Abstract：
:Methaemoglobinaemia is an uncommon problem which can significantly impact on oxygen carriage and may necessitate intensive care management. The occurrence of symptomatic methaemoglobinaemia over a three-month period in four patients with haematological malignancies on dapsone for Pneumocystis jiroveci pneumonia prophylaxis prompted a review of its use in this group of patients. We performed a retrospective audit to identify any contributing factors. Co-oximetry was employed to identify patients with methaemoglobinaemia. Thirty-four patients with haematological malignancies received dapsone between January and December 2008, of whom 53% (n = 18) had co-oximetry studies done. Raised methaemoglobin levels (> or = 1.5%) were seen in 13 patients, four of them symptomatic. Mean peak level was of 7.84% (range 1.9 to 26.8%). Eight patients required intensive care support. Mean onset of methaemoglobinaemia was 11.8 days (range 4 to 18 days) following dapsone commencement. All patients were anaemic with an average haemoglobin of 85.5 g/l (range 59 to 111 g/l). All patients were prescribed 'azole' antifungal agents and five patients were also on high-dose steroids, both agents known to induce cytochrome P-450 enzymes and hence potentiating dapsone toxicity. Our experience suggests that dapsone should be used with caution in patients with haematological malignancies as they are particularly at risk of developing symptomatic methaemoglobinaemia due to underlying anaemia, immunosuppression and potential drug interactions. The current recommendation of dapsone for Pneumocystis jiroveci pneumonia prophylaxis in this group of patients needs to be reviewed. When methaemoglobinaemia does occur early recognition is possible with routine co-oximetry testing and prompt treatment may lessen the need for or duration of intensive care supports.
journal_name
Anaesth Intensive Carejournal_title
Anaesthesia and intensive careauthors
Subramaniam A,Corallo C,Nagappan Rdoi
10.1177/0310057X1003800618subject
Has Abstractpub_date
2010-11-01 00:00:00pages
1070-6issue
6eissn
0310-057Xissn
1448-0271pii
20100099journal_volume
38pub_type
杂志文章abstract：:Perioperative hypoxaemia is a common but serious problem with well recognised causes. However, an anomalous bronchus causing lobar collapse as a cause is seldom mentioned. A healthy young male patient was anaesthetised for a knee operation. He required re-intubation immediately postoperatively for hypoxia. He was foun...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0703500219
更新日期：2007-04-01 00:00:00
abstract：:We studied the effect of rapid sequence induction of anaesthesia on intraocular pressure in physically fit, ASA class I or II patients using combinations of sufentanil (1 microgram/kg), or fentanyl (5 micrograms/kg) and vecuronium (0.2 mg/kg) or atracurium (1.0 mg/kg). All patients received thiopentone (5 mg/kg), foll...
journal_title：Anaesthesia and intensive care
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1177/0310057X9001800317
更新日期：1990-08-01 00:00:00
abstract：:The synthetic glucocorticoid dexamethasone is administered to many patients receiving a general anaesthetic to reduce the risk of postoperative nausea and vomiting. Dexamethasone is known to suppress the hypothalamic-pituitary-adrenal axis; however, the duration of this suppression following the standard anti-emetic i...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章,随机对照试验
doi：10.1177/0310057X1304100504
更新日期：2013-09-01 00:00:00
abstract：:The oxygen saturations of 152 children were studied for the first 30 minutes following general anaesthesia with a pulse oximeter. Thirty-six patients (24%) recorded oxygen saturations of less than 90% while breathing room air and in all cases this occurred during the first ten minutes. Intubation (P less than 0.001), ...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X8801600208
更新日期：1988-05-01 00:00:00
abstract：:Chlormethiazole ethanedisulphonate (Hemineurin) was administered to provide light sedation in patients undergoing surgery with neural blockade. A two stage intravenous infusion system was used and consisted of a loading dose 1520 mg over 30 minutes followed by a maintenance rate of 10 mg/min for the desired period. Pa...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X8000800405
更新日期：1980-11-01 00:00:00
abstract：:This study was performed to assess the changes in pulmonary mechanics before and after tracheostomy in patients with prolonged mechanical ventilation and to detect pre-tracheostomy physiologic factors that predict the outcome of weaning from mechanical ventilation. Pulmonary mechanics were recorded before and after tr...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X9902700604
更新日期：1999-12-01 00:00:00
abstract：:This study confirms that distance to the epidural space from the skin at the L3-4 interspace is only moderately correlated with body mass index in obstetric patients. A similar moderate linear correlation was found in the non-obstetric patients. However, in obese patients (BMI > 25), distance to epidural space from th...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X9302100309
