Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2009
Comparative StudyDose requirements for propofol anaesthesia for dental treatment for autistic patients compared with intellectually impaired patients.
We had clinical grounds to suspect that patients with autism had greater propofol requirements during dental procedures than patients with intellectual impairment without autism. This hypothesis was tested by an audit of a standard anaesthetic technique. The audit was approved by our Hospital Ethics Committee. ⋯ The propofol infusion rates of the intellectually impaired group showed significant decline with age (propofol rate of requirement mg x kg(-1) x h(-1), mean [SD]): < six years 13.6 (3.6), seven to 19 years 9.5 (3.0) (P = 0.008 cf < six years group), > 19 years group 8.5 (2.4) (P = 0.001 cf < six years group). The propofol requirement was greater in the autism group than in the intellectual disability group, and the proportion of the cases where bolus propofol administration was needed after induction was significantly higher in the autistic patient group than in the intellectually impaired patients (P < 0.002). This suggests that autistic patients have greater propofol requirements for anaesthesia during ordinary dental treatment compared with intellectually impaired patients.
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Anaesth Intensive Care · Jan 2009
Multicenter StudyVentilation and weaning practices in Australia and New Zealand.
Using a one-day prospective point prevalence design, this study aimed to characterise the current practice of mechanical ventilation and weaning in Australian and New Zealand intensive care units. During 2005, a bi-national one-day survey of 55 intensive care units found the point-prevalence of mechanical ventilation to be 284/491(58%). Common modes used were synchronised intermittent mandatory ventilation with pressure support, pressure support ventilation (each 116/284, 41%) and pressure-control modes (48/284, 17%). ⋯ Apart from 24/255 (9.4%) patients who received only pressure support ventilation, weaning methods (attempted in 255 patients, 29 prior deaths) included: change to pressure support ventilation (186/255, 73%), T-piece (31/255, 12%) or other methods (14/255, 5.5%). The point prevalence of mechanical ventilation was greater than comparable international studies. Australian and New Zealand intensive care unit ventilatory practices are similar, but differ substantially from published international survey results, due to a near absence of assist/control, prominent use of pressure-control modes and a preference forpressure support ventilation weaning as opposed to T-piece.
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Anaesth Intensive Care · Jan 2009
Multicenter StudyA survey of anaesthetists' perspectives of communication in the operating suite.
We surveyed 222 anaesthetists attending a University of Western Australia conference (n = 110) and two public hospitals in Perth (n = 112) by anonymous questionnaire in March 2006 regarding communication issues in the operating suite. Forty-one percent (n = 92) responded. Questions concerned communication skills, experiences of good and poor communication and relationship to outcome, attitudes to music and communication courses. ⋯ Sixty-four percent of respondents would attend a communications course voluntarily, with implementation of a compulsory communications course supported by 45%. Most anaesthetists surveyed used staff first names and 94% believed poor communication caused procedural delay. The data suggest that further work is required to improve communication in the stressful operating room environment, particularly at the surgeon/anaesthetist interface.
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Anaesth Intensive Care · Jan 2009
Comparative StudyIn situ simulation-based team training for post-cardiac surgical emergency chest reopen in the intensive care unit.
Emergency chest reopen of the post cardiac surgical patient in the intensive care unit is a high-stakes but infrequent procedure which requires a high-level team response and a unique skill set. We evaluated the impact on knowledge and confidence of team-based chest reopen training using a patient simulator compared with standard video-based training. We evaluated 49 medical and nursing participants before and after training using a multiple choice questions test and a questionnaire of self-reported confidence in performing or assisting with emergency reopen. ⋯ In a multiple choice question out of 10, participants improved by a mean of 1.9 marks with manikin-based training compared to 0.9 with video training (P = 0.03). On a questionnaire out of 20 assessing subjective levels of confidence, scores improved by 3.9 with manikin training compared to 1.2 with video training (P = 0.002). Simulation-based training appeared to be at least as effective as video-based training in improving both knowledge and confidence in post cardiac surgical emergency resternotomy.