Limited knowledge of lipid rescue therapy in local anaesthetic systemic toxicity.

INTRODUCTION: There is increasing evidence to support the use of intravenous lipid emulsion (ILE) in the management of local anaesthetic systemic toxicity (LAST) and non-local anaesthetic lipophilic-drug poisoning. This trend is supported by the Association of Anaesthetists of Great Britain and Ireland's latest guidelines on LAST treatment. Similar national guidelines have yet to be introduced in Denmark. The aim of the present study was to study the adoption of lipid rescue therapy in Denmark. MATERIAL AND METHODS: All Danish hospitals with an attending anaesthesiologist (no. 38) were contacted by phone. A total of 34 attending anaesthesiologists (AAs) participated in the systematic telephone survey. RESULTS: A total of 22 (65%) of the AAs were aware of use of ILE in the management of LAST. One (3%) had knowledge of ILE treatment for non-local anaesthetic-drug poisoning. Eight (24%) had access to local guidelines on lipid rescue therapy. The same eight AAs also knew where to find ILE. None of the hospitals lacking guidelines had taken an active stand against the treatment. CONCLUSION: Patients with toxic reactions who could potentially benefit from ILE will not be offered lipid rescue therapy in 26 of 34 hospitals (76%)--either because the AA is not aware of this treatment modality, or due to absence of either guidelines or ILE. To improve the availability of lipid rescue therapy, more hospitals need to develop emergency packs containing ILE and guidelines. Introduction of national guidelines on lipid rescue therapy would probably accelerate this process.

Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm.

BACKGROUND: Acute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort. METHODS: This was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used. RESULTS: A total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%-37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures. CONCLUSION: Moderate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments. TRIAL REGISTRATION NUMBER: RoPR ID 43191.

Cefuroxime pharmacokinetics and pharmacodynamics for intravenous dosage regimens with 750 mg or 1500 mg doses in healthy young volunteers.

Introduction. Cefuroxime is an important antibiotic to treat several serious infections. Rapid elimination through the kidneys and the variation in MICs of various susceptible pathogens such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae give rise to dosing issues, especially in otherwise healthy patients.Aim. To investigate the probability of target attainment (PTA) for obtaining the optimal dosage regimens for cefuroxime in healthy young people.Methodology. Two weeks apart 750 and 1500 mg cefuroxime were administered as an intravenous bolus to 20 healthy volunteers (mean age: 27 years). Population modelling and simulation studies were done based on the obtained data for cefuroxime plasma concentration.Results. With a target value of time above MIC (T >MIC) greater than 50 % the simulations revealed that a PTA of >99 % is obtained for S. pneumoniae with a dosage regimen of 750 mg q12h. For E. coli and K. pneumoniae the PTA was <90 % even with the highest, simulated dosage of 1500 mg q6h. For S. aureus a dosage of 1500 mg q8h gave a PTA above 97 %.Conclusions. S. pneumoniae is most likely treatable with a two-daily dose of 750 mg cefuroxime. Not treatable are K. pneumoniae and E. coli. For S. aureus 1500 mg q8h constitutes an optimal dosing schedule.

The use of ultrasound to identify veins for peripheral venous access in morbidly obese patients.

INTRODUCTION: Peripheral intravenous access (PIA) is a necessity in the treatment and monitoring of the majority of hospitalised patients. Patients with an increased body mass index (BMI) more often than normal-weight patients have a difficult PIA. Identifying veins with ultrasonography has proven helpful when facing a difficult intravenous (IV) access. We hypothesise that, with the help of ultrasonography (US), it is possible to identify at least one vein suitable for IV access in morbidly obese patients (BMI > 40 kg/m(2)). METHODS: We included 55 morbidly obese patients with a BMI > 40 kg/m(2). We performed a detailed US of seven anatomic areas routinely used for PIA. We present a description of parameters that are relevant when attempting PIA. RESULTS: In our study group, all patients had a minimum of one peripheral vein that was suitable for peripheral venous access, including seven patients (12.7%) who did not have clinically detectable veins. CONCLUSIONS: With the aid of US it is possible to identify a minimum of one peripheral vein suitable for IV access in morbidly obese patients. FUNDING: none. TRIAL REGISTRATION: not relevant.

[A case of severe exercise-associated hyponatremia]. / Livstruende elektrolytforstyrrelser efter spinning.

The woman presented to the emergency department with lethargy after a spinning marathon. Severe electrolyte disturbances were measured (Na(+) 109 mmol/l, K(+) 3,2 mmol/l, Cl(-) 86, Ca(++) 0,95 mmol/l). A computed tomography showed signs of brain swelling. During her stay in the intensive care unit the patient had a negative fluid balance of 8,000 ml. She was discharged with habitual weight. We present a brief discussion of the genesis and treatment of EAH.

[Intravenous administration of lipids in poisoning caused by local analgesics]. / Intravenøs administration af lipid ved forgiftning med lipofilt laegemiddel.

OBJECTIVE: To draw attention to the use of intravenous lipids in the treatment of cardiac arrests caused by overdosage of lipophilic drugs. Case reports and animal studies have shown beneficial use of lipids in severe intoxication. The literature is reviewed. CONCLUSION: Lipids have a place in the treatment of severe cardiac events caused by local analgesics for regional anaesthesia. Lipids should be readily available when regional anaesthesia is performed. National guidelines should be prepared. Lipids may also be an option in the treatment of intoxication with other lipophilic drugs.