更新日期：1993-06-01 00:00:00
abstract：:Hydrogen peroxide solutions are found in almost every operating theatre and are used by many surgical specialties, often with little knowledge of their inherent risk. We reviewed the literature and evidence related to the use of hydrogen peroxide in surgery. We found little evidence supporting the use of hydrogen pero...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章,评审
doi：10.1177/0310057X1103900604
更新日期：2011-11-01 00:00:00
abstract：:A longitudinal study of one hundred consecutive admissions to the Royal Adelaide Hospital for carbon monoxide poisoning was conducted from 1986 to 1989. Twenty-five patients left hospital with persistent symptoms and signs of this poisoning. Five subsequently recovered. Twenty-four other patients, who were well when t...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X9202000306
更新日期：1992-08-01 00:00:00
abstract：:Unilateral or bilateral raised hemidiaphragms were observed on chest X-ray in three patients with severe tetanus. Diaphragmatic movement was absent on ultrasonography and fluoroscopy. Nerve conduction study confirmed phrenic nerve palsy. Bilateral involvement caused delayed weaning from the ventilator, whereas unilate...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0403200220
更新日期：2004-04-01 00:00:00
abstract：:We reviewed the clinical characteristics, required intervention and short- and long-term outcomes in obstructive sleep apnoea (OSA) patients requiring intensive care. A retrospective, single-centre, observational cohort study was undertaken in a multidisciplinary teaching medical and surgical intensive care unit. Adul...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X1003800315
更新日期：2010-05-01 00:00:00
abstract：:A 26-year-old woman with a history of intravenous drug use was admitted to hospital with worsening pain in the right buttock radiating to the lateral part of the thigh and to the calf with no suspicion of cauda equina compression. Eventually, a diagnosis of sacroiliitis was made and appropriate antibiotics were admini...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0503300618
更新日期：2005-12-01 00:00:00
abstract：:This paper reports on the causes and preventability of primary anaesthetic deaths in Western Australia between 1985 and 2008. In Western Australia, it is a legal requirement to report all deaths that occur within 48 hours of an anaesthetic and later deaths if an anaesthetic complication is implicated. A committee asse...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X1304100305
更新日期：2013-05-01 00:00:00
abstract：:Transoesophageal Doppler cardiac output measurement was evaluated against the thermodilution method in eleven patients undergoing elective cardiac surgery. A total of 106 pairs of Doppler and thermodilution values were obtained. Cardiac output was measured over a range of 2.3 l.min-1. to 11.51 l.min-1. The mean differ...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X9101900219
更新日期：1991-05-01 00:00:00
abstract：:Thyroid storm is a rare but life-threatening condition manifesting with several clinical presentations. Atypical thyroid storm should be part of the differential diagnosis in patients with multiple organ dysfunction of unknown aetiology. In this case report, delayed recognition of thyroid storm in a young female who p...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0903700609
更新日期：2009-11-01 00:00:00
abstract：:The mechanism of cerebral homeostasis is reviewed, paying particular attention to the way blood-brain barrier, cerebrospinal fluid and cerebral blood flow contribute to the maintenance of normal intracranial pressure. The pathophysiology of raised intracranial pressure is outlined delineating the different types of ce...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章,评审
doi：10.1177/0310057X8100900405
更新日期：1981-11-01 00:00:00
abstract：:We present a case of acute lithium intoxication in a 51-year-old woman on chronic lithium therapy. Her serum lithium level was 10.6 mmol/l 13 hours after ingestion and 5.8 mmol/l at 24 hours. Dialysis therapy was not employed and she recovered well after fluid resuscitation. Serum lithium levels in chronic intoxicatio...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0203000118
更新日期：2002-02-01 00:00:00
abstract：:In a series of patients who suffered severe histamine mediated reactions to induction agents and muscle relaxants, intradermal testing enabled the drug involved to be distinguished. The correct use of intradermal testing to give reliable results is discussed and a protocol described. Prausnitz Kustner testing was of l...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X7600400202
更新日期：1976-05-01 00:00:00
