Anaesthesia and intensive care
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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.
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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.
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Anaesth Intensive Care · Sep 2010
Continuous central venous oxygen saturation monitoring under varying physiological conditions in an animal model.
We compared saturations from a paediatric central venous oximetry catheter with co-oximetry values with changes in drug infusions, intravascular blood volume and hypoxia in an animal model. Piglets (large white) were anaesthetised, intubated and mechanically ventilated. PediaSat oximetry catheters were placed in the superior vena cava via jugular vein cut-down and in the inferior vena cava percutaneously via the femoral vein. ⋯ During the hypoxia study there was good agreement between the co-oximeter to ScvO2-superior catheter but poor agreement with to the inferior vena cava catheter samples. In the hypovolaemic phase of the experiment there was good agreement between the measured co-oximetry value and ScvO2-superior catheter until the mean blood pressure reached 43 mmHg. The oximetry catheter is capable of identifying changes in ScvO2 under physiological conditions usually encountered in clinical medicine but was less accurate at the extremes of physiology and when placed in the inferior vena cava catheter especially during hypovolaemia and hypoxia.
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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.
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Anaesth Intensive Care · Sep 2010
Anaesthesia-related morbidity in Victoria: a report from 1990 to 2005.
This report involves a review of 736 cases of anaesthesia-related morbidity reported from 1990 to 2005 by the Victorian Consultative Council on Anaesthetic Mortality and Morbidity. Using a combination of an established classification system, emerging categorisation definitions and appropriate keywords, an analysis of the clinical issues and contributory factors was undertaken. Airway-related morbidity, respiratory complications and drug-related adverse events are the most commonly reported. Organisational issues are increasingly implicated in adverse anaesthesia outcomes.