Anaesthesia and intensive care
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Anaesth Intensive Care · May 2014
Case ReportsPlatypnoea-orthodeoxia syndrome post laparoscopic surgery in a patient with a patent foramen ovale.
Platypnoea-orthodeoxia syndrome has the pathognomonic clinical findings of dyspnoea and arterial hypoxaemia relieved by recumbency. We report on a patient who presented with platypnoea-orthodeoxia syndrome post laparoscopic surgery. Platypnoea-orthodeoxia syndrome is an important diagnosis to consider when investigating hypoxia without an obvious cause.
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Anaesth Intensive Care · May 2014
Determinants of the relationship between cost and survival time after elective adult cardiac surgery.
Cardiac surgery is increasingly performed on elderly patients with multiple comorbid conditions, but the determinants of the relationship between cost and survival time after cardiac surgery for patients with a serious cardiac condition remain uncertain. Using the long-term outcome data of a cohort study on adult cardiac surgical patients, the relationship between cost and survival time after cardiac surgery from a hospital service perspective was determined. The total cost for each patient was estimated by the costs of the surgical procedures, intra-aortic balloon pump utilisation, operating theatre utilisation, blood products, intensive care unit stay and cumulative hospital stay up to a median follow-up time of 30 months. ⋯ Age, Charlson Comorbidity Index and EuroSCORE were all related to the cost per life-year after cardiac surgery, but EuroSCORE (odds ratio 1.26 per score increment, 95% confidence interval 1.18 to 1.35, P=0.001) was, by far, the most important determinant and explained 32% of the variability in cost per life-year after cardiac surgery. Patients with a high EuroSCORE were associated with a substantially longer length of intensive care unit stay and cumulative hospital stay, as well as a shorter survival time after cardiac surgery compared to patients with a lower EuroSCORE. Of all the subgroups of patients examined, only patients with a EuroSCORE >5 were consistently associated with a cost >A$100,000 per life-year (cost per life-year $183,148, 95% confidence interval 125, 394 to 240, 902).
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Anaesth Intensive Care · May 2014
Hybrid measurement to achieve satisfactory precision in perioperative cardiac output monitoring.
Advanced haemodynamic monitoring employing minimally invasive cardiac output measurement may lead to significant improvements in patient outcomes in major surgery. However, the precision (scatter) of measurement of available generic technologies has been shown to be unsatisfactory with percentage error of agreement with bolus thermodilution (% error) of 40% to 50%. Simultaneous measurement and averaging by two or more technologies may reduce random measurement scatter and improve precision. ⋯ Due to poor inherent precision of QtFT (% error 82.8), hybrid combination of QtFT with QtCO2 did not result in better precision than QtCO2 alone. Hybrid measurement can approach a 30% error, which is recommended as the upper limit for acceptability. This is a practical option where at least one component method, such as Capnotracking, is automated and does not increase the cost or complexity of the measurement process.
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Simulation has been advocated as a useful training tool, and specific manikin simulators have been developed for use in this role. Debriefing and repetition have been identified as key to achieving educational goals and, while the technical features of manikin simulators can influence simulation outcomes, their cost and infrastructure requirements reduce their suitability for smaller healthcare facilities. ⋯ This was effective in running high-fidelity, team-based in situ simulations and 'can't intubate, can't oxygenate' assessments for anaesthetic trainees. Though equipment in other centres may differ both in availability or suitability for simulation, the option we describe or similar may offer a low-cost solution for peripheral centres to run limited high-fidelity scenarios on a regular basis.
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Anaesth Intensive Care · May 2014
Effect of magnetic resonance imaging on core body temperature in anaesthetised children.
Children undergoing magnetic resonance imaging (MRI) often require general anaesthesia (GA). Children under GA are at risk of decreases in body temperature. This risk may be greater during MRI due to MRI scanners requiring cool ambient temperatures. ⋯ The mean (± standard deviation) pre-scan temperature was 36.2°C±0.5°C, and the mean (± standard deviation) post-scan temperature was 35.9°C±0.6°C (an overall mean temperature decrease of 0.28°C was observed [95% confidence interval, -0.36°C to -0.19°C], P <0.001). In conclusion, core body temperature was found to decrease slightly during an MRI scan under GA. These results suggest that more focus is needed regarding the cooling effects of GA agents during MRI, as opposed to the heating effects of the MRI scanner.