Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2012
A survey of anaesthetists' understanding of Australian mandatory reporting laws.
Australian mandatory reporting laws for healthcare practitioners were introduced nationally in July 2010. We distributed an online survey to specialist anaesthetists and anaesthesia trainees in our institution with the aim of assessing anaesthetists' awareness, understanding and interpretation of the new laws. One hundred and three completed responses were received (response rate 67%). ⋯ Some anaesthetists believed the laws would deter them from seeking medical help themselves if they were impaired (39%). Mandatory reporting laws aim to improve patient safety while being fair to doctors who are reported and protecting those who report. Our survey indicates that there are differences among anaesthetists about the type of conduct they would report and their perception of the consequences of making a report.
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Anaesth Intensive Care · Sep 2012
Anaphylaxis to muscle relaxants: an audit of ten years of allergy testing at the Royal Adelaide Hospital.
We audited patients with anaphylaxis to muscle relaxants during anaesthesia referred to the Department of Anaesthesia at the Royal Adelaide Hospital between the start of 2000 and the end of 2009. Of the 220 patients tested during this period, 43 had a positive intradermal test to the muscle relaxant given during their anaesthetic. The majority of these were to rocuronium and suxamethonium. Where rocuronium was the index agent, 65% of patients cross-reacted with another relaxant and 29% of patients with suxamethonium as their index agent demonstrated cross-reaction with another relaxant.
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Anaesth Intensive Care · Sep 2012
Comparative StudyComparison between conventional and protective one-lung ventilation for ventilator-assisted thoracic surgery.
Recent papers suggest protective ventilation (PV) as a primary ventilation strategy during one-lung ventilation (OLV) to reduce postoperative pulmonary morbidity. However, data regarding the advantage of the PV strategy in patients with normal preoperative pulmonary function are inconsistent, especially in the case of minimally invasive thoracic surgery. Therefore we compared conventional OLV (VT 10 ml/kg, FiO2 1.0, zero PEEP) to protective OLV (VT 6 ml/kg, FiO2 0.5, PEEP 5 cmH2O) in patients with normal preoperative pulmonary function tests undergoing video-assisted thoracic surgery. ⋯ Interleukin-6 and malondialdehyde increased over time in both groups (P<0.05); however, the magnitudes of increase were not different between the groups. Postoperatively there were no differences in the number of patients with PaO2/FiO2<300 mmHg or abnormalities on chest radiography. Protective ventilation did not provide advantages over conventional ventilation for video-assisted thoracic surgery in this group of patients with normal lung function.
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Anaesth Intensive Care · Sep 2012
Influence of major cardiopulmonary surgery on serum levels of procalcitonin and other inflammatory markers.
Procalcitonin is a marker of significant bacterial infection. With Food and Drug Administration approval of a new high-sensitive procalcitonin assay in the United States, we felt it would be important to assess its normal elevation and time characteristics, as compared to other inflammatory markers in patients undergoing routine cardiac surgery. This is a prospective observational study including consecutive patients after routine cardiac surgery. ⋯ In addition, mean and peak procalcitonin levels were significantly higher (P=0.004 and P=0.002 respectively) in the 60 patients with a complicated course. This study provides insights into 'normal' kinetics of a new high-sensitive procalcitonin assay after different types of cardiac surgery, and in patients with and without a complicated postoperative course. Our results suggest that using a single procalcitonin level to guide antibiotic therapy decisions during the early period after major cardiac surgery may not be useful and that monitoring its kinetic may be the preferred strategy.
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Anaesth Intensive Care · Sep 2012
Randomized Controlled TrialEffect of preoperative education on behaviour of children during induction of anaesthesia: a randomised clinical trial of efficacy.
In this randomised prospective study we aimed to evaluate whether preoperative anaesthetic education delivered to children on the day of surgery reduces anxiety behaviour during induction of anaesthesia. One hundred children, six to 15 years of age, undergoing general anaesthesia for ambulatory surgery were allocated at random to a preoperative education group (n=50) or a control group (n=50). The main outcomes were behaviour score, self-reporting of satisfaction score and identification of the stage when children felt most fearful. ⋯ Intravenous induction failed in nine out of 38 children in the intervention group (23.7%) compared to five out of 40 in the control group (12.5%). When intravenous induction failed, eight out of nine (89%) of the intervention group remained co-operative during gas induction compared to two out of five (40%) of the control group. Preoperative education delivered on the day of surgery did not reduce anxiety behaviour in children during intravenous induction of anaesthesia, but did reduce anxiety during subsequent inhalational induction.