Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2010
Case ReportsPlasmapheresis treatment in Guillain-Barré syndrome: potential benefit over intravenous immunoglobulin.
Guillain-Barré syndrome includes acute inflammatory demyelinating polyradiculoneuropathy, acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, Miller Fisher syndrome and acute pandysautonomia. Plasma exchange was the first treatment in Guillain-Barrd syndrome proven to be superior to supportive treatment alone and intravenous immunoglobulin was subsequently shown to be equally effective and is now commonly used as first-line treatment. We describe a 78-year-old woman who presented with a two-day history of progressive generalised weakness and left facial nerve palsy, preceded by a flu-like illness lasting for one week. ⋯ A gradual improvement of respiratory function and peripheral muscle strength was observed after the first plasma exchange and on the eighth day the patient was weaned off mechanical ventilation. This case suggests that patients with severe Guillain-Barrd syndrome may benefit from plasma exchange after immunoglobulin treatment in refractory cases. Plasma exchange should be considered early in Guillain-Barrć syndrome cases with axonal involvement, and in the recurrent or familial Guillain-Barré syndrome forms.
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Anaesth Intensive Care · Mar 2010
Case ReportsTotal spinal following labour epidural analgesia managed with non-invasive ventilation.
A 30-year-old woman developed total spinal anaesthesia during establishment of labour analgesia via an epidural catheter The subsequent respiratory failure was successfully managed with non-invasive ventilation. This report describes the use of non-invasive ventilation in the parturient and the process of managing the parturient safely in an appropriately monitored environment. This case displays the potential benefit of this technique in the setting of a total spinal block in preventing the need for intubation and ventilation (and subsequent emergency caesarean section) and providing adequate ventilatory function until the block subsided adequately.
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Anaesth Intensive Care · Mar 2010
Prognostic factors in critically ill patients with solid tumours admitted to an oncological intensive care unit.
The mortality and prognostic factors for patients admitted to the intensive care unit (ICU) with solid tumours are unclear The aim of this study was to describe demographic, clinical and survival data and to identify factors associated with mortality in critically ill patients with solid tumours. A prospective observational cohort study of 177 critically ill patients with solid tumours admitted to a medical-surgical oncological ICU was undertaken. There were no interventions. ⋯ The mortality rate in the ICU was 21.4%. Improved outcomes in critically ill cancer patients extended to the subgroup of patients with solid tumours. Independent prognostic factors for in-ICU death were the need for vasopressors and the APACHE IL score, while the length of stay in the ICU, Charlson comorbidity index score >2, and the need for vasopressors were independent predictors of death after ICU discharge.
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Anaesth Intensive Care · Mar 2010
Pilot study of the air-Q intubating laryngeal airway in clinical use.
The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. ⋯ One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However the proposed advantage of ease of endotracheal intubation requires further investigation.
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Anaesth Intensive Care · Mar 2010
Rural anaesthesia practice: attitudes and recruitment following a period of anaesthetic training in rural and regional hospitals. A survey of new consultants.
The provision of specialist anaesthetic services to rural and remote locations in Australia poses an ongoing challenge. Initiatives to improve delivery of specialist anaesthetic services include the provision of anaesthesia training opportunities at rural hospitals. Previous surveys of trainees demonstrated the positive effect of rural training on attitudes toward subsequent practice in rural areas. ⋯ Six hundred and fifteen surveys were distributed with a response rate of 53%. Respondents held their rural training experience in high regard. Anaesthetic specialists with a period of training in rural/regional areas were more likely to subsequently practise in rural areas compared to those who did not.