Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2013
ReviewInterventional neuroradiological procedures-a review for anaesthetists.
Interventional neuroradiology is a rapidly expanding field, and the complexity and duration of these procedures makes anaesthetic support essential to their success. Such has been the development in this area, that the American Heart Association has published a scientific statement on the indications for these procedures. ⋯ This article will cover the management of intracranial aneurysms, cerebral vasospasm following intracranial haemorrhage, intracranial and spinal arteriovenous malformations, idiopathic intracranial hypertension, carotid artery stenting, intra-arterial thrombolysis for stroke and endovascular treatment of intracranial atherosclerosis. Protection from ionising radiation and acute kidney injury are also discussed.
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Anaesth Intensive Care · Mar 2013
Simulation training for rare medications in the intensive care unit-a study with bivalirudin.
The purpose of this study was to assess whether simulation training can improve the clinician's ability to predict the effect of bivalirudin infusion. Six clinicians with experience using bivalirudin and six without experience (Groups Exp and NoExp) entered predictions for partial thromboplastin time while viewing a running display of clinical data obtained retrospectively from intensive care unit patients who had received bivalirudin infusion after cardiac surgery. All clinicians entered guesses for the same sequence of 30 patients. ⋯ The guessing-errors of Group NoExp were significantly higher than Group Exp in the first and second terciles, with no significant difference in the third tercile. Linear regression indicated a significantly steeper learning curve in Group NoExp than Exp. Brief simulation training using retrospective patient data improved the ability of inexperienced clinicians to predict the effect of bivalirudin as compared to experienced clinicians.
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Anaesth Intensive Care · Mar 2013
The patient inflating valve in anaesthesia and resuscitation breathing systems.
Patient inflating valves combined with self-inflating bags are known to all anaesthetists as resuscitation devices and are familiar as components of draw-over anaesthesia systems. Their variants are also commonplace in transfer and home ventilators. However, the many variations in structure and function have led to difficulties in their optimal use, definition and classification. ⋯ Two new alternatives, the Fenton and Diamedica valves, offer the benefits of location away from the patient while retaining a small functional dead space. They also offer the potential for greater use of hybrid continuous flow/draw-over systems that can operate close to atmospheric pressure. The reliable application of positive end-expiratory pressure/continuous positive airway pressure remains a challenge.