Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2014
Central venous oxygen saturation during high-risk general surgical procedures-relationship to complications and clinical outcomes.
Major non-cardiac surgery is associated with postoperative morbidity, and perioperative central venous oxygen saturation (ScvO2) may be a predictor of morbidity. This pilot study aimed to define intraoperative ScvO2 and to identify factors associated with postoperative complications. ScvO2 (reflection spectrophotometry) was recorded continuously in a convenience sample of adults undergoing high-risk general surgery. ⋯ Hospital length-of-stay (P >0.0001), time ScvO2 >90% (P=0.003), surgery duration (P=0.005) and blood loss (P=0.02) were correlated with the number of complications. Using multivariate analysis, surgery duration (odds ratio 1.008 [95% confidence interval 1.002 to 1.013]; P=0.006) and change in oxygen extraction ratio (O2ER) at the end of surgery compared to the beginning (odds ratio 1.13 [95% confidence interval 1.001 to 1.28]; P=0.04) were independently associated with complications. The surgery duration and an increased O2ER are factors related to the development of postoperative complications.
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Anaesth Intensive Care · Jan 2014
Case ReportsPituitary apoplexy with reversible cerebral vasoconstrictive syndrome after spinal anaesthesia for emergency caesarean section: an uncommon cause for postpartum headache.
Pituitary apoplexy is a rare condition involving pituitary necrosis following either pituitary haemorrhage or infarction. Similarly, reversible cerebral vasoconstrictive syndrome is a cerebrovascular disorder characterised by diffuse, multifocal narrowing of cerebral arteries. ⋯ We report the case of a patient who developed pituitary apoplexy during an emergency caesarean section under spinal anaesthesia. It was further complicated by the development of reversible cerebral vasoconstriction syndrome and stroke.
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Anaesth Intensive Care · Jan 2014
Clarifying the role of activated charcoal filters in preparing an anaesthetic workstation for malignant hyperthermia-susceptible patients.
Malignant hyperthermia (MH) is a life-threatening condition caused by exposure of susceptible individuals to volatile anaesthetics or suxamethonium. MH-susceptible individuals must avoid exposure to these drugs, so accurate and reproducible processes to remove residual anaesthetic agents from anaesthetic workstations are required. Activated charcoal filters (ACFs) have been used for this purpose. ⋯ We found that placement of filters in an unprepared, saturated circuit was insufficient to safely prepare an anaesthetic workstation. Following flushing of the anaesthetic workstation with high-flow oxygen for 90 seconds, a circuit and soda lime canister change and the placement of an ACF on the inspiratory limb, we were able to safely prepare a workstation in less than three minutes. A single filter on the inspiratory limb was able to maintain a clean circuit for 12 hours, with gas flows dropped from 10 lpm to 3 lpm after 90 minutes or removal of the filter after 90 minutes if high gas flows were maintained.
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Anaesth Intensive Care · Jan 2014
Observational StudyTime to get comfortable with a labour epidural.
Women frequently request regional analgesia during labour, yet little is known about how long it takes before they become comfortable. This prospective observational study aimed to determine various time-points following maternal request for regional analgesia in labour until comfort was achieved. It was conducted in two tertiary referral centres for maternity care in Australia between December 2009 and May 2010. ⋯ Median interquartile range times observed were: maternal request to anaesthetist arrival: 20 (10 to 35) minutes; anaesthetist arrival to maternal comfort: 40 (30 to 50) minutes; and total time from request to comfort: 65 (50 to 85) minutes. We have shown that approximately one hour is required for a mother to achieve comfort following her request for epidural analgesia during labour. Our findings are likely to provide useful information for antenatal education, enhance informed consent and improve the provision of anaesthetic services for labour analgesia.