Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
The use of epidural analgesia in a New Zealand tertiary hospital before and after publication of the MASTER study.
We audited the total number of perioperative epidural techniques performed at Christchurch Hospital, New Zealand, for three years, before and after The Lancet published the MASTER Anaesthesia Trial in 2002. We also looked specifically at the number of epidural anaesthetic and analgesic techniques performed in combination with general anaesthesia for colonic surgery over the same period. In both cases we found a statistically significant fall in epidural rate in the years after the publication (P < 0.001). A subsequent survey of local specialist anaesthetists, who have worked throughout this period, revealed the majority (75%) were knowingly performing fewer epidural techniques and that the findings of the MASTER Anaesthesia Trial had influenced their decisions.
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Anaesth Intensive Care · Jan 2008
Pre-existing cardiac disease, troponin I elevation and mortality in patients with severe sepsis and septic shock.
A prospective, observational study was undertaken to determine the frequency of troponin I elevation and the incidence of pre-existing cardiac disease in patients with severe sepsis and septic shock, and to determine their relationship to mortality. The setting was the surgical intensive care unit of a tertiary care medical centre. Sixty-six consecutive patients admitted with severe sepsis or septic shock requiring pulmonary artery catheterisation for haemodynamic monitoring were studied. ⋯ Troponin I elevation alone was not associated with increased mortality. We conclude that pre-existing cardiac disease and elevated troponin I are commonly found in surgical patients with severe sepsis and septic shock. In our study, pre-existing cardiac disease, and not troponin I elevation, was associated with increased mortality.
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Anaesth Intensive Care · Jan 2008
Attitudes towards and evaluation of medical emergency teams: a survey of trainees in intensive care medicine.
A survey was conducted to explore the perception of intensive care registrars on the impact of activities outside the intensive care unit (ICU), particularly in medical emergency teams, on their training and the care of patients. An anonymous mail-out survey was sent to 356 trainees registered with the Joint Faculty of Intensive Care Medicine, half of whom were determined to be involved in ICU duties. No patients were involved and respondents participated voluntarily. ⋯ Sixty-six percent of respondents reported that medical emergency team involvement had a positive effect on training but 77% reported little or no supervision of team duties. While trainees did not believe they spent too much time performing medical emergency team duties, the time spent on medical emergency teams at night, when ICU staffing levels are at their lowest, was the same as during the day. Serious concern was expressed about the negative impact of medical emergency team activities on their ability to care for ICU patients and the additional stress on ICU medical and nursing staff Overall, ICU trainees regarded participation in a medical emergency team as positive on training and on patient care in wards, but other results have resource implications for the provision of clinical emergency response systems, care of patients in ICUs and the training of the future intensive care workforce.
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Anaesth Intensive Care · Jan 2008
Prediction of successful defibrillation in human victims of out-of-hospital cardiac arrest: a retrospective electrocardiographic analysis.
In the present study we sought to examine the efficacy of an electrocardiographic parameter, 'amplitude spectrum area' (AMSA), to predict the likelihood that any one electrical shock would restore a perfusing rhythm during cardiopulmonary resuscitation in human victims of out-of-hospital cardiac arrest. AMSA analysis is not invalidated by artefacts produced by chest compression and thus it can be performed during CPR, avoiding detrimental interruptions of chest compression and ventilation. We hypothesised that a threshold value of AMSA could be identified as an indicator of successful defibrillation in human victims of cardiac arrest. ⋯ An AMSA value of 12 mV-Hz was able to predict the success of each defibrillation attempt with a sensitivity of 0.91 and a specificity of 0.97. In conclusion, AMSA analysis represents a clinically applicable method, which provides a real-time prediction of the success of defibrillation attempts. AMSA may minimise the delivery of futile and detrimental electrical shocks, reducing thereby post-resuscitation myocardial injury.
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Anaesth Intensive Care · Jan 2008
The influence of passive leg elevation on the cross-sectional area of the internal jugular vein and the subclavian vein in awake adults.
The aim of this study was to evaluate the influence of passive leg elevation and Trendelenburg position on the cross-sectional area (CSA) of the internal jugular (II) and subclavian veins (SCV). Ultrasound imaging was used for the following measurements of both the IJV and SCV baseline in the supine position (control); Trendelenburg position 15 degrees; reverse Trendelenburg position 15 degrees and passive leg elevation 50 degrees. Twenty healthy male volunteers were studied. ⋯ Mean CSA of the SCV was 0.92 +/- 0.23 cm2 in control, 0.98 +/- 0.17 cm2 in the Trendelenburg position, 0.86 +/- 0.21 cm2 in the reverse Trendelenburg position and 0.93 +/- 0.18 cm2 during passive leg elevation. The results indicate that passive leg elevation increases the CSA of the IJV, but has little effect on the SCV. The CSA of the IJV appears to be influenced more by gravitational factors than the SCV.