Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2004
Comparative StudyPost anaesthesia care unit discharge: a clinical scoring system versus traditional time-based criteria.
This prospective cohort analysis compared the efficiency of time-based discharge criteria (Group 1) to a modified clinical scoring system (Group 2), incorporating the assessment of pain and temperature, in the post anaesthesia care unit (PACU). Two consecutive series of patients (n = 292) were assessed following general anaesthesia for various surgical procedures. The time taken for patients to satisfy their respective discharge criteria was recorded as PACU length of stay (LOS). ⋯ Surgical time, as a linear function, intra- and postoperative opioid administration, as well as postoperative antiemetic use were predictors of increased PACU-LOS. Patient age, gender, urgency of surgery, and ASA classification were not predictive of PACU-LOS. Using covariate adjusted estimates, the new PACU discharge criteria, based on the Aldrete's scoring system, was associated with a significantly reduced PACU-LOS in comparison with time-based criteria.
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Anaesth Intensive Care · Feb 2004
Continuing education and New Zealand anaesthetists: an analysis of current practice and future needs.
A survey of Continuing Medical Education (CME) of New Zealand anaesthetists was undertaken to identify current patterns of participation, usefulness of different activities, evidence of effectiveness, motivators and barriers to participation and to define future CME needs. The response rate was 74% and showed high levels of participation in a range of CME activities. Ratings for usefulness differed significantly between these activities. ⋯ Such reviews conclude that there is no evidence that conferences are effective in changing physician behaviour, yet respondents to this survey attributed many changes in practice to their attendance at a conference. Analysis of the needs of NZ anaesthetists supports increasing the number of workshops and interactive sessions and promoting smaller meetings and practice-based activities. The survey provides a basis for designing a future program of CME for New Zealand.
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Anaesth Intensive Care · Feb 2004
An assessment of small simulators used to teach basic airway management.
This study assessed small simulators sold for teaching basic airway management. The assessment used criteria based on guidelines produced by the Australian Resuscitation Council and our experience teaching health professional trainees. Criteria included how well the simulators demonstrated manoeuvres to open the airway, mouth-to-mouth and mask-to-mouth expired air resuscitation and artificial ventilation using a bag and mask. ⋯ Generally, models with hard surfaces tended to be less realistic in both look and feel compared to those with flexible "skin". Realism of lung inflation and its relationship to airway opening manoeuvres varied greatly between simulators. The Little Anne small simulator functioned most realistically in our tests.
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Anaesth Intensive Care · Feb 2004
Randomized Controlled Trial Comparative Study Clinical TrialBispectral index during modified rapid sequence induction using thiopentone or propofol and rocuronium.
This randomized controlled trial compared Bispectral Index (BIS) values in 40 patients after a modified rapid sequence induction using thiopentone 4 mg/kg or propofol 2 mg/kg with rocuronium 0.6 mg/kg as muscle relaxant. Endotracheal intubation was performed at 60 seconds from induction of anaesthesia and BIS values were recorded for three minutes after induction. ⋯ No explicit recall of intubation was detected clinically with either induction agent. The BIS scores we have measured suggest that thiopentone 4 mg/kg is more likely to be associated with lighter planes of anaesthesia and consequent risk of awareness than propofol 2 mg/kg, if intubation is delayed or prolonged.
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Anaesth Intensive Care · Feb 2004
Review Case ReportsPleural puncture: an unusual complication of a thoracic epidural.
Thoracic epidural analgesia is a common method of pain relief for major thoracic and abdominal surgery. Numerous complications may occur, including temporary or permanent neurological injury. A rare and potentially life-threatening complication of thoracic epidural analgesia is pleural puncture by the needle or the catheter. Such a case is presented and pleural puncture in association with attempted thoracic epidural catheter placement is discussed.