Thirty-six unpremedicated women due for gynaecological surgery were examined for time-dependent prolongation of the QT interval in the electrocardiogram (ECG) before and after induction of anaesthesia using either sevoflurane or propofol. The conventional inhalational technique to induce anaesthesia with sevoflurane. ECG recordings were taken before, 2, 5 and 10 min after drug administration. Sevoflurane significantly lengthened (P < 0.001) the heart rate corrected QT interval within 10 min from 434±5ms to 459±6ms (mean ±SEM). Already after 2 min of sevoflurane application a trend towards prolongation was visible. The critical value of 440ms in the rate-corrected QT interval was exceeded in four patients in the sevoflurane group (n=18) but in only in one patient in the propofol group (n=18). Rate-corrected QT interval prolongation caused by sevoflurane needs to be recognized early in order to prevent the critical ventricular tachycardia torsade de pointes

The elimination of procalcitonin and the course of plasma concentrations during continuous veno-venous haemodiafiltration were measured in patients with sepsis or multiple organ dysfunction syndrome, because these patients are a main target group for the measurement of procalcitonin and often require renal replacement therapy. Procalcitonin was measured in the prefilter plasma and the filtrate at 5 min, 15 min and 1, 2, 4, 6, 12, 24 h after set-up of continuous veno-venous haemodiafiltration. In a prospective study, 19 patients with plasma levels of procalcitonin >3ng mL−1 and acute oliguric renal failure treated with continuous veno-venous haemodiafiltration using a polysulphone membrane, were evaluated for the study of clearance. Twenty-one control patients (procalcitonin <2ng mL−1) were studied to determine whether filtration itself induced a procalcitonin response. No interventions were required. In patients with low procalcitonin concentrations (procalcitonin <2ng mL−1) continuous veno-venous haemodiafltration did not cause a rise in procalcitonin. In patients with increased procalcitonin plasma concentrations (>3ng mL−1), the protein was removed through the polysulphone membrane, with a final clearance of 4 mL min−1 after the initial adsorption period (clearance 0.4–0.9mL min−1 during the first hour of continuous veno-venous haemodiafiltration). Thus, on the average, approximately 10% of plasma concentrations were measurable in the filtrate ultimately. However, procalcitonin plasma levels were not significantly altered during continuous veno-venous haemodiafiltration (86% of the initial concentration after 24 h). Although procalcitonin is removed from the plasma during continuous veno-venous haemodiafiltration in measurable amounts plasma procalcitonin concentrations did not change significantly during haemodiafiltration. Procalcitonin thus can also be used as a diagnostic parameter in patients undergoing continuous veno-venous haemodiafiltration.

The inhalation of lidocaine attenuates bronchial hyper-reactivity but also causes airway irritation. However, how lidocaine dose and plasma concentration influence relationships are unknown. Accordingly, we evaluated the effects of three concentrations of lidocaine (1, 4, and 10%, total dose of 0.5, 2.0, and 5.0mg kg−1, respectively) vs. placebo in 15 mild asthmatic patients, selected by their response to a histamine challenge (decrease in FEV1 >20% to less than 18mg mL−1 of histamine [PC20]). Baseline lung function, histamine-induced bronchoconstriction, topical anaesthesia, and lidocaine plasma concentrations were obtained. FEV1 following lidocaine inhalation showed the greatest decrease for the highest dose (from 3.79 ± 0.15−3.60 ± 0.15; P=0.0012). Lidocaine inhalation increased baseline PC20 (6.1 ± 1.3mg mL−1) significantly (to 11.8 ± 3.1, 16.1 ± 3.3, and 18.3 ± 4.5mg mL−1, respectively) with no difference between the two highest doses. The duration of local anaesthesia was not significantly different between lidocaine concentrations of 4% and 10%. Thus, lidocaine inhalation, with increasing concentrations of the aerosolized solution, increases initial bronchoconstriction while significant attenuation of bronchial hyper-reactivity is not further enhanced with increasing concentrations from 4 to 10%. Plasma concentrations of lidocaine were always far below the toxic threshold. In conclusion, when local anaesthesia of the airways is required a lidocaine dose of 2.0mg kg−1 as a 4% solution can be recommended for local anaesthesia and attenuation of bronchial hyper-reactivity with the least airway irritation.

