Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2006
Randomized Controlled Trial Comparative StudyComparison of remifentanil and fentanyl in anaesthesia for elective cardioversion.
This prospective, randomized, double-blind study was designed to compare the recovery characteristics of remifentanil and fentanyl in combination with propofol for direct current cardioversion. Patients undergoing elective cardioversion received either intravenous fentanyl 1 microg/kg (n=33) or remifentanil 0.25 microg/kg (n=30) and propofol was titrated to a Ramsay sedation score of 5 by slow intravenous injection. ⋯ Side-effects and patient discomfort were similar for both groups. Remifentanil can be used as a suitable supplement to propofol for direct current cardioversion and may provide a faster recovery profile than fentanyl.
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Anaesth Intensive Care · Jun 2006
Randomized Controlled Trial Comparative StudyRecovery after prolonged anaesthesia for acoustic neuroma surgery: desflurane versus isoflurane.
In this study, 33 patients were randomly assigned to receive desflurane (D) or isoflurane (I) for acoustic neuroma surgery. The time from end of the procedure to spontaneous breathing, extubation, eye-opening, hand-squeezing to command, and ability to state name, birthdate and phone number were recorded. The Steward recovery score was also recorded every five minutes during the first 20 minutes postoperatively and then every 10 to 15 minutes. ⋯ Steward recovery scores were also better during the first postoperative hour in the D group (D: 40 min vs I: 90 min, P<0.005 for 100% of patients with Steward score of 6). The results indicate that desflurane is associated with similar operating conditions and faster postoperative recovery following acoustic neuroma surgery. The faster recovery following desflurane may be desirable after long surgical procedures, enabling the patient's full cooperation and facilitating early diagnosis of any potential neurological deficit.
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By exposing the mu-receptor (MOP-R) to more than one exogenous ligand, the administration during general anaesthesia of more than one opioid with principal action on the receptor may confound and lead to complications or unexpected outcomes. The giving of such a 'mixed message' can result in respiratory depression, excess sedation and delayed recovery to an unusual degree. We present a case of apparent extreme opioid sensitivity and discuss a possible mechanism. Such occurrences may be more common than previously realised.
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Anaesth Intensive Care · Jun 2006
A pilot study to test the use of a checklist in a tertiary intensive care unit as a method of ensuring quality processes of care.
This pilot study aimed to test the use of a checklist as a method of ensuring that certain processes of care are performed routinely and systematically in a tertiary intensive care unit. The pilot involved the development of a process indicator checklist, its implementation and review. The checklist contained 16 items sourced from the literature or deemed important by local clinicians. ⋯ Results demonstrated good compliance in completing the checklist (81%) and that when checked, certain aspects of care were not always delivered when appropriate. At the conclusion of the study the majority of medical staff believed that care in the intensive care unit actually improved with the use of the checklist, and all thought that it assisted in ensuring that good quality care was delivered. The checklist is a useful tool that can be readily applied to facilitate best practice and quality in everyday clinical care, ultimately leading to better health outcomes for patients.
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Amongst Australian anaesthetists there have been many whose ingenuity and mechanical knowledge produced ingenious devices. Lidwill and Geoffrey Kaye come immediately to mind, and their contributions are well-described elsewhere. In this paper, two inventions with contrasting fates are described: the Grant Humidifier and the Komesaroff single-use analgesia device. ⋯ Nevertheless, he has remained interested and in touch with technical matters, and has a number of other devices to his credit. Mention is briefly made of others: Stokes (of the suction bullet), Bill Cole (an early volatile specific vaporiser), Fisk (the paediatric ventilator) and Noel Cass (the Cass needle) These achievements are by no means the end of the road. Already an Australian-designed single-use laryngoscope is being manufactured and launched on both the national and international markets.