Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2004
Review Case ReportsSuccessful use of ECMO in adults with life-threatening infections.
Two cases of critically ill patients who received extracorporeal membrane oxygenation (ECMO) using different forms of circuitry and for different indications are presented. Both patients had life-threatening infections with septic shock and were not able to be supported by conventional means. ⋯ The second patient had psittacosis and received venovenous ECMO for respiratory failure. We discuss the expanding indications for this technology and the role it has to play in adult intensive care.
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Anaesth Intensive Care · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialEffect of metoclopramide on pain on injection of propofol.
We undertook a randomized, double-blind, placebo-controlled study to examine the efficacy of metoclopramide at three different doses (2.5 mg, 5 mg, 10 mg) for reducing pain on injection of propofol in 100 patients scheduled for elective surgery. Patients received intravenously the study drug, with venous occlusion for one minute, followed by propofol 2 mg/kg into a dorsal hand vein. ⋯ No difference between metoclopramide 2.5 mg and the placebo groups was found. We conclude that pretreatment of a dorsal hand vein with metoclopramide in a dose of 5 or 10 mg, with venous occlusion for one minute, effectively decreases the incidence of pain caused by propofol injection.
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Anaesth Intensive Care · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialPain during injection of propofol: the effect of prior administration of ephedrine.
Propofol causes pain on intravenous injection in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. In a randomized, double-blind, placebo-controlled trial, we compared the efficacy of ephedrine 30 microg/kg pretreatment to lignocaine 40 mg for prevention of propofol-induced pain. ⋯ In the lignocaine group, propofol-induced pain was observed in only 13 (42%) when compared with other study groups (P<0.05). Pretreatment with ephedrine 30 microg/kg did not attenuate pain associated with intravenous injection of propofol, nor did it improve haemodynamic stability during induction. However, pretreatment with 2% lignocaine (40 mg) was effective in attenuating propofol-associated pain.
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Anaesth Intensive Care · Oct 2004
Multicenter Study Comparative StudyThe use of end-tidal carbon dioxide monitoring to confirm endotracheal tube placement in adult and paediatric intensive care units in Australia and New Zealand.
The use of end-tidal carbon dioxide monitoring to assist in confirming endotracheal tube placement is currently not mandatory in intensive care units (ICUs) in Australia and New Zealand. Early detection of failed tracheal intubation is vital to optimize management and to prevent complications. Questionnaires were sent to the lead clinician/head of department of all 66 intensive care units approved for training purposes by the Joint Faculty of Intensive Care Medicine in Australia and New Zealand. ⋯ Thirty-eight respondents (62.3%) thought that end-tidal carbon dioxide monitoring should be mandatory to confirm tracheal intubation in the intensive care unit. If it were available, 42 respondents (68.8%) would use end-tidal carbon dioxide monitoring for confirmation of every intubation. Mandatory end-tidal carbon dioxide confirmation of endotracheal tube placement was policy in 33 (54.1%) of the intensive care units.
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Anaesth Intensive Care · Oct 2004
Multicenter StudyMetropolitan audit of appropriate referrals refused admission to intensive care.
We undertook a three-month prospective cohort study of critically ill adult patients referred to the Intensive Care Units (ICUs) of public hospitals in metropolitan Melbourne and Geelong, Victoria. The aim was to ascertain the prevalence and immediate consequences of "refused" admission amongst patients appropriately referred to the ICU of first choice. Between August 1 and October 31, 1999, 10 (out of 12) public hospitals collected data. ⋯ The reasons for "refusal" were limited staffing (52%) and shortage of beds (46%.) Acute inter-hospital transfer (1.7 per day) was the most common immediate triage outcome (57%). These rates are higher than previously reported figures. We conclude that refused admission to the ICU of first choice, and acute inter-hospital transfer in this region and time period, were common events.