Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2006
Case ReportsSubdural spinal haematoma after epidural anaesthesia in a patient with spinal canal stenosis.
A 60-year-old male with a past history of T12 fracture had epidural analgesia for a radical prostatectomy. It was unknown prior to epidural insertion that the patient had a canal stenosis at T12 from the previous injury. ⋯ The patient made a successful recovery with conservative management. Neuraxial blockade should be approached with caution in patients with previous back injury, and only after a thorough assessment has been obtained to exclude spinal canal stenosis.
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Anaesth Intensive Care · Apr 2006
Estimate of the number of patients eligible for treatment with drotrecogin alfa (activated) based on differing international indications: post-hoc analysis of an inception cohort study in Australia and New Zealand.
We aimed to estimate the potential number of patients eligible for treatment with drotrecogin alfa (activated) when applying different international criteria. The study was a post-hoc analysis of inception cohort study of 691 patients with severe sepsis during 5878 consecutive intensive care unit admission episodes in 23 closed multi-disciplinary ICUs of 21 hospitals (16 tertiary and 5 university-affiliated) in Australia and New Zealand. Outcomes assessed were presence of contraindications to treatment with drotrecogin alfa (activated), an admission APACHE II score of 25 or greater and dysfunction of two or more organs. ⋯ Two hundred and six patients (3.5%, 3.0-4.0%) had an APACHE II score of 25 or greater, 452 (7.7%, 7.0-8.4%) had dysfunction of two or more organs, 469 (8.0%, 7.3-8.7%) had either dysfunction of two or more organs or an APACHE II score of 25 or greater Relatively few patients had an absolute contraindication to treatment with drotrecogin alfa (activated). Selection based on the APACHE II score results in fewer eligible patients than selection based on multiple organ dysfunction. Depending on the selection criteria used, for every hundred admissions to intensive care, between 3.5 and 8.0 of patients may be eligible for treatment with drotrecogin alfa (activated).
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Anaesth Intensive Care · Apr 2006
Quality of life at three years after cardiac surgery: relationship with preoperative status and quality of recovery.
A reduction in symptoms, increased longevity, and improved quality of life (QoL), are goals of cardiac surgery. We measured QoL in 108 adult cardiac surgical patients at about three years after cardiac surgery, and assessed the predictive ability of a 40-item quality of recovery (QoR-40) score. Our follow-up rate was 86% (n = 93). ⋯ A poor quality recovery in the days after surgery can predict a poor QoL at three years after surgery. The QoR-40 is a valid and reliable measure of quality of recovery after surgery and anaesthesia. The QoR-40 is a useful, patient-oriented method of assessing recovery from anaesthesia and surgery.
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Anaesth Intensive Care · Apr 2006
Issues of consent for regional analgesia in labour: a survey of obstetric anaesthetists.
Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior to administering regional analgesia in labour. We surveyed consultant members of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric anaesthesia, in order to identify and compare which risks of regional analgesia they report discussing with women prior to and during labour. We also asked about obstetric anaesthetists' beliefs about informed consent, the type of consent obtained and its documentation. ⋯ Obstetric anaesthetists reported making a considerable effort to inform patients of risks prior to the provision of regional analgesia in labour. Verbal consent may be appropriate for labouring women, using standardized forms that serve as a reminder of the risks, and a record of the discussion. Consensus is required as to what are the levels of risk from regional analgesia in labour.
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We describe a new technique for achieving a deep cervical plexus block using a portable vascular access ultrasound scanner (Site-Rite II, Bard Access Systems, Pittsburgh, PA).