Anaesthesia and Intensive Care最新文献_第6页

Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARS-CoV-2. 氯胺酮输注对机械通气SARS-CoV-2患者镇静深度、炎症及临床转归影响的观察研究

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231201184

David Wyler, Marc C Torjman, Ron Leong, Michael Baram, William Denk, Sara C Long, Richard J Gawel, Eugene R Viscusi, Irving W Wainer, Eric S Schwenk

{"title":"Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARS-CoV-2.","authors":"David Wyler, Marc C Torjman, Ron Leong, Michael Baram, William Denk, Sara C Long, Richard J Gawel, Eugene R Viscusi, Irving W Wainer, Eric S Schwenk","doi":"10.1177/0310057X231201184","DOIUrl":"10.1177/0310057X231201184","url":null,"abstract":"Severely ill patients with COVID-19 are challenging to sedate and often require high-dose sedation and analgesic regimens. Ketamine can be an effective adjunct to facilitate sedation of critically ill patients but its effects on sedation level and inflammation in COVID-19 patients have not been studied. This retrospective, observational cohort study evaluated the effect of ketamine infusions on inflammatory biomarkers and clinical outcomes in mechanically ventilated patients with SARS-CoV-2 infection. A total of 186 patients were identified (47 received ketamine, 139 did not). Patients who received ketamine were significantly younger than those who did not (mean (standard deviation) 59.2 (14.2) years versus 66.3 (14.4) years; P = 0.004), but there was no statistically significant difference in body mass index (P = 0.25) or sex distribution (P = 0.91) between groups. Mechanically ventilated patients who received ketamine infusions had a statistically significant reduction in Richmond Agitation-Sedation Scale score (-3.0 versus -2.0, P < 0.001). Regarding inflammatory biomarkers, ketamine was associated with a reduction in ferritin (P = 0.02) and lactate (P = 0.01), but no such association was observed for C-reactive protein (P = 0.27), lactate dehydrogenase (P = 0.64) or interleukin-6 (P = 0.87). No significant association was observed between ketamine administration and mortality (odds ratio 0.971; 95% confidence interval 0.501 to 1.882; P = 0.93). Ketamine infusion was associated with improved sedation depth in mechanically ventilated COVID-19 patients and provided a modest anti-inflammatory benefit but did not confer benefit with respect to mortality or intensive care unit length of stay.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"105-112"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A weighing method for measuring nitrous oxide leakage from hospital manifold-pipeline networks. 一种测量医院歧管管网氧化亚氮泄漏的称重方法。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231198123

Steven J Gaff, Victor X Chen, Eugenie Kayak

{"title":"A weighing method for measuring nitrous oxide leakage from hospital manifold-pipeline networks.","authors":"Steven J Gaff, Victor X Chen, Eugenie Kayak","doi":"10.1177/0310057X231198123","DOIUrl":"10.1177/0310057X231198123","url":null,"abstract":"Nitrous oxide is a potent greenhouse gas and ozone-depleting agent with a long atmospheric lifetime. Several previous reports indicate that over half of supplied nitrous oxide is wasted from leaking manifold-pipeline systems infrastructure prior to patient use, and that remediating leaks can have significant environmental benefits. We describe an accurate, simple and cost-effective cylinder weighing method to quantify nitrous oxide leak from the manifold-pipeline network at our tertiary non-obstetric facility. Nitrous oxide cylinder depletion was prospectively compared with clinical usage derived from the electronic medical record over an 18-day period. A total of 1932 l (3.62 kg) of nitrous oxide was used in 35 operating theatre cases during the period. This was only 16.5% of actual cylinder depletion (11,686 l; 21.88 kg), indicating that 83.5% (9754 l; 18.26 kg) of nitrous oxide had leaked to the atmosphere (376 ml/minute; 22.6 l/hour; 542 l/day). The fraction of nitrous oxide wasted was consistent with a retrospective analysis of the previous 2-year period at the site that compared purchasing records with estimated clinical use. If maintained over a year, the leak would be equivalent to 101 tonnes of carbon dioxide per annum.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"127-130"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Percutaneous electrical nerve stimulation in post-mastectomy neuropathic pain: A case report. 经皮神经电刺激治疗乳房切除术后神经性疼痛1例。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231199800

Gary W Wong, Akhilesh K Tiwari

引用次数: 0

Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review. 区域麻醉下眼科手术后视网膜动脉闭塞:叙述回顾。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231215826

Alfred Wy Chua, Matthew J Chua, Brian P Harrisberg, Chandra M Kumar

{"title":"Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review.","authors":"Alfred Wy Chua, Matthew J Chua, Brian P Harrisberg, Chandra M Kumar","doi":"10.1177/0310057X231215826","DOIUrl":"10.1177/0310057X231215826","url":null,"abstract":"Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. The anaesthetic techniques included 40 retrobulbar blocks, 36 peribulbar blocks, 19 sub-Tenon's blocks, one topical anaesthetic and one unspecified local anaesthetic. Different strengths of lidocaine, bupivacaine, mepivacaine and ropivacaine, either alone or in various combinations, were used. The details of the anaesthetic techniques were often incomplete in the reports, which made comparison and analysis difficult. Only nine cases had their cause (optic nerve sheath injury) identified, while the mechanism of injury was unclear in the remaining patients. Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"82-90"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138469783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bronchial blockers: Has side-by-side fallen by the wayside? Not quite. 支气管阻滞剂:肩并肩已经被淘汰了吗?不完全是。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231202812

Blake J Vorias, Nicholas J Barton, Desmond P McGlade, Naveed Alam

引用次数: 0

Does gender still matter in the pursuit of a career in anaesthesia? 在追求麻醉学的职业生涯中，性别仍然重要吗?