In an attempt to overcome infections associated with central venous catheters, a new antiseptic central venous catheter coated with benzalkonium chloride on the internal and external surfaces has been developed and evaluated in a clinical trial. Patients (235) randomly received either a triple-lumen central venous catheter coated with benzalkonium chloride (117) or a polyurethane non-antiseptic catheter (118). The incidence of microbial colonization of both catheters and retained antiseptic activity of the benzalkonium chloride device following removal were determined. The benzalkonium chloride resulted in a significant reduction of the incidence of microbial colonization on both the internal and external catheter surfaces. The reduction in colonization was detected at both the intradermal (21 benzalkonium chloride catheters vs. 38 controls, P=0.0016) and distal segments of the antiseptic-coated catheters. Following catheter removal retained activity was demonstrated in benzalkonium chloride catheters which had been in place for up to 12 days. No patients developed adverse reactions to the benzalkonium chloride catheters. The findings demonstrate that the benzalkonium chloride catheter significantly reduced the incidence of catheter-associated colonization.

Tracheostomy is necessary in intensive care unit (ICU) patients requiring prolonged mechanical ventilation. As an alternative to the standard surgical method, percutaneous techniques are available. Seventy-two patients were electively selected for percutaneous tracheostomy (PCT) in a nine-bed combined medical-surgical intensive care unit. PCT was performed at bedside with the Portex Percutaneous Tracheostomy Kit that uses the Griggs technique. The procedure time and early complications were recorded. The procedure was successful in all patients. The average duration of placement was 7.4 min. There were no tracheostomy-related deaths. Major bleeding occurred in three patients and required surgical intervention. In one patient, minor bleeding occurred at the stoma site that resolved with applied pressure. Wound infections were treated with local antiseptics in two patients. These findings suggest that PCT is a simple, quick and safe procedure.

Alpha-adrenergic agonists produce pain relief through an opioid independent mechanism and may be alternatives to opioids for combination with local anaesthetics for analgesia during labour. We studied 41 pregnant women. Epidural block was performed with 75 μg clonidine (n=20) or 50 μg fentanyl (n=21) combined with 0.125% bupivacaine (10 mL). Maternal vital parameters were measured. Analgesia was evaluated using a visual analogue scale (VAS); sedation was scored using a five-point scale. There were no differences in maternal vital parameters, fetal heart rate (FHR) or Apgar scores between the groups. Analgesia lasted longer in the bupivacaine-clonidine group (139.4±31 min) compared with the bupivacaine–fentanyl group (127.9±48 min) (P=0.42). Additional analgesic requirement was more often in the fentany–bupivacaine group and total bupivacaine requirement was less in the clonidine–bupivacaine group (22.5±12.5mg vs. 30.9±12.8 mg) (P=0.04). This small study confirms that this combination of bupivacaine and clonidine provides satisfactory analgesia for first-stage labour, and of longer duration than bupivacaine–fentanyl.

A telephone survey of 20 English intensive care units (ICUs) confirmed that visual estimation of patient weight is often performed. Four experienced intensive care staff (three doctors and one nurse) estimated the weight and measured the height of 30 volunteers and the estimates were compared with accurate reference measurements. The estimates were shown to be significantly inaccurate for individual observers. We consider the degree of inaccuracy to be of clinical importance. However, pooling the individual estimates of weight as mean values improved accuracy. Recommendations are made concerning the performance of height and weight determination.

We present a case of pulmonary embolism that occurred during the injection of lipiodol during transcatheter arterial chemoembolization under general anaesthesia. A 7-year-old child suffering from a large hepatoblastoma was admitted for arterial chemoembolization and carcinostatic administration. Pulmonary embolism due to lipiodol during arterial chemoembolization was evident by a sudden fall in oxyhaemoglobin saturation from 100 to 90%. This was associated with a spread of lipiodol into both lungs, particularly the middle lung zones and detected by chest fluoroscopy. Arterial blood gases returned to normal values 1 day later but pulmonary infiltration persisted for 7 days before final clearance. Pulmonary embolism caused by lipiodol during arterial chemoembolization is infrequent, but such a complication could prove fatal. Understanding the risk of pulmonary embolism in patients receiving lipiodol, during and after arterial chemoembolization, and late onset pulmonary injury is important and a close follow-up for several days after arterial chemoembolization is advisable.

We describe a patient with aortic dissection extending into the right coronary artery who was successfully resuscitated and operated upon after a cardiac arrest during transfer to the operating room. The use of transoesophageal echocardiography was particularly helpful for rapid diagnosis of aortic type A dissection and urgent surgical treatment.