Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2006
Comparative StudyA comparison of patient self-administered and investigator-administered measurement of quality of recovery using the QoR-40.
A 40-item questionnaire (the QoR-40) had been previously developed to measure five dimensions of quality of recovery after anaesthesia and surgery. Each of the 40 items is rated on a scale of 1 to 5, with a maximum score of 200. In this study we compared patient self-administered with investigator-administered QoR-40. ⋯ The time to complete the questionnaire when investigator-administered was 253 (16) s [mean, (SD)], and on first attempt for patients was 362 (19) s, P<0.001. The QoR-40 is as valid measure of postoperative recovery when administered with the assistance of an investigator as compared with the patient self-administered version. Investigator-administered measurement of the QoR-40 is a more efficient use of resources, as complete and more timely data are collected.
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Anaesth Intensive Care · Oct 2006
Case ReportsThrombogenic side-effects of recombinant factor VIIa after use in coronary artery bypass surgery.
Recombinant activated factor VII (rFVIIa) has been used 'off licence' to successfully treat bleeding and reduce transfusion requirements in complex cardiac surgery. However; concerns over thrombogenic side-effects have limited but not excluded its use in patients undergoing coronary artery bypass surgery (CABG). ⋯ However the first case suffered from severe postoperative arrhythmias, myocardial infarction, cardiac arrest and worsening left ventricular dysfunction, suggesting graft patency may have been impaired, whereas the second case remained symptom-free suggesting graft patency was unaffected by the use of rFVIIa. If rFVIIa is needed to treat bleeding during CABG surgery, it may be more appropriate to administer smaller, repeated doses to minimize the risk of thrombosis and early graft failure.
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Anaesth Intensive Care · Oct 2006
The margin of safety of a left double-lumen tracheobronchial tube depends on the length of the bronchial cuff and tip.
The left tracheobronchial double-lumen tube is the commonest device to separate the left and right lungs for differential ventilation. With the appropriate tube, the left bronchial cuff is positioned in the bronchus so that the cuff is beyond the carina but the tip of the tube does not occlude the aperture of the left upper lobe bronchus. The difference between the length of the left main bronchus and the length of the cuff and tip of the bronchial segment of the tube has been termed "the margin of safety" by Benumof. ⋯ There was also a marked variation in cuff-tip lengths of the same size tube from the same manufacturer. The largest variation was 18 mm for the Portex 41 but substantial variation of 8 mm or more was found in at least one French size of all manufacturers. Users must be aware that significant cuff-tip length variation occurs and match the selected tube to the patient to ensure an adequate margin of safety.
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Propofol is widely used for sedation in critically ill patients. Several adult patients, all with acute neurological disorders, have been reported suffering from propofol infusion syndrome, which occurs in patients receiving high-dose propofol and catecholamines and/or steroids. We present a case of a septic patient without neurological illness who developed propofol infusion syndrome.
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Anaesth Intensive Care · Oct 2006
Association of obesity with increased mortality in the critically ill patient.
The impact of obesity on critical care outcomes has been an issue for debate in the literature. Variable data and conflicting results have been reported. The purpose of our study is to examine the impact of obesity on the outcome of patients admitted to a tertiary closed Intensive Care Unit (ICU) in Saudi Arabia. ⋯ In conclusion, mortality of obese critically ill patients was not higher than patients with normal weight. In fact, the hospital mortality was lower for patients with BMI >40 kg/m2 compared to the normal BMI group despite similar severity of illness. Obesity might have a protective effect, although further studies are needed to substantiate this finding.