Anaesthesia and intensive care
-
Anaesth Intensive Care · Sep 2010
Case ReportsUltrasound-guided bilateral superior laryngeal nerve block to aid awake endotracheal intubation in a patient with cervical spine disease for emergency surgery.
Ultrasound has been widely used to locate nerves for various nerve blocks. The potential advantages of using ultrasound imaging for nerve blocks include reduction in the amount of local anaesthetic required, improved success rate, reduced time to perform the block and reduced complication rate. We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibreoptic intubation in a patient presenting for emergency surgery on the cervical spine.
-
Anaesth Intensive Care · Sep 2010
Risk factors and outcomes of high-dependency patients requiring intensive care unit admission: a nested case-control study.
Intermediate-care or high-dependency units can provide a level of care that lies between the intensive care unit (ICU) and general ward, but the patients who are most likely to benefit from such level of care remains uncertain. This nested case-control study assessed the incidence and risk factors of high-dependency patients requiring ICU admission and whether these admissions were associated with a worse outcome when compared to other emergency ICU admissions. Seventy-seven consecutive high-dependency patients requiring ICU admission (cases) were compared with 77 patients who did not require ICU admission (controls) and also 928 emergency ICU admissions from other areas. ⋯ High-dependency admissions from the ward (odds ratio 4.46, 95% confidence interval 1.55 to 12.78) or emergency department (odds ratio 4.48, 95% confidence interval 1.54 to 13.0) and a need for concurrent non-invasive ventilation, inotrope infusion and acute kidney injury (odds ratio 14.90, 95% confidence interval 3.79 to 58.3) was associated with a higher risk of ICU admission. Hospital mortality of the high-dependency patients requiring ICU admission was not significantly different from other emergency ICU admissions (odds ratio 1.08, 95% confidence interval 0.55 to 2.11). In summary, high-dependency patients requiring ICU admission were uncommon unless they had multi-organ failure and their hospital mortality was not significantly different from other emergency ICU admissions.
-
Anaesth Intensive Care · Sep 2010
Case ReportsIntravascular haemolysis and septicaemia due to Clostridium perfringens liver abscess.
Intravascular haemolysis is a rare but serious complication of Clostridium perfringens sepsis. The outcome is usually fatal unless treatment is started early. We describe a case of survival after haemolysis and multiple organ failure in the setting of a ruptured liver abscess and sepsis caused by C. perfringens in an immunocompetent 58-year-old male.
-
Anaesth Intensive Care · Sep 2010
Case ReportsEstimating the net effect of unmeasured ions in human extracellular fluid using a new mathematical model. Part II: Practical issues.
Building on the theoretical considerations developed in Part I of this two-part series, a population range was established for a new extracellular fluid acid-base parameter using Monte Carlo simulation. This new parameter the unmeasured ion excess, had a normal range of +/- 2.50 mEq/l which was slightly narrower than the normal range for the standard base excess at +/- 3.20 mmol/l. In both cases, most of this variation occurred as a result of the estimation of the bicarbonate concentration. Finally, several short clinical vignettes were explored to highlight the differences between the unmeasured ion excess and the standard base excess.
-
Anaesth Intensive Care · Sep 2010
The provision of anaesthesia for children by non-subspecialist anaesthetists: expectations of newly qualified consultant anaesthetists and their prospective employers in Victoria.
We surveyed newly qualified consultant anaesthetists and their prospective employers in Victoria, regarding their expectations for the provision of paediatric anaesthesia by anaesthetists who have not completed subspecialty training in paediatric anaesthesia (generally-trained anaesthetists). Responses were received from 15 of 19 (79%) eligible Directors and 26 of 37 (70%) newly qualified Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. Of those responding, 80% of Directors and 82% of Fellows would expect a generally-trained anaesthetist to anaesthetise children two years of age or older Regional Directors expected generally-trained anaesthetists to anaesthetise younger children than metropolitan Directors, and Directors' expectations were not influenced by their own practice. ⋯ Only 50% agreed they still met all the requirements of the ANZCA paediatric module and only 37.5% had the level of confidence they achieved during their paediatric rotations. We suggest that current training provides capacity to routinely anaesthetise well children two years of age or older However it appears more training would be required for most anaesthetists undertaking anaesthesia for younger patients or more complex paediatric cases. This raises the question of subspecialty endorsements within ANZCA Fellowship.