abstract：:The aim of this randomised controlled study was to compare continuous subcutaneous insulin infusion using an insulin pump with the traditional continuous intravenous infusion method for tight glycaemic control. Sixty patients admitted to our University Hospital medical intensive care unit with an initial blood glucose...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章,随机对照试验
doi：10.1177/0310057X0803600421
更新日期：2008-07-01 00:00:00
abstract：:We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be related to patent blue V dye (Guerbet - Chemical Abstract Service 3536-49-0). All three cases were associated with moderate to severe hypotension. Two cases had delayed onset, and two were associated with a rash. None of the...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X1103900221
更新日期：2011-03-01 00:00:00
abstract：:Unselected preoperative coagulation testing is known to have low positive yield. However, no study has specifically evaluated neurosurgical patients. A retrospective study of 1211 patients having neurosurgery over a one-year period was therefore conducted. Preoperative test results (activated partial thromboplastin ti...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0102900410
更新日期：2001-08-01 00:00:00
abstract：:Spontaneous rupture of a hydatid cyst is reported in a 19-year-old cattleman. Mechanical ventilation for respiratory failure and a right lower lobectomy were required for flooding of the airway with hydatid cyst fluid. The postoperative course was complicated by the development of acute respiratory distress syndrome. ...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X9802600614
更新日期：1998-12-01 00:00:00
abstract：:Prophylaxis of acute upper gastrointestinal bleeding by control of gastric pH has been widely advocated for intensive care patients. H2-blockers and antacids have been used and demonstrated to be incompletely effective at maintaining gastric pH above 4. A study of 100 patients measured the efficacy of two-hourly gastr...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X9101900114
更新日期：1991-02-01 00:00:00
abstract：:The Competency-Based Training program in Intensive Care Medicine in Europe identified 12 competency domains. Professionalism was given a prominence equal to technical ability. However, little information pertaining to fellows' views on professionalism is available. A nationwide qualitative study was performed. The mod...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X1103900118
更新日期：2011-01-01 00:00:00
abstract：:A nationwide survey (70% response) documented anaesthetists' hours of work, their perceptions about safety limits and their recollection of fatigue-related errors in clinical practice. In the preceding six months, 71% of trainees and 58% of specialists had exceeded their self-defined safety limits for continuous anaes...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0002800209
更新日期：2000-04-01 00:00:00
abstract：:Saline tonometry has been replaced by automated air tonometry (TONOCAP). As with saline tonometry there are some pitfalls to consider. We investigated the influence of different filling handicaps to the tonometry catheter sampling balloon on measurement of regional PCO2 (PrCO2). In an in vitro set-up, PrCO2 was measur...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0203000613
更新日期：2002-12-01 00:00:00
abstract：:Emery-Dreifuss muscular dystrophy is a rare form of muscular dystrophy associated with cardiac implications such as cardiomyopathy and arrhythmias leading to sudden death. We describe the anesthetic management of a patient with Emery-Dreifuss muscular dystrophy who presented for orthopaedic surgery and discuss the dis...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0203000320
更新日期：2002-06-01 00:00:00
abstract：:A thirty-year-old female presented with a high fever, conjunctivitis, confusion, vomiting, watery diarrhoea, diffuse erythroderma, shock and oliguric renal failure. Staphylococcus aureus phage 29/52 (Group 1) was isolated from a high vaginal swab. In addition to all the previously reported features which defined toxic...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X8100900410
更新日期：1981-11-01 00:00:00
abstract：:A 74-year-old man with cardiac failure and renal impairment was admitted to the cardiothoracic intensive care unit with metformin-induced lactic acidosis and shock. He was successfully treated with high-dose (80 ml/kg/hour) continuous venovenous haemodiafiltration. Lactic acidosis is a known complication of metformin ...
journal_title：Anaesthesia and intensive care
pub_type： 杂志文章
doi：10.1177/0310057X0903700520
更新日期：2009-09-01 00:00:00
abstract：:A randomised prospective controlled study was conducted during a one-year period on patients scheduled for oesophagectomy via a right thoracotomy approach. Twenty-two patients received one-lung ventilation (OLV group) and twenty patients received high frequency positive pressure ventilation (HFPPV group). Episodic hyp...
journal_title：Anaesthesia and intensive care
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1177/0310057X9101900209
更新日期：1991-05-01 00:00:00
