Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2011
Clinical prediction of weaning and extubation in Australian and New Zealand intensive care units.
Our objective was to describe, in Australian and New Zealand adult intensive care units, the relative frequency in which various clinical criteria were used to predict weaning and extubation, and the weaning methods employed. Participant intensivists at 55 intensive care units completed a self-administered questionnaire, using visual analogue scales (0 = not at all predictive, 10 = perfectly predictive, not used = null score) to record the perceived utility of 30 potential predictors. Survey response rate was 71% (164/230). ⋯ Most popular clinical criteria were those perceived to have high predictive accuracy, both for weaning (respiratory rate 96%, pressure support setting 94% and Glasgow coma score 91%) and extubation readiness (respiratory rate 98%, effective cough 94% and Glasgow Coma Score 92%). Weaning mostly employed pressure support ventilation (55%), with less use of synchronised intermittent mandatory ventilation (32%) and spontaneous breathing trials (13%). Classic ventilatory performance predictors including respiratory rate and effective cough were reported to be of greater clinical utility than other more recently proposed measures.
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Anaesth Intensive Care · Jul 2011
Biography Historical ArticleGolden Rules of Anaesthesia: the smallest book on anaesthesia?
Golden Rules of Anaesthesia, a waistcoat pocket-sized book by Robert James Probyn-Williams was published in three editions between 1904 and 1908. It may be the smallest English-language book on anaesthesia.
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Anaesth Intensive Care · Jul 2011
Remifentanil patient-controlled analgesia for labour: a complete audit cycle.
Remifentanil patient-controlled analgesia (PCA) was introduced to a small maternity unit where an extensive epidural service was difficult to provide. This was a new service and the New Zealand College of Midwives had serious doubts about the efficacy and safety of remifentanil, so auditing its use was important. In a two-stage audit, clinical notes of 244 consecutive remifentanil users were studied between January 2008 and November 2009. ⋯ A comparison of Apgar scores of consecutive neonates born by normal vaginal delivery to women receiving no analgesia, with those born to women using remifentanil PCA, demonstrated no difference. As a result of our audit, remifentanil PCA is now viewed by our midwives as an effective and safe method when accompanied by 1:1 care and appropriate monitoring. With our input other maternity units have introduced it, especially where epidural service provision is limited, and for patients in whom epidural analgesia is contraindicated.
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Anaesth Intensive Care · Jul 2011
Biography Historical ArticleThe leech airway or pharyngeal bulb gasway.
Beverley Charles Leech (1898 to 1960) patented the Leech airway or "Pharyngeal Bulb Gasway" in 1937. The Leech airway formed a seal with the pharyngeal tissues, resulting in a closed system during cyclopropane anaesthesia. Two prototypes and four commercially available versions of the airway have been identified.