Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2009
A national survey on the practice and outcomes of mechanical ventilation in Korean intensive care units.
A study was undertaken to describe the practice and outcomes of mechanical ventilation throughout Korea. This prospective cohort study was conducted over a three-month period enrolling patients (n = 519) who received mechanical ventilation for more than 72 hours in 21 university hospital intensive care units throughout Korea. The most common indication for mechanical ventilation was acute respiratory failure. ⋯ In Korean intensive care units, tuberculous lung disease remains an important cause for mechanical ventilation. The practice of mechanical ventilation in Korean intensive care units in general appeared to comply with the current international recommendations with regard to lung protection and weaning. However, intensive care units lacking critical care physicians seemed to be adopting fewer ancillary measures, such as deep vein thrombosis prophylaxis.
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Anaesth Intensive Care · Mar 2009
Outcome of patients receiving high dose vasopressor therapy: a retrospective cohort study.
The aim of this study was to determine the hospital survival of patients receiving high doses of catecholamines. A retrospective observational study was conducted in a 22-bed multidisciplinary adult intensive care unit of a tertiary referral university hospital. All patients (n = 64) receiving > 100 microg/min of adrenaline or noradrenaline or adrenaline and noradrenaline combined over a one-year period were studied to determine survival to intensive care unit and hospital discharge. ⋯ None of the 32 patients who received > 200 microg/min noradrenaline survived. We conclude that the survival of patients requiring high doses of catecholamines is poor but the use of such doses is probably not futile. It remains for individual clinicians, patients and their surrogates to decide whether use of high doses of vasopressor is appropriate, given the low probability of survival.
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Anaesth Intensive Care · Mar 2009
Case ReportsA patient with intractable posthypoxic myoclonus (Lance-Adams syndrome) treated with sodium oxybate.
Posthypoxic myoclonus is a rare and devastating complication of near-fatal cardiopulmonary arrest. Despite treatment with available anti-myoclonic agents, some patients may recover cognitively but remain completely disabled by severe myoclonus. We report a 16-year-old patient with severe treatment-refractory posthypoxic myoclonus, which improved markedly with administration of the drug sodium oxybate.
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Anaesth Intensive Care · Mar 2009
The effect of increasing operating room capacity on day-of-surgery cancellation.
Several studies have been conducted to evaluate the utilisation of the operating room, a fixed resource, in terms of conditions that prevent day-of-surgery cancellation due to deficient operative capacity. In this study, we surveyed the causes and overall rates of elective surgery cancellation and then compared the number of cancellations that occurred before and after the installation of additional operating rooms. We surveyed all patients undergoing elective surgery for 100 days prior to and after the installation of additional operating rooms. ⋯ After the operating room capacity was increased, the primary reasons for cancellation were departmental issues, abnormal laboratory data and over-booking, in that order Taken together the results of this study indicate that increased operating room capacity can prevent cancellation due to over-booking. However; the numbers of cancellations due to ward overflow exceeded the numbers of cancellations that occurred as a result of over-booking. In conclusion, increasing the operating room capacity is not an appropriate option for preventing the cancellation of operations.
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Anaesth Intensive Care · Mar 2009
Case ReportsMagnetic resonance scanning of the upper airway following difficult intubation reveals an unexpected lingual tonsil.
We present a case of a 40-year-old woman requiring elective surgery who had an unexpected Grade 4 Cormack and Lehane laryngoscopy view. Both curved and straight laryngoscope blades in the sniffing and hyperextended head and neck positions were used. ⋯ We feel that a comprehensive postoperative evaluation should be conducted after every difficult laryngoscopy (Cormack and Lehane Grade 3b and 4). The use of magnetic resonance imaging may provide important objective information for both the anaesthetist and the patient, allowing a better understanding of causes and possible solutions for future airway management.