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McDonnell N.J.,University of Western Australia | Pavy T.J.G.,University of Western Australia | Green L.K.,King Edward Memorial Hospital for Women | Platt P.R.,Sir Charles Gairdner Hospital
British Journal of Anaesthesia | Year: 2011

Anaphylaxis during anaesthesia is a rare event that in ∼6070 of cases is secondary to neuromuscular blocking agents. It has been suggested previously that the recent introduction of sugammadex may provide a novel therapeutic approach to the management of rocuronium-induced anaphylaxis. We describe the case of a 33-yr-old female who suffered a severe anaphylactic reaction to rocuronium, presenting with cardiovascular collapse on induction of anaesthesia. After 19 min of traditional management, she was given a bolus of sugammadex 500 mg. This was associated with an improvement in the adverse haemodynamic state. The underlying reasons for this are unclear, but sugammadex may potentially be a useful adjunct in the management of rocuronium-induced anaphylaxis. © The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

Paech M.J.,University of Western Australia | Bloor M.,King Edward Memorial Hospital for Women | Schug S.A.,University of Western Australia
Drugs of Today | Year: 2012

Intravenous fentanyl citrate has stood the test of time as a valuable formulation for pain management. The desirable physicochemical properties of fentanyl have allowed the development of several alternative formulations for delivery using less invasive routes, for example, transmucosal (intranasal, oral buccal and oral sublingual) and transdermal. These new formulations have been applied to clinical settings in which rapid onset of analgesia is desired, using convenient but noninvasive methods. Recent commercialization of various formulations has been driven largely by the needs of cancer patients, for whom severe but self-limiting "breakthrough" pain is less suitably treated by parenteral or oral routes of opioid administration. However, these formulations are also used for acute analgesia in prehospital and in-hospital emergency department care, and for pediatric acute pain management. Finally, they are increasingly used by patients with chronic pain of nonmalignant origin, although there is considerable debate about their merit in this group. We searched the databases MEDLINE, PubMed, EMBASE, CINAHL and Cochrane up to October 2011, using search terms "fentanyl AND nasal; intranasal; transmucosal; buccal; sublingual; oral; inhaled; inhalation; transdermal". The characteristics of several formulations of fentanyl are reviewed, detailing their pharmacokinetics, pharmacodynamics and clinical experience with their use for acute pain management. Copyright © 2012 Prous Science, S.A.U. or its licensors. All rights reserved.

McDonnell N.J.,St. John of God Hospital | Percival V.,King Edward Memorial Hospital for Women | Paech M.J.,University of Western Australia
International Journal of Obstetric Anesthesia | Year: 2013

Amniotic fluid embolism is a rare and potentially catastrophic condition that is unique to pregnancy. The presentation may range from relatively subtle clinical events to sudden maternal cardiac arrest. Despite an increased awareness of the condition, it remains a leading cause of maternal mortality. The underlying mechanisms of amniotic fluid embolism are poorly understood, but current theories support an immune-based mechanism which is triggered by potentially small amounts of amniotic fluid gaining access to the maternal circulation. This can result in a wide spectrum of clinical findings, with cardiovascular and haematological disturbances being prominent. The management of a suspected episode of amniotic fluid embolism is generally considered to be supportive, although in centres with specific expertise, echocardiography may assist in guiding management. Whilst outcomes after an episode of amniotic fluid embolism are still concerning, mortality would appear to have decreased in recent times, likely secondary to an improved awareness of the condition, advances in acute care and the inclusion of less severe episodes in case registries. © 2013 Elsevier Ltd. All rights reserved.

Rakshasbhuvankar A.A.,King Edward Memorial Hospital for Women | Patole S.K.,King Edward Memorial Hospital for Women | Patole S.K.,University of Western Australia
Resuscitation | Year: 2014

Background: Simulation-based training (SBT) is being more frequently recommended for neonatal resuscitation education (NRE). It is important to assess if SBT improves clinical outcomes as neonatal resuscitation aims to improve survival without long-term neurodevelopmental impairment. We aimed to assess the evidence supporting benefits of SBT in NRE. Method: A systematic review was conducted using the Cochrane methodology. PubMed, Embase, PsycInfo and Cochrane databases were searched. Related abstracts were scanned and full texts of the potentially relevant articles were studied. Randomised controlled trials (RCT) and quasi-experimental studies with controls (non-RCT) assessing SBT for NRE were eligible for inclusion in the review. Results: Four small studies [three RCT (. n=. 126) and one non-RCT (. n=. 60)] evaluated SBT for NRE. Participants included medical students (one RCT and one non-RCT), residents (one RCT) and nursing staff (one RCT). Outcomes included performance in a simulation scenario, theoretical knowledge, and confidence in leading a resuscitation scenario. One RCT favoured simulation [improved resuscitation score (. p=. 0.016), 2.31 more number of critical actions (. p=. 0.017) and decreased time to achieve resuscitation steps (. p=. <0.001)]. The remaining two RCTs and the non-RCT did not find any difference between SBT and alternate methods of instruction. None of the four studies reported clinical outcomes. Conclusions: Evidence regarding benefits of SBT for NRE is limited. There are no data on clinical outcomes following SBT for NRE. Large RCTs assessing clinically important outcomes are required before SBT can be recommended widely for NRE. © 2014 Elsevier Ireland Ltd.

Deshpande G.,King Edward Memorial Hospital for Women | Rao S.,King Edward Memorial Hospital for Women | Patole S.,King Edward Memorial Hospital for Women | Patole S.,University of Western Australia | Bulsara M.,The University of Notre Dame Australia
Pediatrics | Year: 2010

OBJECTIVE: Systematic reviews of randomized, controlled trials (RCTs) indicate lower mortality and necrotizing enterocolitis (NEC) and shorter time to full feeds after probiotic supplementation in preterm (<34 weeks' gestation) very low birth weight (VLBW; birth weight <1500 g) neonates. The objective of this study was to update our 2007 systematic review of RCTs of probiotic supplementation for preventing NEC in preterm VLBW neonates. METHODS: We searched in March 2009 the Cochrane Central register; Medline, Embase, and Cinahl databases; and proceedings of the Pediatric Academic Society meetings and gastroenterology conferences. Cochrane Neonatal Review Group search strategy was followed. Selection criteria were RCTs of any enteral probiotic supplementation that started within first 10 days and continued for ≥7 days in preterm VLBW neonates and reported on stage 2 NEC or higher (Modified Bell Staging). RESULTS: A total of 11 (N = 2176), including 4 new (n = 783), trials were eligible for inclusion in the meta-analysis by using a fixed-effects model. The risk for NEC and death was significantly lower. Risk for sepsis did not differ significantly. No significant adverse effects were reported. Trial sequential analysis) showed 30% reduction in the incidence of NEC (α = .05 and .01; power: 80%). CONCLUSIONS: The results confirm the significant benefits of probiotic supplements in reducing death and disease in preterm neonates. The dramatic effect sizes, tight confidence intervals, extremely low P values, and overall evidence indicate that additional placebo-controlled trials are unnecessary if a suitable probiotic product is available. Copyright © 2010 by the American Academy of Pediatrics.

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