Anaesthesia and intensive care
-
Anaesth Intensive Care · Jun 1998
Intraoperative transoesophageal echocardiography: impact on adult cardiac surgery.
Although multiple case reports have demonstrated the capability of transoesophageal echocardiography (TOE) to detect unsuspected cardiac pathology with important therapeutic implications, few studies have examined the effect of real-time interpretation of routine TOE on clinical management of a typical series of cardiac surgery patients. To assess the impact of intraoperative TOE on cardiac surgical management, we conducted a prospective observational study on 238 consecutive patients undergoing intraoperative TOE during adult cardiac surgery. Potentially important new diagnostic information was detected in 39 of 184 (21%) routine and in 53 of 54 requested TOE examinations, and led directly to different surgical procedures in 11 of 184 (6%) routine and in 12 of 54 (22%) requested TOE examinations. Our data suggests that intraoperative TOE may be a valuable tool in the routine management of adult cardiac surgical patients.
-
Anaesth Intensive Care · Jun 1998
Case ReportsCardiac arrest associated with sulprostone use during caesarean section.
Sulprostone, a synthetic prostaglandin with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case in which a bolus intravenous injection of sulprostone 30 micrograms was administered to treat postpartum haemorrhage during caesarean section. ⋯ Post resuscitation there was no myocardial infarction and she had complete neurological recovery. We postulate that the bolus of sulprostone resulted in possible coronary spasm that resulted in cardiac arrest.
-
Anaesth Intensive Care · Jun 1998
Case ReportsCentral regional anaesthesia in a patient with Klippel-Trenaunay syndrome.
A 27-year-old female with Klippel-Trenaunay Syndrome presented for reconstructive surgery of the deep venous system of the right leg. Contrast enhanced dynamic computed tomography was performed to exclude the presence of arteriovenous malformation of the lumbosacral spine. A combined spinal-epidural technique supplemented with light general anaesthesia was performed. The patient's condition was stable throughout the three hours of surgery and postoperative analgesia was maintained successfully for three days.
-
Anaesth Intensive Care · Jun 1998
Australian Incident Monitoring Study in intensive care: local unit review meetings and report management.
The Australian Incident Monitoring Study in the intensive care unit (AIMS-ICU) is a national study established through nursing and medical collaboration to develop, introduce and evaluate an anonymous voluntary incident reporting system. To ensure incident monitoring results in improved patient safety, it is essential that reported incidents are followed up regularly. Local unit review meetings are an effective forum for discussion and review of reports amongst a wide group of practitioners from the intensive care unit (ICU). ⋯ Ongoing momentum of the project is assisted by highlighting its positive contributions to patient care and safety via newsletters, poster displays and targeted correspondence. New staff require orientation to the reporting system and assurance regarding safety of data. The emphasis must focus on the system, not the individual.
-
Anaesth Intensive Care · Jun 1998
Case ReportsRhabdomyolysis following severe physical exercise in a patient with predisposition to malignant hyperthermia.
A 21-year-old man suffered from exertional heat stroke with impaired consciousness and rhabdomyolysis after strenuous physical exercise. Within two weeks the patient recovered completely without any specific therapy. ⋯ An in vitro contracture test was performed and a predisposition to malignant hyperthermia was diagnosed; other muscular diseases were excluded by histological examination. At present, the in vitro contracture test is the only method used to determine susceptibility to malignant hyperthermia and should be performed when the diagnosis is suggested on clinical grounds.