Philip Newman

Dengue Hemorrhagic Fever with Fulminant Hepatic Failure in an Immigrant Returning to Bangladesh

An immigrant from Bangladesh living in the United Kingdom presented with a nonspecific febrile illness after visiting his homeland and subsequently developed fulminant hepatic failure accompanied by hypotension, ascites, a generalized coagulopathy, and thrombocytopenia. Serology and detection of dengue virus serotype 3 by PCR established a postmortem diagnosis of hepatic failure secondary to dengue hemorrhagic fever.

Sevoflurane anaesthesia for major intra-abdominal surgery.

The cardiovascular effects and recovery characteristics of sevoflurane and isoflurane anaesthesia were compared in 30 gynaecological and 20 general surgical patients undergoing elective intra‐abdominal surgery. Patients were randomly allocated to receive either sevofurane or isofurane as the volatile agent, in a balanced anaesthetic technique including morphine and atropine prernedication and thiopentone, fentanyl. vecuronium and nitrous oxide. The concentration of volatile agent was titrated according to clinical variables. Mean heart rate, systolic and diastolic arterial pressure and duration of surgery did not differ between the two groups. Time to emergence from anaesthesia in the gynaecological patients was significantly faster after sevoflurane compared with isoflurane (p < 0.005). Sevoflurane provided stable anaesthesia during major intra‐abdominal surgery.

The effect of improvement of acidaemia with bicarbonate buffered haemofiltration on the requirement for inotropic support

HAEMOFILTRATION ON THE REQUIREMENT FOR INOTROPIC SUPPORT F J Lamb, D Duane, A Jones, P Newman and E D Bennett Department of Intensive Care Medicine, St Georges Hospital, London Severe acidosis with renal failure is associated with impaired cardiovascular function and reduced response to catecholamines. Administration of intravenous sodium bicarbonate solution is frequently used for the correction of acidaemia in an attempt to improve the sensitivity of cardiac muscle to catecholamines, but there is little evidence to support this. Although a useful technique to correct acidaemia, there is a risk of fluid overload which may be avoided with the use of continuous haemofiltration with bicarbonate buffered filtration fluid. We studied 7 patients (Mean (SEM) age 62 (8) years, all males, mean first 24 hour APACHE Ill score 79 (9)) who were all ventilated and anuric, with a base deficit <5 mmol/L and a requirement for one or more inotropes to achieve a mean blood pressure of 65 mmHg. Doses of intravenous catecholamines were recorded at the start and aRer 2 hours of bicarbonate buffered haemofiltration with flow rates of 6 LJh. Haemodynamic parameters were recorded with the aid of a pulmonary artery floatation catheter and invasive arterial blood pressure monitoring. During the 2 hour period of bicarbonate buffered haemofiltration, there were significant changes in arterial pH and base deficit but there was no significant change in the haemodynamic profile (table 1). In spite of the improvement in arterial pH, there was a trend toward an increase in the inotrope requirement during this period. Table 1

Base excess and lactate as prognostic indicators for patients admitted to intensive care

39