Anaesthesia and intensive 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.
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Anaesth Intensive Care · Feb 2006
Case ReportsLaryngotracheal hypoplasia--a rare cause of difficult intubation.
Generalized hypoplasia of the larynx and trachea is a very rare condition with only one case reported in the literature. A pregnant woman presented for an emergency laparotomy under general anaesthesia. ⋯ Subsequent investigations demonstrated generalized hypoplasia of the larynx and trachea. In this report, successful anaesthetic management of this case is discussed along with other possible options.
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Anaesth Intensive Care · Feb 2006
Comparative StudyThe yield of lumbar puncture to exclude nosocomial meningitis as aetiology for mental status changes in the medical intensive care unit.
We aimed to evaluate the diagnostic value of lumbar puncture in excluding nosocomial meningitis as the cause of mental status changes in medical intensive care unit patients. We retrospectively reviewed the records of all patients admitted to the medical intensive care unit at our institution over a four-year period who had a lumbar puncture performed during their stay. Patients with central nervous system devices were excluded. ⋯ In no non-HIV subject did lumbar puncture alter management. Lumbar puncture performed in the medical intensive care unit to exclude nosocomial meningitis as the cause of mental status changes has a low yield and rarely changes management. These findings should not be generalized to patients who have sustained head trauma, have undergone neurosurgical procedures, or may be immunosuppressed.
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Anaesth Intensive Care · Feb 2006
Case ReportsAnaesthesia for major orthopaedic surgery in a child with an acute tracheobronchial injury.
A 12-year-old boy presented after a motorbike accident with mediastinal and cervical emphysema but no pneumothorax, minor head injury and several fractures including a comminuted open leg fracture. The child had no signs of respiratory compromise and was stable. ⋯ To avoid general anaesthesia and the risks associated with intubation and ventilation, urgent surgery for correction of his orthopaedic injuries was successfully conducted under spinal, epidural and intravenous regional anaesthesia. The surgical and anaesthetic management of tracheobronchial injury is complex and controversial.
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Anaesth Intensive Care · Feb 2006
Case ReportsAnaesthesia for a patient with congenital methaemoglobinaemia and temporomandibular joint ankylosis.
We report a 10-year-old child with congenital methaemoglobinaemia and temporomandibular joint ankylosis who presented for ophthalmic surgery. He had had two previous anaesthetics in another institution. The first was short and uneventful, and no abnormality was noted. ⋯ The patient required prolonged intensive care and tracheostomy. The tracheostomy was ultimately decannulated. Before his third anaesthetic (after referral to the authors' institution) preoperative investigation revealed that the patient, his father and brother all had methaemoglobinaemia.