Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2009
An audit of potentially recyclable waste from anaesthetic practice.
Little is known about the amount of anaesthesia waste that is recyclable. We tested the hypotheses: 1) that anaesthetists produce a small proportion (< 10%) of total operating suite waste, 2) that much of this waste (> 30%) is recyclable and 3) that there is little (< 10%) cross-contamination of infectious and non-infectious waste. For five weekdays in a metropolitan hospital with six operating theatres, we weighed waste and determined the proportion of anaesthesia waste that was recyclable. ⋯ Anaesthesia waste was a quarter of total operating suite waste. Almost 60% of anaesthesia general waste could be recycled. Failure to eliminate infectious waste from general waste could be a barrier to recycling.
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Anaesth Intensive Care · Sep 2009
The functional outcome and recovery of patients admitted to an intensive care unit following drug overdose: a follow-up study.
Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. ⋯ The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.
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Anaesth Intensive Care · Sep 2009
Case ReportsArytenoid subluxation after a difficult intubation treated successfully with voice therapy.
Arytenoid subluxation is a rare laryngeal injury that may follow instrumentation of the airway and present as hoarseness, vocal fatigue, stridor, dysphagia, odynophagia and sore throat. We report the case of an 88-year-old man with type 2 diabetes mellitus who developed this complication during a difficult intubation where a Macintosh laryngoscope and gum elastic bougie were used to facilitate intubation. Previously considered to play a minor role in treatment, voice therapy was used successfully in this patient to correct subluxation of the arytenoid, with prompt resolution of his symptoms.
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Anaesth Intensive Care · Sep 2009
Incidence and risk factors for chronic pain after caesarean section under spinal anaesthesia.
This study investigated the incidence and risk factors associated with chronic pain after elective caesarean section under spinal anaesthesia in an Asian population. A prospective cohort study was conducted among subjects who underwent elective caesarean section under spinal anaesthesia, with morphine patient-controlled analgesia administered for 24 hours postoperatively. Perioperative, surgical and obstetric factors were investigated prospectively. ⋯ Of the 51 subjects with persistent pain at the time of subsequent survey, 9.8% (n = 5) had constant pain, 9.8% (n = 5) had daily pain and 23.5% (n = 12) had pain intermittently, at an interval of days. The independent risk factors for development of chronic pain were higher pain scores recalled in the immediate postoperative period (odds ratio [OR, 95% confidence interval] 1.348 [1.219 to 1.490], P = 0.0001), pain present elsewhere (OR 2.471 [1.485 to 4.112], P = 0.001) and non-private insurance status (OR 1.679 [1.034 to 2.727], P = 0.036). The two most common sites of pain other than wound pain were back pain (n = 316) and migraine (n = 87).