Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2011
Case ReportsIntraoperative thrombolysis in a patient with cardiopulmonary arrest undergoing caesarean delivery.
Thromboembolic events during pregnancy remain a major cause of morbidity and mortality with possible catastrophic sequelae for the patient. The decision whether to use high-risk therapeutic thrombolytics during pregnancy or perinatally is complicated and many considerations pertain. We report on the thrombolytic management of a 34-year-old woman who had an asystolic cardiac arrest secondary to massive pulmonary embolism while undergoing emergency caesarean delivery. ⋯ Return of spontaneous circulation was accompanied by massive uterine bleeding. Instead of performing a postpartum hysterectomy, the uterus was preserved through continuous manual pressure and packing for four hours by the obstetric team until haemostasis was achieved. The patient survived and was later discharged without any major neurological deficit.
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Anaesth Intensive Care · Jul 2011
Case ReportsCalcitonin for acute neuropathic pain associated with spinal cord injury.
Neuropathic pain associated with spinal cord injury is caused by complex neural mechanisms and is often refractory to standard therapy. Salmon calcitonin was an effective treatment for neuropathic symptoms in this case series of three patients with recent spinal cord injury. ⋯ Calcitonin is thought to exert its effect by modulation of the serotonergic system and is generally well tolerated and convenient to administer. This underutilised drug may be a very useful adjuvant for neuropathic pain associated with spinal cord injury.
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Anaesth Intensive Care · Jul 2011
Changing patterns in endotracheal intubation for anaesthesia trainees: a retrospective analysis of 80,000 cases over 10 years.
Several overseas studies have suggested that opportunities for anaesthesia trainees to learn and practise endotracheal intubation have decreased over time. We analysed the operating theatre data collection system at a large Australian metropolitan teaching hospital from 1998 to 2008 to determine if numbers for trainees' caseloads in general, and endotracheal intubation in particular had changed. The total caseload per trainee of approximately 800 cases per year was stable throughout the study period. ⋯ The mean number of endotracheal intubations per trainee per year fell by 10% and of supraglottic devices by 16%, neither of which was statistically significant. Endotracheal intubation for caesarean sections did however fall significantly from an average of nine to an average of six cases per trainee per year. Our findings contrast with other reports of much larger decreases in the number of endotracheal intubations performed by trainees over the last decade, but suggest that our local practice is similar to the international experience of decreasing opportunities for endotracheal intubation in obstetric anaesthesia.
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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.
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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.