Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2007
Outcome of patients who have therapy withheld or withdrawn in ICU.
Many deaths among patients treated in intensive care units (ICUs) occur following the withdrawal or withholding of life support. Following limitation of life support, most of these patients die in the ICU or ward after the decision to limit life support is made, although some may survive to hospital discharge. This study described the characteristics of patients who had life support limitations in ICU and their subsequent in-hospital and out-of-hospital survival using linked data from the state's death registry. ⋯ Of these nine patients who survived to hospital discharge, four died within 10 days of hospital discharge and a further two died within six months. There were two patients, both with significant neurological disabilities at hospital discharge, who survived for longer than three years after hospital discharge. Long-term survival in critically ill patients who had life support limitations was very rare in this ICU.
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Anaesth Intensive Care · Jun 2007
Case ReportsThe use of activated protein C in severe Plasmodium falciparum malaria.
A 56-year-old man presented to a peripheral hospital in New Zealand with severe Plasmodium falciparum malaria with cerebral involvement and subsequently developed multi-system organ failure. Activated protein C was used in an attempt to stop the cascade of events into multi-organ failure. Severe infection with P. falciparum is life-threatening and appears to activate a hypercoagulable state similar to that of severe sepsis. Activated protein C is currently used in the treatment of severe sepsis and may provide a new adjuvant therapy for severe P. falciparum malaria.
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Morphine is administered intrathecally alone or in combination with other drugs to provide spinal analgesia. Dose-finding studies have recommended 100 microg be used intrathecally to optimise analgesia and minimise side-effects for caesarean section and hip replacement surgery. Dilute solutions of morphine are generally not available, mandating preparation from a 10 mg/ml ampoule. ⋯ A single-step dilution technique using 0.1 ml of a solution diluted to 1.0 mg/ml was more accurate than when a double-dilution technique was used (P = 0.047). Given that dose-finding studies suggest that analgesia and side-effects vary at the dose range found in this study, we advocate the use of prediluted solutions. If dilution is to be performed a single-step dilution technique should be used.
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Geoffrey Kaye was primarily an anaesthetist, but there were many facets to his life, not all of them involving medicine. He was also a researcher; author, teacher, engineer, inventor, metalworker; organiser traveller; visionary and collector. Geoffrey Kaye had a vision for Australian anaesthesia. ⋯ It is his core collection of equipment, documents and memorabilia that now gives us insight into the development of our specialty. His collecting extended beyond his love of medicine. He was renowned for his collection and knowledge of exquisite tableware, porcelain, and furniture, much of which now remains in the Ian Potter Museum collection, also in Melbourne.
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Anaesth Intensive Care · Jun 2007
Historical ArticleThe history of anaesthetic mortality reporting.
Anaesthetists are acutely aware of the legal constraint of reporting to the coroner deaths in association with anaesthesia. The evolution of the office of the coroner in England is presented and the relationship with the discovery and evolution of anaesthesia is examined. The legal and medical climate in the 19th century is described, with some of the key participants named and their roles explained. ⋯ The collaboration of the various state mortality committees in producing a triennial national report is an important way to ensure that the lessons of the past are kept in mind in the present. The author believes that mortality reporting, the analysis of data and the dissemination of information is a valuable field of research, monitoring and educational tool. Primum non nocere is particularly pertinent in anaesthesia.