Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1981
ReviewFactors affecting an anaesthetist's work: some findings on vigilance and performance.
This paper reviews factors which may influence the vigilance tasks of an anaesthetist during an anaesthetic. Vigilance tasks are found to be unlike any other automatic, repetitive or monotonous tasks. ⋯ We suggest, however, that there are many parallels between findings related to vigilance in general and the type of work done by anaesthetists. Implications of major factors are discussed, and recommendations for further study are proposed.
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Anaesth Intensive Care · Nov 1981
Randomized Controlled Trial Clinical TrialSpinal anaesthesia or general anaesthesia for emergency hip surgery in elderly patients.
One hundred and thirty-two elderly patients undergoing emergency hip surgery were randomly allocated to receive subarachnoid block (SAB) or general anaesthesia (GA). Using the 125. I fibrinogen uptake test, deep vein thrombosis was found to occur in 17 of 37 patients in the SAB group and 30 of 39 patients in the GA group (P 0.05). ⋯ At 24 hours postoperatively the fall in PaO2 was similar in both groups and recovered only slowly during the first week. Twelve patients died, three in the SAB group and nine in the GA group. This difference in mortality was not statistically significant.
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Anaesth Intensive Care · Nov 1981
Respiratory and cardiovascular responses to PEEP in artificially ventilated patients after cardiopulmonary bypass surgery.
The respiratory and haemodynamic effects of incremental levels of positive and expiratory pressure (PEEP) to 9 cm H2O were studied in ten adult patients 3--6 hours after uneventful cardiopulmonary bypass surgery. Functional residual capacity was increased and deadspace-tidal volume ratio tended to fall, the latter approaching significance at +6 and +9 cm PEEP. ⋯ Cardiac index, and left ventricular strokework index were marginally depressed at 6 cm PEEP and further at 9 cm, while right atrial pressure and pulmonary artery occlusion pressure were raised at 9 cm PEEP. It would appear that low levels (3--6 cm) of PEEP do not improve gas exchange in the lungs to any worthwhile degree, and levels (6--9 cm) may impair cardiac performance.
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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 shock syndrome, there were pustular skin vesicles, altered red cell morphology, and severe myocardial involvement. Treatment with fluid replacement, cloxacillin, haemodialysis, positive inotropic agents, and supportive measures resulted in a full recovery.
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Anaesth Intensive Care · Nov 1981
ReviewPathophysiology and management of raised intracranial pressure.
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 cerebral oedema. Guidelines for the management of patients with raised intracranial pressure are presented as well as the techniques of intracranial pressure monitoring.