Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 1996
Comparative StudyPercutaneous dilational tracheostomy--a clinical study evaluating two systems.
Percutaneous dilational tracheostomy (PDT), first described in the 1950s, has become a common bedside technique in the Intensive Care Unit (ICU). This study compares the early complications associated with the use of the Ciaglia PDT (Cook Critical Care, Bloomington, USA) technique, with the newly available Portex PDT technique (Portex Ltd., UK). The Ciaglia technique was adopted in this ICU in July 1994 and twenty-nine patients had a tracheostomy using this set until January 1995. ⋯ The first routine tracheostomy tube change at day 7 was complicated in four cases in the Ciaglia group. One infected stoma was noted in the Ciaglia group at day 7. Both techniques result in rapid, safe placement of a tracheostomy tube in critically ill patients in the ICU, obviating the need for surgical referral and transport to the operating room.
-
The New South Wales Special Committee Investigating Deaths Under Anaesthesia classified 1503 deaths before full recovery from anaesthesia occurring between 1984 and 1990. 172 deaths were attributed to anaesthesia, including 11 in which the anaesthetic choice or management could not be criticized. In the remaining 161 an average of 1.8 errors per case were identified, the most frequent being inadequate preparation of the patient (in 72 cases), inadequate postoperative care (52 cases), the technique of anaesthesia chosen (44 cases) and overdose (43 cases). ⋯ Urgent non-emergency cases, 10% of the 1503 cases classified, constituted 26% of those deaths attributed to anaesthesia. One death attributable to anaesthesia occurred per 20,000 operations and the rate of such deaths was 0.44 per 100,000 population per annum.
-
Anaesth Intensive Care · Feb 1996
Clinical TrialEvaluation of a disposable device for patient-controlled epidural analgesia after caesarean section.
We evaluated a disposable device (Baxter PCA Infusor) for patient-controlled epidural analgesia (PCEA) using pethidine in twenty women after lower segment caesarean section. Efficacy, as measured by visual analogue pain scores, was comparable with historical controls from PCEA studies using electronic devices. Three patients reported inadequate analgesia, attributable in two cases to problems with epidural catheter. ⋯ Pethidine consumption ranged from 125 to 1500 mg (median 575 mg) in 48 hours. Plasma concentrations of pethidine varied widely. Disposable devices for PCEA after caesarean section provide an alternative to bolus administration or PCEA using more expensive and cumbersome electronic devices, although we suggest currently available apparatus requires modifications to improve clinical performance.
-
Anaesth Intensive Care · Feb 1996
Cerebral effects of propofol following bolus administration in sheep.
The effects of bolus administration of propofol (50 mg, 100 mg and 200 mg) on cerebral blood flow and cerebral metabolic rate for oxygen were examined in a chronically catheterized sheep preparation. Depth of anaesthesia was simultaneously measured using a withdrawal response to a noxious electrical stimulus and it was demonstrated that the 100 mg dose induced moderate sedation while the 200 mg dose induced relatively deep anaesthesia. ⋯ These were accompanied by parallel decreases in cerebral metabolic rate but no change in cerebral oxygen extraction. As cerebrovascular responses in the sheep appear similar to those in man, the parallel changes in cerebral blood flow and metabolic rate demonstrated in this study supports the suitability of propofol as a neuroanaesthetic agent.