Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2013
Randomized Controlled TrialEffect of an anaesthesia information video on preoperative maternal anxiety and postoperative satisfaction in elective caesarean section: a prospective randomised trial.
Video-based patient information supplementing clinician interview has been shown to reduce anxiety and improve satisfaction in patients undergoing procedures. In Queensland more than 90% of caesarean sections are performed under regional anaesthesia. We aimed to assess the effect of using an information video about neuraxial blockade in patients having regional anaesthesia for elective caesarean section. ⋯ There was no difference in anxiety score (41.2 versus 39.8, P=0.50), maternal satisfaction score (118.5 versus 122.7, P=0.22) or interview duration (16.3 versus 15.8 min, P=0.69) between the two groups. The use of an anaesthesia information video does not reduce preoperative anxiety or increase the duration of the anaesthetic interview. Maternal satisfaction with neuraxial blockade for elective caesarean is high and not improved by an anaesthesia information video.
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Anaesth Intensive Care · Nov 2013
ReviewVeterinary and human anaesthesia: an overview of some parallels and contrasts.
The history of human and veterinary anaesthesia is both intertwined and parallel. Physicians and anaesthetists often first experimented on animals and developments from human anaesthesia have been incorporated into veterinary medicine. Within veterinary medicine, anaesthesia is a specialty discipline as it is in human medicine. ⋯ Furthermore, some agents, particularly alpha-2 adrenoreceptor agonists and ketamine, are used very widely in veterinary practice. Also in contrast to most human anaesthesia, in large animal and exotic animal practice the patients can present a physical danger to the anaesthetist. The most notable contrast between human and veterinary anaesthesia is in the reported perioperative complication and mortality rates, with a species dependent perianaesthetic mortality of up to 2% in dogs, cats and horses and greater than 2% in guinea pigs and birds, which is up to 100-fold higher than in human anaesthesia.
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Anaesth Intensive Care · Nov 2013
Incidence of inferior vena cava thrombosis detected by transthoracic echocardiography in the immediate postoperative period after adult cardiac and general surgery.
Venous thromboembolism is an important complication after general and cardiac surgery. Using transthoracic echocardiography, this study assessed the incidence of inferior vena cava (IVC) thrombosis among a total of 395 and 289 cardiac surgical and major surgical patients in the immediate postoperative period after cardiac and major surgery, respectively. All transthoracic echocardiography was performed by a specialist intensivist within 24 hours after surgery with special emphasis on using the subcostal view in the supine position to visualise the IVC. ⋯ In summary, visualisation of the IVC was feasible in most patients in the immediate postoperative period after both adult cardiac and major surgery. IVC thrombosis appeared to be more common after adult cardiac surgery than general surgery. A large prospective cohort study is needed to define the risk factors for IVC thrombus and whether early thromboprophylaxis can reduce the incidence of IVC thrombus after adult cardiac surgery.
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Anaesth Intensive Care · Nov 2013
Assessment of the plethysmographic variability index as a predictor of fluid responsiveness in critically ill patients: a pilot study.
Optimising intravascular volume in patients with hypotension requiring vasopressor support is a key challenge of critical care medicine. The optimal haemodynamic parameter to assess fluid responsiveness in critically ill patients, particularly those requiring a noradrenaline infusion and mechanical ventilation, remains uncertain. This pilot study assessed the accuracy of the plethysmographic variability index (PVI), (Radical-7 pulse co-oximeter, Masimo®, Irvine, CA, USA) in predicting fluid responsiveness in 25 patients who required noradrenaline infusion to maintain mean arterial pressure over 65 mmHg and were mechanically ventilated with a 'lung-protective' strategy, and whether administering a fluid bolus was associated with a change in PVI (Δ PVI). ⋯ As static haemodynamic parameters, PVI, central venous pressure and inferior vena cava distensibility index were all inaccurate at predicting volume responsiveness with PVI being the least accurate (area under the receiver operating characteristic curve=0.41, 95% confidence interval 0.18 to 0.65). However, fluid responsiveness was associated with a change in PVI, but not a change in heart rate or central venous pressure. This association between Δ PVI and fluid responsiveness may be a surrogate marker of improved cardiac output following a fluid bolus and warrants further investigation.
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Anaesth Intensive Care · Nov 2013
Case ReportsUtility of thromboelastography in managing acquired Factor VIII inhibitor associated massive haemorrhage.
Disorders of clotting and coagulation are common in the intensive care unit. Diagnosis, treatment and monitoring of these disorders are traditionally based on conventional coagulation tests such as activated partial thromboplastin time (APTT) and international normalised ratio (INR). We present here a patient who developed massive postoperative haemorrhage secondary to an acquired factor VIII inhibitor. The case highlights the utility and sensitivity of thromboelastography (TEG) in the diagnosis of the condition and monitoring the response to therapy.