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Pat Neligan

Pat Neligan lives and works in Galway, Ireland
Pat Neligan has written 33 posts for AnaesthesiaWest

SOLAR trial – Saline vs Lactated Ringers’

The SOLAR trial, which compared a composite outcomes in perioperative colorectal or orthopaedic patients, assigned to Lactated Ringers’ (similar to Hartmann’s) solution – over 2 week blocks over a few years (8,616), has been published this month in Anesthesiology. The median volume of fluid administered in the perioperative period was 1.9L, and, no surprise here … Continue reading

We’re Back

Thanks for the appeal, anaesthesiawest is now reactivated.

Nitrous SAVES lives? Maybe, but the discussion is still open….

Following Paul Myles’ paper in Anesthesiology in 2007 – that demonstrated bad outcomes in patients anaesthetised with nitrous oxide (click here), “experts” clamoured to demand that we stop using the stuff in our clinical practice. Their opinions were enhanced by the ENIGMA trial, that claimed increased risk of myocardial infarction in patients receiving nitrous (click … Continue reading

Surviving Sepsis Guidelines 2013

The most recent iteration of Surviving Sepsis has been published in Critical Care Medicine and Intensive Care Medicine. The can be downloaded here (please click). Below is a summary of the Guidelines: A. Initial Resuscitation 1. Protocolized, quantitative resuscitation of patients with sepsis-induced tissue hypoperfusion (defined in this document as hypotension persisting after initial fluid … Continue reading

Taking slow vent weans by the collar

Our ICUs are crowded by patients that are slow to liberate from mechanical ventilation. In North America, such patients are often transferred to long term mechanical ventilation facilities (LTAC) – where they are weaned to liberation. There are many strategies for weaning tracheostomised ¬†patients from mechanical ventilation – a progressive reduction in pressure support, intermittent … Continue reading

High Frequency Oscillation – Shaken by Bad News!

Summary: Two Papers Published Online in the NEJM, OSCILLATE and OSCAR, have failed to demonstrate that HFOV benefits patients with ARDS. In the OSCILLATE study there was an 11% increase in 28 day mortality (NNH 9). HFOV should not be used in routine management of patients with ARDS. For the past two decades many intensivists … Continue reading

Beachchair and Blood Pressure

It is now more than 5 years since the Anesthesia Patient Safety Foundation highlighted the risk of central nervous system injury following anesthesia for shoulder surgery (SS) in the Beachchair position (BCP)¬†(click here). Although we can never be certain, it appears likely that such injuries – principally devastating stroke, results from hypoperfusion and watershed ischaemia. … Continue reading

Transfusion Strategy – Think Restrictive

A half generation ago, the TRICC trial (here) suggested that routine blood transfusion in critically ill patients did not confer benefit if the haemoglobin level was above 7g/dl. This resulted in a evidence based paradigm for lower transfusion triggers. The problem was – how do you deal with the bleeding patients? A recent study in … Continue reading

Troponin Leak Postop – what does it mean?

Twenty years ago perioperative myocardial ischaemia was a relatively easy thing to diagnose – we checked ECG looking for ST segment and T wave changes, and looked for an MB-CK rise. Then troponin arrived, and suddenly the proportion of patients with perioperative ischaemia increased drastically. For many of us, the report of a “postoperative troponin … Continue reading

The Obesity Paradox – Weight there’s more!

The media are constantly harping on about the obesity epidemic – “two in three of us are fat – this is going to lead to an explosion of obesity related morbidity – heart disease, cancer, cerebrovascular disease, crumbling joints etc.” It never seems to occur to the same talking heads on television and in print … Continue reading