Anaesthesia and intensive care
-
Anaesth Intensive Care · May 2011
Anaesthesia trainees' exposure to regional anaesthesia in an Australian tertiary adult teaching hospital.
The purpose of this study was to quantify the exposure of anaesthetic trainees to regional anaesthesia in an Australian tertiary adult teaching hospital. We reviewed data collected on all regional blocks performed by the anaesthetic department over a two-year period. The data was then broken down to give an estimate of the number of each block performed by each training year group. ⋯ The number of total blocks and the proportion of advanced blocks increased with increasing level of training while supervision declined. Trainees in the two regional fellowship positions (7% of the trainee pool) performed 42% of the 1374 blocks. Factors that may influence the exposure of trainees to regional anaesthesia and the assessment of competency are considered.
-
Anaesth Intensive Care · May 2011
Observational study of anaesthetists' fresh gas flow rates during anaesthesia with desflurane, isoflurane and sevoflurane.
Reducing excessive fresh gas flow rates (FGF) is an established and simple strategy to reduce the administration of volatile anaesthetic agents. We studied clinicians' FGF use to understand better why two previous clinical trials achieved significant reductions in FGF by using feedback to anaesthetists. Anaesthesia information management system data from a US academic medical centre were analysed retrospectively. ⋯ Even if all anaesthetists had identical mean FGF, the standard deviation of FGF among cases would be reduced by less than 0.1 l/minute for all agents. Most of the achievable reductions in FGF were small reductions in FGF for the many cases with < 3 l/minute. These results show that departments choosing to use inexpensive automatic email feedback on FGF should target all anaesthetists and focus on variation in FGF among anaesthetists' cases.
-
Anaesth Intensive Care · May 2011
Comment Letter Case ReportsThe use of sugammadex to reverse rocuronium in a patient with myotonic dystrophy.
-
Anaesth Intensive Care · May 2011
Randomized Controlled Trial Comparative StudyMyocardial injury in remifentanil-based anaesthesia for off-pump coronary artery bypass surgery: an equipotent dose of sevoflurane versus propofol.
This randomised controlled trial compared the effect of equipotent anaesthetic doses of sevoflurane (S group) versus propofol (P group), during remifentanil-based anaesthesia for off-pump coronary artery bypass surgery, on myocardial injury. Either sevoflurane or propofol was titrated to maintain bispectral index values between 40 and 50. In both groups, a targeted concentration of remifentanil 20 ng x ml(-1) was maintained during anaesthesia. ⋯ The postoperative values of creatine kinase MB (S group: 15.08 +/- 18.97, 20.78 +/- 20.92, 12.76 +/- 12.82 vs 2.09 +/- 1.54 ng x ml(-1); P group: 10.99 +/- 13.15 27.16 +/- 56.55 11.88 +/- 18.80 vs 1.84 +/- 1.67 ng x ml(-1)) and troponin I (S group: 3.56 +/- 5.19, 566 +/- 7.89, 3.35 +/- 4.55 vs 0.52 +/- 1.90 ng x ml(-1); P group: 2.42 +/- 3.33, 4.11 +/- 6.01, 3.04 +/- 5.31 vs 0.43 +/- 1.28 ng x ml(-1)) were significantly higher than preoperative values in both groups but there were no significant differences between the two groups. There were no significant differences in time to extubation (S group, 476 +/- 284 minutes; P group, 450 +/- 268 minutes) and intensive care unit length of stay (S group, 2775 +/- 1449 minutes; P group, 2797 +/- 1534 minutes) between the two groups. In conclusion, sevoflurane and propofol at equipotent doses guided by bispectral index with remifentanil 20 ng x ml(-1) had similar creatine kinase MB and troponin I values.