Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2008
Randomized Controlled Trial Comparative StudyContinuous infusion of subcutaneous compared to intravenous insulin for tight glycaemic control in medical intensive care unit patients.
The aim of this randomised controlled study was to compare continuous subcutaneous insulin infusion using an insulin pump with the traditional continuous intravenous infusion method for tight glycaemic control. Sixty patients admitted to our University Hospital medical intensive care unit with an initial blood glucose level over 6.1 mmol/l, were enrolled and randomised into two treatment groups: the subcutaneous insulin group received continuous subcutaneous insulin infusion and the intravenous group received insulin by traditional intravenous infusion with infusers. Three patients died in the first 24 hours and were excluded from the final analysis. ⋯ According to Vogelzang's hyperglycaemic index, better glycaemic control was achieved in the subcutaneous insulin group while there was no significant difference in terms of hypoglycaemic events. Daily insulin bolus and infusion requirements were also significantly lower in the subcutaneous insulin group. Despite the small number of patients involved in this study in a medical intensive care unit, strict blood glucose control using a subcutaneous insulin pump was achieved more efficiently than the traditional intravenous infusion method without increasing hypoglycaemic events.
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Anaesth Intensive Care · Jul 2008
Randomized Controlled TrialThe effect of timing of application of positive end-expiratory pressure on oxygenation during one-lung ventilation.
Many studies have confirmed that applying positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation (OLV) improves oxygenation. Our purpose was to investigate the best time and level of PEEP application. Thirty patients undergoing thoracic surgery were randomised into three groups. ⋯ When PEEP was set to 10 cmH2O, the airway pressure increased significantly (P <0.05). These findings indicate that PEEP applied at the initial time of OLV improves oxygenation most beneficially. Five cmH2O PEEP may produce this beneficial effect without the increase in airway pressure associated with 10 cmH2O PEEP.
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Anaesth Intensive Care · Jul 2008
Sedation and delirium in the intensive care unit: an Australian and New Zealand perspective.
A survey was conducted to determine sedation and delirium practices in Australian and New Zealand intensive care units. The survey was in two parts, comprising an online survey of reported sedation and delirium management (unit survey) and a collection of de-identified data about each patient in a unit at a given time on a specified day (patient snapshot survey). All intensive care units throughout Australia and New Zealand were invited by email to participate in the survey. ⋯ Failed and self-extubation rates were low: 3.2% and 0.5% respectively. In Australian and New Zealand intensive care units, routine use of sedation scales is common but not universal, while routine delirium assessment is rare. The use of a sedation protocol is valuable and should be encouraged.
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Anaesth Intensive Care · Jul 2008
Biography Historical ArticleDr Corlette and the first textbook of regional anaesthesia in Australia.
The first Australian textbook on regional anaesthesia was published in 1948 by a surgeon, Dr Cyril Corlette. He was 80 years old at the time but had lectured, published and strongly promoted regional anaesthesia his whole career. ⋯ He also published controversial work on heat loss under anaesthesia and anaesthetic mortality. This textbook, "A Surgeon's Guide to Local Anaesthesia", subtitled "A Manual of Shockless Surgery", helped to promote the concept of regional anaesthesia in Australia.
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Historically, anaesthetic equipment manufacturers used a number of differently-sized connectors in anaesthetic breathing systems. This gave rise to the potentially dangerous possibility of mismatched taper connections and a failure to create a gas-tight breathing system capable of ventilating a patient. ⋯ The problem was aggravated by a move to adopt a slightly different International Standards Organisation design. By the time that universally-interchangeable connectors were widespread twenty years later disposable breathing systems had replaced the old, heavy metal connectors.