Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2006
Randomized Controlled TrialEffect of tramadol on Bispectral Index during intravenous anaesthesia with propofol and remifentanil.
The aim of this study was to investigate the effects of tramadol on the Bispectral Index (BIS) during total intravenous propofol-remifentanil anaesthesia. Forty-four adult ASA Physical status I-II patients, scheduled for elective general surgical procedures were included in a prospective observational randomized study. Doses for anaesthetics and opioids were adjusted to keep the BIS value at 50 +/- 5. ⋯ There were no significant changes in mean arterial pressure, SpO2, or heart rate (P > 0.05). The results indicate that the administration of tramadol during stable total intravenous anaesthesia with propofol-remifentanil does not affect BIS values. The clinical relevance is that tramadol can be safely administered pre- and intraoperatively as pre-emptive or preventive analgesia without modification of the depth of anaesthesia.
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Anaesth Intensive Care · Feb 2006
Comparative StudyThe impact of an ICU liaison nurse on discharge delay in patients after prolonged ICU stay.
The mismatch between intensive care unit (ICU) bed availability and demand may be improved with timely patient discharges, however little is known about the nature and contributing factors of discharge delays. This study investigated the impact of a specific intervention--the ICU liaison nurse role--in reducing ICU discharge delay using a prospective block intervention study. One hundred and eighty-six ICUpatients (101 control and 85 liaison nurse intervention) with an ICU length of stay of three days or longer and who survived to ICU discharge were examined. ⋯ While no demographic or clinical variables were significant predictors of ICU discharge delay, those in the liaison nurse group were almost three times less likely to experience a discharge delay of at least two hours and about 2.5 times less likely to experience a delay of four or more hours. The positive effect of the liaison nurse role in reducing the discharge delay remained after adjustingforpotential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer
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Anaesth Intensive Care · Feb 2006
Comparative StudyA national survey of infection control practice by New Zealand anaesthetists.
Anaesthetists have an important role in preventing nosocomial infection. Failures in this role have resulted in critical reports in the media. We ascertained the current practices of New Zealand anaesthetists relating to infection control, by distributing a questionnaire to all 450 anaesthetists practising in New Zealand. ⋯ The median response was 7, the modal response was 10 and interquartile range was 4 to 8. There was a high level of awareness of the risks of contributing to cross-infection inherent in anaesthesia, most anaesthetists reporting that they followed recommended guidelines in this context. However, these data suggest more effort is required to promote compliance with appropriate guidelines.
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Patients who are malignant hyperthermia susceptible are often admitted overnight for observation, even after minor surgery. They may be declined care in a stand-alone day stay unit. This prospective audit set out to investigate whether patients susceptible to malignant hyperthermia can be safely treated as day stay patients. ⋯ Only minor complications arose in the postoperative period, and none suggested a malignant hyperthermia reaction. Postanaesthesia care unit nursing staff contacted 49 (68%) of the patients the following day, and there was no evidence of malignant hyperthermia reactions. This audit suggests that malignant hyperthermia susceptible patients can be safely managed as day stay patients in appropriate facilities, with appropriate postoperative care.
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Anaesth Intensive Care · Feb 2006
Comparative StudyPerformance of three systems for warming intravenous fluids at different flow rates.
This study compared the intravenous fluid warming capabilities of three systems at different flow rates. The devices studied were a water-bath warmer, a dry-heat plate warmer, and an intravenous fluid tube warmer Ambient temperature was controlled at 22 degrees to 24 degrees C. Normal saline (0.9% NaCl) at either room temperature (21 degrees to 23 degrees C) or at ice-cold temperature (3 degrees to 5 degrees C) was administered through each device at a range of flow rates (2 to 100 ml/min). ⋯ The temperature of the fluid delivered by the dry-heat plate warmer significantly increased as the flow rate was increased within the range tested (due to decreased cooling after leaving the device at higher flow rates). The temperature of fluid delivered by the intravenous fluid tube warmer did not depend on the flow rate up to 20 ml/min but significantly and fluid temperature-dependently decreased at higher flow rates (>30 ml/min). Under the conditions of our testing, the dry heat plate warmer delivered the highest temperature fluid at high flow rates.