Anaesthesia and intensive care
-
Anaesth Intensive Care · Feb 2007
Comparative StudyTrends in intra-aortic balloon counterpulsation: comparison of a 669 record Australian dataset with the multinational Benchmark Counterpulsation Outcomes Registry.
The aim of this study was to review and describe indications for intraaortic balloon counterpulsation (IABP) use and identify the impact these have on outcomes at an Australian cardiothoracic tertiary referral hospital. A secondary aim was comparison of the Australian practice with a large multinational IABP data registry. Patient demographics, IABP indication, IABP complication rate and mortality in 662 patients treated with IABP at The Prince Charles Hospital (TPCH), Brisbane, between January 1994 and December 2004 inclusive were compared with The Benchmark Counterpulsation Outcomes Registry. ⋯ TPCH indications for IABP were: weaning from cardiopulmonary bypass (34.2%); cardiogenic shock (24.4%); preoperative support (13%); catheter laboratory support (10.6%); refractory ventricular failure (7.3%); ischaemia related to intractable ventricular arrhythmias (4.5%); unstable refractory angina (4%); mechanical complications due to acute myocardial infarction (1.2%) and other (0.4%) (0.4% not reported). In comparison to Benchmark, IABP at TPCH demonstrated a prejudice toward intraoperative use (34.2% versus 16.6%; P < or = 0.0001) and an aversion to catheter laboratory support (10.6% versus 19%; P < or = 0.0001). TPCH and Benchmark IABP outcomes demonstrated comparable mortality (22% versus 20.8%; P = ns) but increased TPCH complications (10.3% vs. 6.2%; P < or = 0.0001) owing to a 2% difference in observed insertion site bleeding.
-
Anaesth Intensive Care · Feb 2007
Risks of regional anaesthesia for caesarean section: women's recall and information sources.
Recall and information sources regarding the risks of regional anaesthesia in women having lower segment caesarean section have not been adequately assessed previously. We aimed to survey women's recall of their pre-anaesthesia risk discussion and determine where women, presenting for lower segment caesarean section under regional anaesthesia, obtain risk information. Following a small pilot survey, women's responses were recorded for "spontaneous" or "prompted" recalled risks, the information source and its reliability. ⋯ Of those women giving at least four spontaneous responses, 41 (58.6%) had elective and 26 (32.5%) had emergency lower segment caesarean section (P = 0.001). The majority of women stated that anaesthetists were the main, and most reliable, source of their information regarding risks of regional anaesthesia for caesarean section. This report identifies the risks associated with regional anaesthesia for caesarean section that women most frequently recall, namely headache, paralysis, nerve damage and inadequate block.
-
Anaesth Intensive Care · Feb 2007
Case ReportsPurpura fulminans associated with Lactobacillus paracasei liver abscess.
Purpura fulminans is a rare but devastating haemorrhagic condition often associated with sepsis. Many different organisms have been implicated in the aetiology of purpura fulminans, most commonly Neisseria meningitidis and Streptococcus pneumoniae. We report a case of purpura fulminans associated with Lactobacillus paracasei liver abscess. Purpura fulminans has not previously been associated with this organism and specific bacteriological testing was used to exclude the presence of other species.
-
Anaesth Intensive Care · Feb 2007
Case ReportsDiagnostic dilemmas and management of fulminant myocarditis.
Myocarditis is commonly a diagnosis of exclusion. We report a case of fulminant myocarditis in a patient with cardiogenic shock in whom the initial diagnosis was unclear. ⋯ Complete recovery of cardiac function was achieved. This case highlights the difficulty in diagnosing myocarditis and the benefits of early intensive support.
-
Anaesth Intensive Care · Feb 2007
Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks.
Peripheral nerve blockade is gaining popularity as an analgesic option for both upper or lower limb surgery. Published evidence supports the improved efficacy of regional techniques when compared to conventional opioid analgesia. The incidence of neurological deficit after surgery associated with peripheral nerve block is unclear. ⋯ Overall incidence of block-related neuropathy was 0.22%. Persistent postoperative neuropathy is a rare but serious complication of surgery associated with peripheral nerve block. Formal follow-up of all such blocks is recommended to assess causality and allow for early intervention.