Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2004
Safe duration of postoperative monitoring for malignant hyperthermia susceptible patients.
Postoperative management of malignant hyperthermia (MH) susceptible patients has changed substantially over the last 20 years, with many patients now managed as day cases. Our previous policy was to monitor known MH susceptible patients (and relatives of known MH susceptible individuals not yet investigated by muscle biopsy) for four hours in the Post Anaesthetic Care Unit. ⋯ On the basis of this review we instituted a policy change and reduced our monitoring time to one hour in the Post Anaesthetic Care Unit with a further 1.5h in a step-down unit if indicated. A prospective study in a further 68 MH susceptible/related patients showed that no MH reactions were missed due to the shorter monitoring period.
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Anaesth Intensive Care · Aug 2004
Survey of intensive care nurses' knowledge relating to the pulmonary artery catheter.
In 2003 there was an increase in the use of pulmonary artery catheters in Australia from 12,000 to 16,000 units in intensive care and peri-operative care. This survey of intensive care nurses in five intensive care units in Queensland addressed knowledge of use, safety and complications of the pulmonary artery catheter, using a previously validated 31 question multiple choice survey. One hundred and thirty-nine questionnaires were completed, a response rate of 46%. ⋯ Scores were significantly higher in those participants with more ICU experience, higher nursing grade, a higher self-assessed level of knowledge and greater frequency of PAC supervision. There was no significant correlation between total score and hospital- or university-based education, or total score and public or private hospital participants. Fifty-one per cent were unable to correctly identify the significant pressure change as the catheter is advanced from the right ventricle to the pulmonary artery.
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Anaesth Intensive Care · Aug 2004
Anaesthetic management of planned or emergency endovascular stent graft surgery for thoracic aneurysms and dissections.
We reviewed the intraoperative anaesthetic management and outcome of seven consecutive cases of endovascular stent graft surgery for thoracic aortic aneurysms or dissections over a period of 20 months in our institution. Seven males (median age 63) underwent endovascular stent graft surgery of the thoracic aorta under general anaesthesia. Four were emergency procedures for acute dissection or leaks of thoracic aneurysms. ⋯ Endovascular stent graft surgery of the thoracic aorta is a relatively new alternative to conventional open surgery. Our experience suggests satisfactory short-term outcome even for patients with acute dissection. However, long-term survival and results require further evaluation.
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Anaesth Intensive Care · Aug 2004
Case ReportsAnaphylaxis with associated fibrinolysis, reversed with tranexamic acid and demonstrated by thrombelastography.
In the surgical setting, fibrinolysis can be a serious complication of anaphylaxis. We present four cases of anaphylaxis that were associated with fibrinolysis during anaesthesia, and the use of the thrombelastograph to demonstrate this haemostatic defect and its correction using tranexamic acid.
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Anaesth Intensive Care · Aug 2004
Barriers to effective perioperative communication in indigenous Australians: an audit of progress since 1996.
This prospective study was designed to elucidate barriers limiting effective perioperative communication between indigenous Australians and anaesthetists, and to identify strategies for improving communication. A questionnaire was used to collect data on 1040 consecutive patients undergoing anaesthesia at Royal Darwin Hospital between February and March 2003. 27.1% of these patients described themselves as Aboriginal. Aboriginal patients were more likely to undergo emergency surgery and were more likely to be classified as ASA 3, 4 or 5 than non-indigenous patients. ⋯ Unfortunately, the anaesthetic team utilized the Aboriginal interpreter service in only a minority of cases. Communication difficulty in indigenous Australians is pervasive and often goes unrecognized. The results suggest that heath care providers may need staff training in cross-cultural communication and that protocols need to be developed within the health care system so that interpreters are called upon automatically early in the admission process.