Therapeutic hypothermia after cardiac arrest - implementation in UK intensive care units.

A telephone survey was carried out to determine how many United Kingdom intensive care units were using therapeutic hypothermia as part of their management of unconscious patients admitted after cardiac arrest. All 247 intensive care units listed in the 2008 Directory of Critical Care Services were contacted to determine how many units were using hypothermia as part of their post-cardiac arrest management and how it was implemented. We obtained information from 243 (98.4%) of the intensive care units. At the time of the study, 208 (85.6%) were using hypothermia as part of post-cardiac arrest management. There has been a steady increase annually in the number of units performing therapeutic cooling from 2003 to date, with the majority of units starting in 2007 or 2008. The International Liaison Committee on Resuscitation guidelines, which recommend the use of therapeutic hypothermia for comatose patients following successful resuscitation from cardiac arrest, have taken at least 4-5 years to achieve widespread implementation in the United Kingdom.

Prescribing intramuscular opioids for labour analgesia in consultant-led maternity units: a survey of UK practice.

BACKGROUND: Intramuscular opioids are widely used for analgesia in labour. We conducted a postal survey to establish current prescribing and monitoring guidelines for intramuscular opioids in consultant-led obstetric units in the UK. METHODS: A postal questionnaire was sent between December 2005 and January 2006 to the lead obstetric anaesthetist of all 234 consultant-led obstetric units in the UK. We enquired about dose regimens of intramuscular opioids in labour and monitoring of mother, fetus and neonate. RESULTS: The response rate was 71%; 84.4% of responding units used pethidine and 34.1% diamorphine. Meptazinol and morphine were available in 13.8% and 13.2% of units respectively. Some units used more than one opioid. The choice of opioid was dictated mainly by tradition (65.3%) and familiarity (40.7%). Prophylactic antiemetics were co-administered in 73.7% of units, the most commonly used being prochlorperazine (30.5%). Vital signs were monitored in 91.6% of units: in total 10.2% measured haemoglobin oxygen saturations and 4.8% respiratory rate. Pain scores were recorded in 13.7% of units. CONCLUSIONS: When compared with previous studies the use of intramuscular diamorphine is increasing in UK consultant-led obstetric units, although pethidine remains the widely used opioid. At present this change cannot be justified by a suitably powered, randomised study comparing intramuscular pethidine with diamorphine.

Reversible posterior leucoencephalopathy syndrome in a peripartum patient.

We present the case of a multiparous parturient who developed hypertension associated with a severe headache in the immediate post-partum period. She subsequently suffered a generalised tonic clonic seizure on the fifth post-partum day. Following recovery of consciousness, she developed a left homonymous hemianopia. Apart from hypertension, headache and convulsion, she had no symptoms and no proteinuria or other biochemical or haematological changes associated with eclampsia. The magnetic resonance imaging findings were consistent with vasogenic oedema in the right posterior parieto-occipital white matter and these in turn are consistent with reversible posterior leucoencephalopathy syndrome. The differential diagnosis of convulsions in the post-partum period is discussed and the clinical and radiological features of reversible posterior leucoencephalopathy syndrome are described.

Lipid analysis of the major salivary glands in streptozotocin-diabetic rats and the effects of insulin treatment.

Two separate sets of experiments were performed on female Wistar rats made diabetic with streptozotocin: (1) a time-course study where groups of three animals were removed at weekly intervals, up to 4 weeks after induction of diabetes, with an age-matched group of control (normal) animals kept for 4 weeks; (2) six further animals were made diabetic and kept for 7 weeks; three of these were given insulin in the final week. At the required time the animals were anaesthetized and the salivary glands removed and preserved by fixation or freezing. The frozen tissues were later homogenized and the protein and lipid content analysed. Histologically, intracellular lipid droplets had accumulated in the majority of the diabetic salivary glands. In the time-course experiment, the visible amount of intracellular lipid reached a maximum after 2 weeks and then decreased, with a concomitant disappearance of interstitial lipid. The increased lipid content was not attributable to any one class. The fatty acid profiles of the glands showed an increase in the percentages of C18:0 (stearic acid) and C18:2w6 (linoleic acid) and a decrease in the percentages of C18:1w9 (oleic acid) and C20:4w6 (arachidonic acid). After 1 week of insulin treatment the lipid content and the fatty acid profiles returned to normal. Thus the effect of insulin on salivary gland lipid metabolism is rapid both in its occurrence and reversibility. The effects seen in the diabetic rats are considered to be due to a lack of insulin and not to the presence of streptozotocin.

Life-threatening fetal anemia secondary to fetal-maternal hemorrhage. A case report.

Decreased fetal movement noted by the mother was the presentation of a severe fetal-maternal bleed. A nonstress test and oxytocin challenge test resulted in cesarean section. The infant, with Apgar scores of 7 and 8 at one and five minutes, respectively, was viable, and her initial hemoglobin was 4.9 and hematocrit, 14. A fetal-maternal bleed of approximately 350 ml was documented. This case demonstrates the importance of careful prenatal monitoring. We recommend looking for severe fetal-maternal hemorrhage as the cause of fresh stillbirth.