Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2001
Meta AnalysisDo anaesthetists need to wear surgical masks in the operating theatre? A literature review with evidence-based recommendations.
Many operating theatre staff believe that the surgical face mask protects the healthcare worker from potentially hazardous biological infections. A questionnaire-based survey, undertaken by Leyland' in 1993 to assess attitudes to the use of masks, showed that 20% of surgeons discarded surgical masks for endoscopic work. Less than 50% did not wear the mask as recommended by the Medical Research Council. ⋯ Policies relating to the wearing of surgical masks by operating theatre staff are varied. This indicates some confusion about the role of the surgical mask in modern surgical and anaesthetic practice. This review was undertaken to collate current evidence and make recommendations based on this evidence.
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Anaesth Intensive Care · Aug 2001
Randomized Controlled Trial Clinical TrialIntrathecal anaesthesia for the elderly patient: the influence of the induction position on perioperative haemodynamic stability and patient comfort.
Ninety elderly (>65 y) patients were studied to assess the influence of patient position during induction of spinal anaesthesia on the incidence of perioperative hypotension and haemodynamic stability. Prior to induction of anaesthesia, Lactated Ringer's solution (8-10 ml/kg) was administered. In the Sitting Group, intrathecal anaesthesia was performed with the patient in the sitting position. ⋯ Patient comfort was similar. In summary, the incidence of hypotension and hypotension-related adverse effects was similar when intrathecal anaesthesia was induced in the sitting or lateral position. Furthermore, subjective perception of the induction process or anaesthetic experience was not affected by patient position.
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Unselected preoperative coagulation testing is known to have low positive yield. However, no study has specifically evaluated neurosurgical patients. A retrospective study of 1211 patients having neurosurgery over a one-year period was therefore conducted. ⋯ Many patients had factors on history indicating a potential bleeding tendency, but only a prolonged aPTT, cranial surgery and the use of anti-hypertensive and anaesthetic drugs preoperatively predicted postoperative bleeding. Prolonged aPTT was predictable on history in most patients. We conclude that routine screening of all preoperative neurosurgical patients in our hospital is unnecessary.
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Anaesth Intensive Care · Aug 2001
Relationship between work of breathing provided by a ventilator and patients' inspiratory drive during pressure support ventilation; effects of inspiratory rise time.
Inspiratory drive and work of breathing provided by a ventilator (WOBv) during pressure support ventilation (PSV) were examined in 15 patients. At PSV 10 and 15 cm H2O during CPAP 5 cm H2O, patients with low P0.1 (<4.2 cm H2O, n=9) showed WOBv 0.57 and 0.92 J/l, those with high P0.1 (>4.2 cm H2O, n=6) showed 0.31 and 0.62 J/l respectively. WOBv was smaller and pressure-time product of oesophageal pressure (PTP) was significantly larger in high P0.1 patients. ⋯ Compared with higher PSV, shorter IRT reduced PTP more. In conclusion, WOBv decreased as inspiratory drive increased due to inability to increase inspiratory flow. Increasing initial inspiratory flow was more effective than raising PSV to preserve inspiratory assistance of PSV at high inspiratory drive.
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Anaesth Intensive Care · Aug 2001
Case ReportsConcealed post-tonsillectomy haemorrhage associated with the use of the antiemetic tropisetron.
A two-year-old child experienced concealed haemorrhage after adenotonsillectomy. In our patient, the absence of vomited or significant gastric blood and the presence of melaena stools may partly be attributed to prophylactic antiemetic treatment with tropisetron. This group of patients has a high incidence of postoperative nausea and vomiting, and antiemetic treatment is important and valuable. Rather than advocating the withholding of prophylactic antiemetic treatment, we suggest that whatever medication and techniques are used, good clinical care is dependent on careful postoperative observation and assessment for an appropriate period of time.