Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2013
Phenytoin loading doses in adult critical care patients: does current practice achieve adequate drug levels?
Phenytoin is regularly employed in the critically ill for prophylaxis against or treatment of seizure disorders. No prior studies have examined current dosing practices in an Australasian intensive care unit (ICU) setting. The aims of this study were to: a) describe the adequacy of contemporary dosing in respect to free and total serum phenytoin concentrations; b) identify factors associated with therapeutic drug concentrations; and c) examine the accuracy of predictive equations that estimate free concentrations in this setting. ⋯ Twenty-six patients (49%) had suboptimal trough free concentrations, although this subgroup was significantly heavier and therefore received a lower per kilogram dose (12.8 [3.1] vs 16.3 [3.4] mg/kg, P=0.001). In multivariate analysis, larger weight adjusted doses (P=0.018), higher albumin concentration (P=0.034) and receiving phenytoin for an indication other than seizure (P=0.035), were associated with a greater likelihood of adequate concentrations. In conclusion, phenytoin dosing remains complex in critically ill patients, although lower per kilogram loading doses are strongly associated with free concentrations below the desired target.
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Anaesth Intensive Care · Sep 2013
Home blood pressure monitoring in an anaesthetic pre-admission clinic.
We suspected that many high blood pressure measurements taken in our anaesthetic pre-assessment clinic and immediately prior to induction of anaesthesia were unusually elevated due to a 'white coat' effect. These high blood pressure measurements were causing late cancellations of surgery, even though white coat measurements may not be representative of the patient's usual blood pressure or of their risk of end-organ damage due to hypertension. In this audit, patients with high blood pressure in our pre-admission clinic were provided with training and a home blood pressure monitor to use prior to surgery. ⋯ A total of 33% of general practice clinic measurements were also ≥ 20 mmHg higher than average home measurements. White coat hypertension was common in our audit population. Relying on average home blood pressure measurements rather than 'one off' in-hospital measurements may have helped to prevent the postponement or cancellation of surgery for 13 patients who had recorded blood pressure ≥ 180/110 mmHg in our pre-admission clinic.
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Anaesth Intensive Care · Sep 2013
Historical ArticlePioneering paediatric intensive care medicine in New Zealand.
The origin of New Zealand's paediatric intensive care medicine lay in the formal establishment of Auckland Hospital's Central Respiratory Unit within the hospital's Infectious Diseases Unit (December 1958). It was initially established for the care of critically ill children, chiefly with airway and respiratory disorders or tetanus. Senior Specialist Anaesthetist Matthew Spence soon took charge, his first annual report (1960) briefly describing six children among 19 admissions and another six consulted on elsewhere. ⋯ Dr James Judson computerised record-keeping from 1984 and developed a large database, containing details of children with numbers approaching 2000. At the end of 1991, the (now) Department of Critical Care Medicine completed its paediatric role over three decades, with care of children passing to a paediatric intensive care unit in the new Auckland paediatric hospital (soon to be called "Starship"). Regional intensive care units still make a substantial contribution to paediatric intensive care countrywide.