Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2010
Randomized Controlled Trial Comparative StudyRemifentail infusion for paediatric bronchoscopic foreign body removal: comparison of sevoflurane with propofol for anaesthesia supplementation for bronchoscope insertion.
The study compared sevoflurane or propofol as anaesthesia supplements to remifentanil infusion and topical local anaesthesia for insertion of a rigid bronchoscope for bronchial foreign body removal in children aged one to three years. Seventy children were randomly allocated to two groups to receive remifentanil infusion at 0.2 microg x kg(-1) x min(-1) with either sevoflurane or propofol supplements for insertion of the rigid bronchoscope. Heart rate and systolic blood pressure before anaesthesia, prior to and on insertion of the bronchoscope and one, three, five, seven and ten minutes after insertion were measured. ⋯ The sevoflurane group had a lower incidence of cough than the propofol group. No significant difference was detected in the incidence of apnoea between groups. It can be concluded that remifentanil infusion with modest use of general anaesthetic agents facilitates rigid bronchoscopy successfully in children.
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Anaesth Intensive Care · Sep 2010
Randomized Controlled Trial Comparative StudyA comparison of two different doses of rectal ketamine added to 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine in infants and young children.
In some circumstances, a high degree of sedation that results in a child being unconscious at the time of parental separation is desirable. We set out to investigate the efficacy and safety of a rectal premedication regimen designed to produce this increased level of sedation. Sixty-seven children aged two to 24 months were randomised into two groups. ⋯ Sedation scores were significantly increased at both time points. There was no difference between groups in vital signs at the time of parental separation and no adverse respiratory events occurred during the study period. In cases where a high degree of sedation following premedication in infants and toddlers is desired, the addition of 8 mg x kg(-1) ketamine to 0.5 mg x kg(-1) midazolam and 0.02 mg x kg(-1) atropine administered rectally is more efficacious than 4 mg x kg(-1) ketamine.
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Anaesth Intensive Care · Sep 2010
Accuracy of weight and height estimation in an intensive care unit.
We report the findings from a prospective study determining the magnitude of errors in the visual estimation of weight and height of critically ill patients. Forty-two consecutive patients were weighed by a physician with a calibrated stretcher scale and length measured with a steel measuring tape. The predicted body weight was calculated using the ARDSnet formulae. ⋯ Our study shows that estimations of patient's weight made by intensive care unit staff are often inaccurate. In contrast, estimations of height made by intensive care unit staff are usually adequate. Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution.
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Anaesth Intensive Care · Sep 2010
What are we telling our patients? A survey of risk disclosure for anaesthesia in Australia and New Zealand.
The aim of our study was to determine the range of risks disclosed in four commonly-encountered clinical scenarios: knee arthroscopy, lumbar laminectomy, laparoscopic appendicectomy and laparotomy, and then to determine how often five commonly-disclosed risks were disclosed for each scenario. We conducted a pilot survey of consultant anaesthetists in the Auckland City Hospital, the Royal Melbourne Hospital and the Austin Hospital (response rate 59%). A web survey was then sent to 500 randomly-selected Australian and New Zealand College of Anaesthetists Fellows (response rate 29%). ⋯ While the low response rate limits the validity and generalisability of many of our findings, we can nevertheless confidently conclude that risk disclosure varies widely in Australia and New Zealand. This large variation should be of concern to all anaesthetists. More work is needed to understand the reasons for this variation, and to develop a stronger consensus among anaesthetists about what risks should be disclosed.
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Anaesth Intensive Care · Sep 2010
Prognosis and resuscitation status of critically ill patients with lung cancer admitted to the intensive care unit.
The aims of the study were to assess the intensive care unit (ICU) outcome for critically ill patients with lung cancer to determine the risk factors for mortality and to examine the resuscitation status on admission and during their ICU course. Data was collected from May 1999 to March 2009 for patients with lung cancer admitted to the ICU. ⋯ The majority of patients were full resuscitation on admission to ICU The resuscitation status was changed in 56% of patients during the ICU course. It is suggested that end-of-life decisions should be addressed earlier in these patients' illnesses.