Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2007
The effects of acidosis and hypothermia on blood transfusion requirements following factor VII administration.
While there is laboratory evidence that the activity of recombinant activated factor VII (rFVIIa) is reduced by the presence of acidosis and hypothermia, there is limited clinical data to support this observation. Recombinant FVIIa may be used as rescue therapy in surgical patients who have bleeding that is refractory to conventional therapy. However, these patients are also frequently acidotic and hypothermic at the time the drug is administered. ⋯ The implication of this study is that rFVIIa may be less effective when administered to severely acidotic patients. Further studies are required to examine whether this is related to the acidosis directly, or is secondary to other intraoperative variables affecting acidosis. The clinical utility of rFVIIa in acidotic patients also requires further investigation.
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Anaesth Intensive Care · Aug 2007
Randomized Controlled Trial Comparative StudyComparative safety and efficacy of two high dose regimens of oral paracetamol in healthy adults undergoing third molar surgery under local anaesthesia.
This study compared the efficacy and safety of single oral doses of 60 mg/kg and 90 mg/kg paracetamol in fit young adult patients undergoing third molar extractions. The study was a randomised, blinded, crossover design on 20 young, fit adults. ⋯ There was a reduction in factor VII activity with 90 mg/kg dose compared to 60 mg/kg dose. It may be concluded that the 90 mg/kg dose, though safe, does not offer any advantages over 60 mg/kg dose of paracetamol in young fit adults undergoing third molar surgery.
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Anaesth Intensive Care · Aug 2007
Multicenter StudyAfter-hours discharge from intensive care increases the risk of readmission and death.
Despite reports showing night discharge from an intensive care unit (ICU) is associated with increased mortality, it is unknown if this has resulted in changes in practice in recent years. Our aim was to determine prevalence, trends and effect on patient outcome of discharge timing from ICU throughout Australia and New Zealand. Two datasets from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) were examined: (1) All submissions to the APD from 1.1.2003 to 31.12.2004 to determine contemporary practices. (2) Forty hospitals which had submitted continuous data between 1.1.2000 and 31.12.2004 to determine trends in practice over time. ⋯ After-hours discharge from ICU is associated with increased risk of death and readmission to ICU. It has become more frequent. The risk of death increases as more after-hours discharges occur.
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Anaesth Intensive Care · Aug 2007
Comparative StudyProspective audit comparing intrathecal analgesia (incorporating midazolam) with epidural and intravenous analgesia after major open abdominal surgery.
Potentiation of opioid analgesia can be achieved by the addition of midazolam intrathecally. At our institution, analgesia following open abdominal surgery is provided by continuous infusion of analgesic solutions either intravenously, intrathecally (incorporating midazolam) or epidurally. We report the results of a study comparing outcomes with these three analgesic regimens following major open abdominal surgery. ⋯ Pain scores differed significantly between groups and were lowest in the intrathecal group at all time points. The findings indicate that the intrathecal group had both a low requirement for postoperative interventions/resources and excellent analgesia. It appears to be a suitable alternative to the other techniques.
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Anaesth Intensive Care · Aug 2007
Patients' knowledge of the qualifications and roles of anaesthetists.
Patients' knowledge of anaesthetists' qualifications and roles remains inaccurate despite the efforts of professional bodies worldwide. However, patients have not been surveyed on this subject in Australia for more than 20 years. We therefore surveyed 200 patients attending the pre-admission clinic prior to elective non-cardiothoracic surgery in an Australian teaching hospital to determine current knowledge. ⋯ Younger age, an English-speaking background and previous experience with surgery predicted knowledge of anaesthetists' qualifications. Most patients believed that anaesthetists work in the operating theatre and are continually present during surgery, but few recognised their leading role in the care of patients during surgery or their other roles outside the operating theatre. Increased efforts are required to inform patients about the roles of anaesthetists in their care.