Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2000
Case ReportsEpileptiform activity in the EEGs of two nonepileptic children under sevoflurane anaesthesia.
Two case reports of nonepileptic children are presented, who developed paroxysmal EEG potentials in routinely performed EEG recordings during inhalation of sevoflurane, 7 and 8% by volume respectively. Taking into account several reports from the literature about epileptiform potentials or convulsive movements under similar conditions, it seems to be important to investigate carefully the circumstances under which these phenomena appear as well as possible clinical consequences.
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Anaesth Intensive Care · Apr 2000
An analysis of excess mortality not predicted to occur by APACHE III in an Australian level III intensive care unit.
The APACHE III derived standardized mortality ratio has been suggested as a statistic to measure intensive care unit (ICU) effectiveness. From 1991 data collected on 519 consecutive admissions to the Royal Adelaide Hospital ICU a standardized mortality ratio of 1.25 was calculated. Of the 174 deaths only 95 had a prediction of death greater than 0.5. ⋯ Amongst low mortality prediction patients admitted to the Royal Adelaide Hospital ICU we identified age, a history of acute myocardial infarction, presentation to ICU after a cardiac arrest or with an elevated creatinine and the development of acute renal failure and septicaemia during the ICU admission as being associated with in-hospital mortality. We also documented that late hospital deaths on the ward after ICU discharge occurred more frequently with low predicted hospital mortality ICU patients. Factors other than the APACHE III score may be associated with hospital deaths of ICU patients.
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Anaesth Intensive Care · Apr 2000
Case ReportsAnaesthetic management of a parturient with a colloid cyst of the third ventricle.
A colloid cyst in the third ventricle near the foramen of Monroe can obstruct cerebrospinal fluid (CSF) flow from the lateral ventricles. Any change in the CSF pressure on either side of the cyst can lead to displacement and thus precipitate acute hydrocephalus. ⋯ We describe our management of a patient with a small colloid cyst who was permitted to labour with the assistance of patient-controlled epidural analgesia. The available alternatives are discussed.
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Anaesth Intensive Care · Apr 2000
Hours of work and fatigue-related error: a survey of New Zealand anaesthetists.
A nationwide survey (70% response) documented anaesthetists' hours of work, their perceptions about safety limits and their recollection of fatigue-related errors in clinical practice. In the preceding six months, 71% of trainees and 58% of specialists had exceeded their self-defined safety limits for continuous anaesthesia administration. ⋯ Specialists were more likely to report a fatigue-related error if they had exceeded their own safety limits for continuous anaesthesia administration, or for weekly work hours. Current measures are not preventing anaesthetists from working hours that they consider to be unsafe for patients or harmful to their own well-being.
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Surgeons, anaesthetists and intensivists need to be reminded of an alternative to tracheostomy in the management of patients with severe maxillofacial injuries. The technique and indications for submental intubation are described.