Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2014
Inter-rater reliability of the ASA physical status classification in a sample of anaesthetists in Western Australia.
The American Society of Anesthesiologists (ASA) scale is a widely used six-point ordinal scale that allows anaesthetists to assign a risk score to each patient scheduled for anaesthesia. Earlier studies of inter-rater reliability in assigning ASA physical status classifications to a standard set of patient descriptions have shown modest agreement. We surveyed 401 anaesthetists practising in Western Australia using descriptions of clinical history, physical examination and investigation results of ten hypothetical adult patients, pre-designed by other researchers, to have ASA class ranging 1 through 5. ⋯ Correctly identifying ASA class was not related to age, level of training, sex or training region. We found only fair agreement among anaesthetists in assigning ASA class to ten fictitious patients, which was no better than that observed in earlier studies. Further, the range of scores assigned to standard patients' histories by anaesthetists supports earlier concerns about the robustness of this classification.
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Anaesth Intensive Care · Sep 2014
Predicting patients at risk of early postoperative adverse events.
Adverse events after surgery are common. Identification of markers of at-risk patients may facilitate efficient and effective perioperative resource allocation. This pilot study aimed to identify simple preoperative factors associated with postoperative adverse events. ⋯ Areas under receiver operating characteristic curves ranged from 0.63 to 0.80. Patients with adverse events in the post-anaesthesia care unit appeared to have a higher risk of intervention in postoperative wards from a medical emergency or intensive care unit team. Our preliminary findings suggest that preoperative identification of key factors may have utility in determining risk of early postoperative problems and hence, aid perioperative planning.
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A clinician's perspective on the first 20 years of the Australian and New Zealand Intensive Care Society Clinical Trials Group and its influence on intensive care clinical practice over this same time period. This point of view discusses the importance of the Clinical Trials Group and the significance of several major published research trials.
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Anaesth Intensive Care · Sep 2014
Lateral cutaneous femoral nerve blockade-limited skin incision coverage in hip arthroplasty.
This paper seeks to assess the potential use of blocking the lateral cutaneous femoral nerve (LCN) for patients undergoing hip surgery. In this study, ultrasound guidance was used to specifically block the LCN using a small volume of local anaesthetic in 20 healthy volunteer anaesthetists. An orthopaedic surgeon then drew lines on the volunteers reflecting three common cutaneous incision lines (anterolateral, lateral, and posterior approach) for hip arthroplasty using an ultraviolet reflecting pen invisible in normal lighting. ⋯ Of the remaining incision lines drawn, most were less than half covered by LCN blockade with only three lines more than 50% covered and none more than 75% covered. The skin anaesthesia produced by LCN blockade was usually anterior and inferior to the surgical lines marked. This significant lack of overlap between common hip arthroplasty incision lines and the anaesthesia produced by blockade of the lateral cutaneous femoral nerve draws into question the utility of this block for hip surgery.