Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2006
ReviewMethods to assess performance of models estimating risk of death in intensive care patients: a review.
Models that estimate the probability of death of intensive care unit patients can be used to stratify patients according to the severity of their condition and to control for casemix and severity of illness. These models have been used for risk adjustment in quality monitoring, administration, management and research and as an aid to clinical decision making. Models such as the Mortality Prediction Model family, SAPS II, APACHE II, APACHE III and the organ system failure models provide estimates of the probability of in-hospital death of ICU patients. ⋯ These attributes should be assessed in existing models that predict the probability of patient mortality, and in any subsequent model that is developed for the purposes of estimating these probabilities. The literature contains a range of approaches for assessment which are reviewed and a survey of the methodologies used in studies of intensive care mortality models is presented. The systematic approach used by Standards for Reporting Diagnostic Accuracy provides a framework to incorporate these theoretical considerations of model assessment and recommendations are made for evaluation and presentation of the performance of models that estimate the probability of death of intensive care patients.
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Anaesth Intensive Care · Apr 2006
Randomized Controlled TrialEffect of scalp block on postoperative pain relief in craniotomy patients.
The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. ⋯ The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P < 0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.
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Anaesth Intensive Care · Apr 2006
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the oropharyngeal leak pressure between the reusable Classic laryngeal mask airway and the single-use Soft Seal laryngeal mask airway.
We tested the oropharyngeal leak pressure with the reusable laryngeal mask airway and the single-use Soft Seal laryngeal mask airway. These two types of laryngeal mask airway (LMA) have a similar design but the reusable LMA cuff is made from silicone whereas the Soft Seal LMA cuff is polyvinylchloride. ⋯ However, in four subjects the oropharyngeal leak pressure was higher with the reusable by > 4 cm H2O. We concluded that the reusable LMA may provide a better seal in some individuals but that, on average, the Soft Seal provides a higher oropharyngeal leak pressure than the reusable LMA.
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Surveys allow convenient and inexpensive research. Surveys include mail-out questionnaires, email questionnaires, telephone interviews, and personal interviews. Despite a widespread perception that surveys are easy to conduct, good surveys need rigorous design, implementation and analysis. ⋯ The main goal when implementing a survey is to maximize the response rate to avoid misleading results. Evidence-based strategies, including brief personalized surveys with stamped return envelopes, can be used to maximize the response rate. A poorly conducted survey can lead to misleading or invalid conclusions and may undermine participation in subsequent surveys by the target population.
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Anaesth Intensive Care · Apr 2006
Case ReportsPneumothorax from intrapleural placement of a nasogastric tube.
Nasogastric tube insertion is a commonly performed procedure that can be associated with significant morbidity and even mortality. There is no universally accepted technique to confirm correct placement. ⋯ Due to the deficiencies of traditional confirmatory bedside techniques, and the limitations of modern and more sophisticated confirmatory methods, the plain chest X-ray remains the gold standard test to confirm correct nasogastric tube placement. We appraise the methods commonly employed to confirm nasogastric tube placement, and discuss factors that may increase the risk of misplacement.