Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2009
Randomized Controlled TrialEffect of pump prime on acidosis, strong-ion-difference and unmeasured ions during cardiopulmonary bypass.
We tested the hypothesis that a cardiopulmonary bypass prime with lactate would be associated with less acidosis than a prime with only chloride anions because of differences in the measured strong-ion-difference. We randomised 20 patients to a 1500 ml bypass prime with either a chloride-only solution (Ringer's Injection; anions: chloride 152 mmol/l) or a lactated solution (Hartmann's solution; anions: chloride 109 mmol/l, lactate 29 mmol/l). Arterial blood was sampled before bypass and then two, five, 15 and 30 minutes after initiating bypass. ⋯ There was, however a difference in the net-unmeasured-ions (strong-ion-gap). We conclude that acid-base changes with cardiopulmonary bypass may differ with the prime but that the early differences between chloride-only and lactated primes appear not to be due to differences in the measured strong-ion-difference. We suggest future studies examine other possible mechanisms including unmeasured ions.
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Anaesth Intensive Care · Sep 2009
Randomized Controlled Trial Comparative StudyThe performance of customised APACHE II and SAPS II in predicting mortality of mixed critically ill patients in a Thai medical intensive care unit.
The aim of this study was to evaluate and compare the performance of customised Acute Physiology and Chronic Health Evaluation HII (APACHE II) and Simplified Acute Physiology Score HII (SAPS II) in predicting hospital mortality of mixed critically ill Thai patients in a medical intensive care unit. A prospective cohort study was conducted over a four-year period. The subjects were randomly divided into calibration and validation groups. ⋯ The customised SAPS II showed good calibration in only the younger, postoperative and sepsis patients subgroups. The overall performance of the customised APACHE II was better than the customised SAPS II (Brier score 0.089 and 0.109, respectively). Our results indicate that the customised APACHE II shows better performance than the customised SAPS II in predicting hospital mortality and could be used to predict mortality and quality assessment in our unit or other intensive care units with a similar case mix.
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Anaesth Intensive Care · Sep 2009
Randomized Controlled TrialAmbulatory continuous femoral analgesia for major knee surgery: a randomised study of ultrasound-guided femoral catheter placement.
Needle-nerve stimulation has a false negative motor response rate, which may increase needle passes. This prospective, randomised study tested the hypothesis that femoral nerve catheters placed with ultrasound-only guidance could provide comparable postoperative analgesia to those placed using a conventional nerve stimulation endpoint. Patients presenting for major knee surgery to the lead investigator were recruited. ⋯ The median (quartiles) needle time under the skin was 58 seconds (51 to 76) in the ultrasound group and 120 seconds (95 to 178) in the nerve stimulation group (P = 0.001). The median (quartiles) insertion numerical rating pain score was 2 (0 to 2) in the ultrasound group and 4 (2 to 6) in the nerve stimulation group (P = 0.014). Femoral nerve catheters placed for major knee surgery using an ultrasound endpoint provided postoperative analgesia comparable to that obtained when using a nerve stimulation endpoint and were associated with a reduction in both needle manipulations and procedure-related pain.
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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
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.