumb. Bland–Altman analysis for repeated measurements was used to assess precision and agreement of electromyography responses with and without muscle preload. Two hundred and seventy-five sets of repeated measurements were collected from 35 participants. The repeatability coefficient for train-of-four ratios recorded by electromyography with a preload was 0.030 (95% confidence intervals, CI, 0.028 to 0.031) versus 0.068 (95% CI 0.064 to 0.072) without. Train-of-four ratios with preload demonstrated a bias of +0.038 (95% CI 0.037 to 0.042) compared to electromyography without, with 95% limits of agreement of 0.035–0.111. Preload significantly improved the precision of electromyographic train-of-four ratios, with 95% of consecutive measurements differing by less than 3%. Furthermore, electromyography with preload demonstrated a positive bias of 0.04 compared with electromyography alone, the clinical significance of which requires further research.
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
An audit of the diagnostic accuracy of rotational thromboelastometry for
the identification of hypofibrinogenaemia and thrombocytopenia during
cardiopulmonary bypass
- Authors: SA. Matzelle; WM. Weightman, NM. Gibbs
  Abstract: We audited the diagnostic accuracy of ROTEM® (TEM Innovations, GmbH, Munich, Germany) measurements of hypofibrinogenaemia (fibrinogen
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Functional assessment tools in the intensive care unit: are we comparing
apples and oranges'
- Authors: A. Taylor; V. Sarode, DJ. Brewster
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
It's hard to kill off an old paradigm—starvation in the midst of
plenty
- Authors: PD. McLoughlin
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
In reply
- Authors: R. Kerridge; J. Luu, I. Whyte, F. Prior, DA. Story
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Persistent opioid use after arthroplasty
- Authors: MJ. Lennon; FJ. Torlot, J. Micallef, RJ. Khan, P. Vasantharao
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Primum non nocere: greening anaesthesia
- Authors: RH. Burrell
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Use of the LMA® Gastro™ Airway, a novel dual channel laryngeal mask
airway, for endoscopic retrograde cholangiopancreatography: a report of
two cases
- Authors: MW. Skinner; PS. Galloway, DJ. McGlone, C. Middleton
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
A cost comparison between total intravenous and volatile-based anaesthesia
- Authors: DH. Lam; MD. Ng
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
In reply
- Authors: GTC. Wong; MG. Irwin
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Postoperative residual curarisation is still an issue when weaning
patients in intensive care following cardiac surgery
- Authors: G. Cammu; E. Neyens, J. Coddens , F. Van Praet, K. De Decker
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
Anaesthesia, Intensive Care and Perioperative Medicine A-Z: an
Encyclopaedia of Principles and Practice, 6th edition. Steve Yentis,
Nicholas P. Hirsh and James Ip. Published by Elsevier, 2018. ISBN:
9780702071652. pp. 654. A$147.95
- Authors: M. Miller
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT
A Practice of Anesthesia for Infants and Children (6th edition). Charles
J. Coté, Jerrold Lerman, Brian Anderson. Published by Elsevier, 2018.
ISBN 9780323429740; pp. 1,192. A$250.21
- Authors: S. McLaughlin
  PubDate: Sat, 01 Dec 2018 00:00:00 GMT