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231212210

Claire H Stewart, Jane Carter, Natalie Purcell, Maryanne Balkin, Julia Birch, Greta C Pearce, Timothy Makar

{"title":"Does gender still matter in the pursuit of a career in anaesthesia?","authors":"Claire H Stewart, Jane Carter, Natalie Purcell, Maryanne Balkin, Julia Birch, Greta C Pearce, Timothy Makar","doi":"10.1177/0310057X231212210","DOIUrl":"10.1177/0310057X231212210","url":null,"abstract":"A survey sent to fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) aimed to document issues affecting gender equity in the anaesthesia workplace. A response rate of 38% was achieved, with women representing a greater proportion of respondents (64.2%). On average women worked fewer hours than men and spent a larger percentage of time in public practice; however, satisfaction rates were similar between genders. There was a gender pay gap which could not be explained by the number of hours worked or years since achieving fellowship. The rates of bullying and harassment were high among all genders and have not changed in 20 years since the first gender equity survey by Strange Khursandi in 1998. Women perceived that they were more likely to be discriminated against particularly in the presence of other sources of discrimination, and highlighted the importance of the need for diversity and inclusion in anaesthetic workplaces. Furthermore, women reported higher rates of caregiving and unpaid domestic responsibilities, confirming that anaesthetists are not immune to the factors affecting broader society despite our professional status. The overall effect was summarised by half of female respondents reporting that they felt their gender was a barrier to a career in anaesthesia. While unable to be included in statistics due to low numbers, non-binary gendered anaesthetists responded and must be included in all future work. The inequities documented here are evidence that ANZCA's gender equity subcommittee must continue promoting and implementing policies in workplaces across Australia and New Zealand.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"113-126"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prevention of airway fires during tracheostomy is preferable. Comment on: Simulation training results in performance retention for the management of airway fires: A prospective observational study. 气管造口术期间最好预防气道火灾。评论：模拟训练在气道火灾管理中的成绩保持：一项前瞻性观察性研究。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-10-06 DOI: 10.1177/0310057X231196908

Kar-Soon Lim

引用次数: 0

Metabolic crisis in maple syrup urine disease: an unusual complication of a rare disease: a case report. 枫糖浆尿病的代谢危机:罕见疾病的罕见并发症:1例报告。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-23 DOI: 10.1177/0310057X231183981

Hemang P Doshi, Hemal H Vachharajani, Michael C Tchan, Mohamed A Nasreddine, Kate E Billmore

引用次数: 0

The introduction of blood gases into clinical practice. 将血气引入临床实践。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 DOI: 10.1177/0310057X231212299

Christine M Ball, Peter J Featherstone

引用次数: 0

Risk factors for mortality in severe COVID-19: Exploring the interplay of immunomodulatory therapy and coinfection. 重症 COVID-19 患者死亡的风险因素：探索免疫调节疗法与合并感染的相互作用。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-09-17 DOI: 10.1177/0310057X231183451

Annaleise R Howard-Jones, Stephen Huang, Sam R Orde, James M Branley

{"title":"Risk factors for mortality in severe COVID-19: Exploring the interplay of immunomodulatory therapy and coinfection.","authors":"Annaleise R Howard-Jones, Stephen Huang, Sam R Orde, James M Branley","doi":"10.1177/0310057X231183451","DOIUrl":"10.1177/0310057X231183451","url":null,"abstract":"Patients with severe clinical manifestations of coronavirus disease 2019 (COVID-19) present particular diagnostic and management challenges to critical care physicians, including identifying and responding to concurrent bacterial and fungal coinfections. This study evaluates risk factors for in-hospital mortality in patients admitted to the intensive care unit with severe COVID-19 during circulation of the B.1.617.2 (Delta) variant, including the impact of immunomodulators and bacterial and/or fungal coinfection. This retrospective cohort study enrolled patients with severe COVID-19. A Cox proportional hazard ratio analysis identified risk factors for in-hospital mortality. Outcomes were also compared between patients receiving and not receiving immunomodulatory therapy alongside standard care. Ninety patients admitted to the intensive care unit were enrolled. On multivariate analysis, the greatest risk factors for in-hospital mortality were invasive mechanical ventilation (hazard ratio (HR) = 15.27; 95% confidence interval (CI) 3.29-71.0; P < 0.001), elevated body mass index (HR = 1.07 per unit; 95% CI 1.02-1.13; P = 0.007) and older age (HR = 1.53 per decade; 95% CI 1.05-2.24; P = 0.028). Bacterial and/or fungal coinfection occurred at equal frequency in patients receiving and not receiving immunomodulatory therapy. However, in patients receiving immunomodulators, coinfection carried a significantly higher mortality risk (63.0%) compared with those without coinfection (15.4%; P = 0.038). Mortality from severe COVID-19 is significantly higher in older patients and those with elevated body mass index and requiring mechanical ventilation. Immunomodulatory therapy necessitates vigilance towards evolving coinfection in the intensive care setting.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"52-63"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0