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ABSTRACTS OF PAPERS
Anaesthesi a and I ntensi ve Care, Vol . 35, No. 5, October 2007
(16.2+ 7.34 vs. 8.6+ 5.97 hours, P < 0.01). The transplanted kidney
formed urine earlier in group-2 than group-1 (9+ 4.76 vs. 18+ 10.85
mins, P < 0.05). Despite a higher diuresis rate for first 12 hours
postoperative in group-2, serum creatinine values were comparable
in both the groups at 24 and 48 hours. There was no acute renal
failure or rejection in any patient.
Concl usi on: Omitting AHT on the day of surgery in ESRD
patients with normal BP control should be considered. Continuation
of AHT on the morning of surgery increases chances of hypotension
at the time of revascularisation under combined epidural general
anaesthesia technique in well controlled hypertensive ESRD
patients. Hypotension and requirement of inotropic support
2
during revascularisation adversely effect renal graft functions in
the immediate postoperative period.
References
1. Sprung J, Kapural L, Bourke DL, OHara JF Jr. Anesthesia for
kidney transplant surgery. Anesthesiol Clin North Am 2000;
18:919-951.
2. Kadieva VS, Friedman L, Margolius LP, Jackson SA, Morrell
DF. The effect of dopamine on graft function in patients
undergoing renal transplantation. Anesth Analg 1993; 76:362-
365.
THE MEDI SEUS EPI DURAL SI MULATORDOES I T
REPLI CATE REAL PATI ENTS?
K.N. El ks, R.H. Ri l ey. Department of Anaesthesi a and Pai n Medi ci ne,
Royal Perth Hospi tal , Perth, Western Austral i a, Austral i a.
Study obj ecti ve: The Mediseus epidural simulator (MES) is a
full procedure training simulator using 3D anatomy and haptics,
virtual learning aids and in-built objective assessment. We surveyed
realism of the MES within our department.
Methods: During November 2006 anaesthetists experienced the
MES, then completed a questionnaire scoring its realism and
collecting demographic dataage, years of practice, epidural
technique performed and data on attitudes towards simulator
training.
Resul ts: Of 24 participating anaesthetists, 23 (96%) had learnt
their technique without simulation and only six (25%) had ever
used a training device. Fifty percent believed trainees should be
simulator-educated before patient exposure. The realism of the
syringe and epidural needle were rated as high (92% and 75%) but
not the models skin (37.5%). Surface anatomy and back shape were
considered unrealistic although about half reported epidural space
depth and insertion resistance as typically real. Forty-two percent
found the tactile feel , 54% the loss of resistance to air (LORTA)
and needle grip realistic. Seventy-five percent recommended
the educational program for teaching, which compares well with
a study
1
reporting that 76% of anaesthetists expressed enthusiasm
for anaesthesia simulation training.
Concl usi ons: Results were equivocal concerning epidural space
depth, needle insertion resistance, LORTA and needle grip. The
simulator and the educational program in particular was perceived
as a useful teaching tool by most participants. Development of loss
of resistance to saline and spinal/lumbar puncture models were
encouraged (87.5%)
Reference
1. Riley RH, Wilks DH, Freeman JA. Anaesthetists attitudes
towards an anaesthesia simulator. A comprehensive survey:
USA and Australia. Anaesth I ntensive Care 1997; 25:514-519.
MAI NTENANCE OF BLOOD PRESSURE DURI NG
SPI NAL ANAESTHESI A FOR CAESAREAN SECTI ON:
DEVELOPMENT AND TESTI NG OF A CLOSED-LOOP
FEEDBACK COMPUTER-CONTROLLED I NFUSI ON
SYSTEM
W.D. Ngan Kee, Y.H. Tam, K.S. Khaw, F.F. Ng. Department of
Anaesthesi a and I ntensi ve Care, The Chi nese Uni versi ty of Hong
Kong, Shati n, Hong Kong.
Study obj ecti ve: Our aim was to develop and test a closed-
loop feedback computer-controlled infusion system for delivering
phenylephrine in 60 patients having spinal anaesthesia for elective
caesarean section.
Methods: Ethics Committee approval and written patient consent
were obtained. Software was written using C+ + running under
WindowsXP and controlled a Graseby syringe pump infusing
I V phenylephrine at 100 ug/min. The controlled variable was
systolic BP (SBP) and the set point was the baseline SBP. I n
this preliminary study, a simple on-off algorithm was utilised to
simulate our previously-described manual technique
1
. I mmediately
after spinal injection of hyperbaric bupivacaine 10 mg and fentanyl
15 ug, crystalloid cohydration commenced and the phenylephrine
infusion was started manually. Non-invasive BP was measured Q1
min and monitoring data were downloaded at 2 s intervals. One
minute after induction the computer controller was activated and,
until dclivcfy, infuscd phcnylcphfinc if SBP was basclinc and
stopped the infusion if SBP was > baseline. The infusion stopped
and an alarm was activated whenever heart rate was < 50/min.
System performance was assessed by calculating bias (median
performance error (MDPE)), inaccuracy (median absolute
performance error (MDAPE)), wobble and divergence
2
.
Resul ts: Seven patients were excluded for technical reasons. No
patient had nausea/vomiting or umbilical arterial pH < 7.2. 94.6%
of SBP measurements were within the range baseline 20%. Mean
(SD) values for system performance were: MDPE: 2.4 (4.5)%,
MDAPE: 6.0 (3.1)%, wobble 5.5 (2.3)% and divergence 0.06
(0.30)%/min.
Concl usi ons: Closed-loop feedback computer-controlled infusion
of phenylephrine is an effective method for maintaining BP during
spinal anaesthesia for caesarean section. Development of more
advanced algorithms is continuing.
References
1. Ngan Kee WD, Khaw KS, Ng FF. Prevention of hypotension
during spinal anesthesia for cesarean delivery: an effective
technique using combination phenylephrine infusion and
crystalloid cohydration. Anesthesiology 2005; 103:744-750.
2. Varvel JR, Donoho DL, Shafer SL. Measuring the predictive
performance of computer-controlled i nfusi on pumps. J
Pharmacokinet Biopharm 1992; 20:63-94.
THE HAEMOSTASI S REGI STRYAUSTRALI AN AND NEW
ZEALAND EXPERI ENCE WI TH rFVI I a
L .E. Phi l l i ps, J. I sbi ster, S. Dunkl ey, J. McNei l , P. Cameron. Monash
Uni versi ty, Department of Epi demi ol ogy and Preventi ve Medi ci ne
and Emergency and Trauma Centre, The Al fred Hospi tal , Mel bourne,
Vi ctori a, Royal North Shore Hospi tal and Royal Pri nce Al fred
Hospi tal , Sydney, New South Wal es, Austral i a.
Study obj ecti ve: Recombinant activated factor VI I (rFVI I a,
NovoSeven) is approved for the treatment of spontaneous and
surgical bleeding in patients with haemophilia A or B and with
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