Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2004
ReviewSpinal cord stimulation in chronic pain: a review of the evidence.
This review looks at the evidence for the effectiveness of spinal cord stimulation in various chronic pain states. Spinal cord stimulation can only be effective when appropriate dorsal column fibres in the spinal cord are preserved and able to be stimulated. Spinal cord stimulation has been shown to have little to offer for patients with some diagnoses. ⋯ There is a lack of high quality evidence relating to spinal cord stimulation due to difficulties in conducting randomized controlled trials in this area. Serious methodological problems are encountered in blinding, recruitment and assessment in nearly all published trials of spinal cord stimulation. Suggestions regarding appropriate methodologies for trials which would produce better quality evidence are summarized.
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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.
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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
Evaluation of the Intubating Laryngeal Mask Airway used by occasional intubators in simulated trauma.
This observational study assessed the potential role of the intubating laryngeal mask airway (ILMA) for use by emergency care givers with limited laryngoscopy skills. Six ambulance officers with advanced airway training, five doctors with intubation experience and five doctors without intubation experience were given a short instruction course on the use of the ILMA. They subsequently used the device on 80 consenting subjects anaesthetized for elective surgery after the application of cricoid pressure and manual in-line stabilization of the cervical spine. ⋯ The feedback forms were strongly supportive of a prehospital trial and also of having an ILMA available during all intubations. Participants almost universally rated the ILMA as easy to use. This study supports further evaluation of the ILMA in a large prehospital trial.
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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.