Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2015
Minimum effective anaesthetic volume of 0.5% ropivacaine for ultrasound-guided popliteal sciatic nerve block in patients undergoing foot and ankle surgery: determination of ED50 and ED95.
Compared to nerve stimulation or classic paraesthesia techniques, ultrasound (US)-guided popliteal sciatic nerve block requires a smaller volume of local anaesthetic. The up-and-down method was used to determine the minimum effective anaesthetic volume of 0.5% ropivacaine necessary for US-guided popliteal sciatic nerve block to achieve successful surgical anaesthesia for foot and ankle surgery. The study included 32 patients receiving an US-guided popliteal sciatic nerve bock. ⋯ The success rates of sensory blockade of the tibial nerve and common peroneal nerve were 69% and 88%, respectively. The success rates of motor blockade of these nerves were 75% and 90%, respectively. The ED50 and ED95 of 0.5% ropivacaine for US-guided popliteal sciatic nerve block were 6 ml and 16 ml, respectively.
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Anaesth Intensive Care · Jan 2015
The time taken for the regional distribution of ventilation to stabilise: an investigation using electrical impedance tomography.
Electrical impedance tomography is a novel technology capable of quantifying ventilation distribution in the lung in real time during various therapeutic manoeuvres. The technique requires changes to the patient's position to place the electrical impedance tomography electrodes circumferentially around the thorax. The impact of these position changes on the time taken to stabilise the regional distribution of ventilation determined by electrical impedance tomography is unknown. ⋯ Left-right stabilisation was achieved after 15 minutes in Fowler's position and supine. A minimum of 15 minutes of stabilisation should be allowed for spontaneously breathing individuals when assessing ventilation distribution. This time allows stabilisation to occur in the anterior-posterior direction as well as the left-right direction.
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Anaesth Intensive Care · Jan 2015
Anaesthesia priorities for Australian and New Zealand medical school curricula: a Delphi consensus of academic anaesthetists.
The role of anaesthetists has expanded and evolved to include critical care, perioperative and pain medicine and general clinical skills, as well as operating theatre-based clinical anaesthesia. Across Australia and New Zealand, these topics are taught to varying degrees, however no uniform curriculum or standardisation exists between universities. ⋯ A range of appropriate content has been defined, as well as details relating to duration, timing, teaching environment, faculty, feedback and assessment methods. Future enquiry to assess the efficacy of future and current teaching practices is needed to facilitate continued improvement.
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Anaesth Intensive Care · Jan 2015
A retrospective survey of substance abuse in anaesthetists in Australia and New Zealand from 2004 to 2013.
A questionnaire on substance abuse was distributed electronically to the heads of 185 Australian and New Zealand College of Anaesthetists accredited anaesthesia departments in Australia and New Zealand. The response rate was 57%. From January 2004 to December 2013, 61 cases of substance abuse were identified, giving an estimated incidence of 1.2 cases per 1000 anaesthetist years. ⋯ Death was the eventual outcome in 18% overall, with a particularly high mortality associated with propofol abuse (45%). Trainee suicide from all causes was reported at three times the rate of specialists. The findings indicate that substance abuse remains a significant problem in Australia and New Zealand and is associated with a significant mortality rate.
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Anaesth Intensive Care · Jan 2015
The effect of mechanical ventilator settings during ventilator hyperinflation techniques: a bench-top analysis.
Ventilator hyperinflations are used by physiotherapists for the purpose of airway clearance in intensive care. There is limited data to guide the selection of mechanical ventilator modes and settings that may achieve desired flow patterns for ventilator hyperinflation. A mechanical ventilator was connected to two lung simulators and a respiratory mechanics monitor. ⋯ A greater proportion of VC-SIMV trials were ceased due to high peak inspiratory pressures (35%). However, VC-SIMV trials were more likely to be successful at meeting all three outcome measures (26 VC-SIMV trials, 7 PC-SIMV trials, 0 PSV trials). It was found that manipulation of settings in VC-SIMV mode appears more successful than PSV and PC-SIMV for ventilator hyperinflations.