Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2005
Case ReportsBaclofen withdrawal: a cause of prolonged fever in the intensive care unit.
We report a case of baclofen withdrawal syndrome resulting from oral baclofen underdosing. A 24-year-old woman with type 1 neurofibromatosis receiving long-term baclofen therapy was admitted with presumed pneumonia which was successfully treated with antibiotics. The patient continued to have fever and autonomic instability without evidence of infection which entirely resolved within 24 hours of reinstitution of full preadmission dosing of oral baclofen. Baclofen withdrawal syndrome resulting from underdosing of oral baclofen should be considered as a potential source of prolonged fever in the intensive care unit.
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Anaesth Intensive Care · Aug 2005
Changing patterns in the acute pain service: epidural versus patient-controlled analgesia.
This study involved an audit and a survey of the Acute Pain Service at Princess Alexandra Hospital. It was found in the audit that the relative choice of epidural analgesia had declined by 50% over the five-year time period of 1998-2003. ⋯ Two of the most common reasons given for this change in practice related to fear of litigation (34%) and lack of evidence (21%). These results show that within this department approaches to postoperative pain control had changed and that this appears to have resulted from factors such as the medicolegal environment and the possible influence of evidence based medicine.
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Anaesth Intensive Care · Aug 2005
The costs of caring for patients in a tertiary referral Australian Intensive Care Unit.
We determined the direct cost of an Intensive Care Unit (ICU) bed in a tertiary referral Australian ICU and the cost drivers thereof, by retrospectively analysing a number of prospectively designed Hospital- and Unit-specific electronic databases. The study period was a financial year, from 1 July 2002 to 30 June 2003. There were 1615 patients occupying 5692 fractional occupied bed days at a total cost of A dollar 15,915,964, with an average length of stay of 3.69 days (range 0.5-77, median 1.06, interquartile range 2.33). ⋯ The emergency nature of ICU means it is difficult to accurately set a nursing establishment to cater for all admissions and therefore it is hard to decide what is an acceptable percentage difference between agency/overtime costs compared with the costs associated with full-time staff appointments. Consumable expenditure is likely to increase the most with new innovation and therapies. Using protocol driven practices may tighten and control costs incurred in ICU.
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The ability of experienced anaesthetists to discern oxygen saturation by listening to the tones of a Datex AS3 pulse oximeter was examined. Five-second samples were recorded using a high fidelity patient simulator and replayed singly and in pairs. Whilst the lower saturations were generally recognized as lower, the perceived range was greatly compressed. ⋯ This may lead to underestimation of the severity if the auditory signal is relied on in isolation. A non-linear (musical) scale may prove more appropriate and should be investigated. Testing experienced anaesthetists demonstrated that most could detect the direction, but not the magnitude of a change in saturation by listening to the change in pitch of a Datex AS3 pulse oximeter tone.
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Anaesth Intensive Care · Aug 2005
Letter Case ReportsSensorineural hearing loss after general anaesthesia.