Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2016
Biography Historical ArticleThe etymology and use of the word 'anaesthesia' Oliver Wendell Holmes' letter to W. T. G. Morton.
Two published versions of a letter in which Oliver Wendell Holmes, MD, recommended the name anaesthesia were identified from publications supportive of the claims of W. T. G. ⋯ Holmes' letter to Morton was probably lost when a substantial part of a collection of Morton's papers was damaged during storage. There are no reported copies of Holmes's letter. The currently available information does not provide any assistance in determining the correct form of Holmes's letter.
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Anaesth Intensive Care · Jul 2016
Left ventricular diastolic dysfunction-an independent risk factor for weaning failure from mechanical ventilation.
The objective of this study was to investigate the contribution of left ventricular (LV) diastolic dysfunction to weaning failure, along with the levels of the currently used cardiac biomarkers. Forty-two mechanically ventilated patients, who fulfilled criteria for weaning from mechanical ventilation (MV), underwent a two-hour spontaneous breathing trial (SBT). Transthoracic echocardiography (TTE) was performed before the start of the SBT. ⋯ BNP levels on MV were lower in patients who successfully weaned compared to those who did not (361±523 ng/l versus 643±382 ng/l respectively, P=0.008). The presence of diastolic dysfunction was independently associated with weaning failure (odds ratio [OR] 11.23, confidence interval [CI] 1.16-109.1, P=0.037) followed by respiratory frequency/tidal volume (OR 1.05, CI 1.00-1.10, P=0.048). Therefore, assessment of LV diastolic function before the start of weaning could be useful to identify patients at risk of weaning failure.
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Anaesth Intensive Care · Jul 2016
Successful introduction of a daily checklist to enhance compliance with accepted standards of care in the medical intensive care unit.
We introduced a simple checklist to act as an aid to memory for our junior medical staff to ensure that every patient in the intensive care unit (ICU) received every appropriate element of a bundle of care every day. The checklist was developed in consultation with our junior doctors and was designed to be completed every morning for every patient by the junior doctor reviewing the patient. The completed checklist was then checked again by the attending intensivist on the main daily ward round to ensure all the appropriate elements of the checklist had been applied to the patient. ⋯ There was a decrease in the incidence of missed elements of the bundle of care the longer the patient stayed in the ICU. Types of missed elements varied with the duration of the ICU stay. We found that the introduction of a simple checklist, developed in collaboration with the junior medical staff who would be using the checklist every day in the ICU, resulted in the detection and correction of missed elements of a bundle of care we had previously introduced in the ICU.
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Anaesth Intensive Care · Jul 2016
Survey of anaesthetists' practice of sedation for gastrointestinal endoscopy.
We conducted a survey of Australian specialist anaesthetists about their practice of sedation for elective and emergency gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. A 24-item survey was emailed to 1,000 anaesthetists in August 2015. Responses were received from 409 anaesthetists (response rate=41%) with responses from 395 anaesthetists analysed. ⋯ Propofol was routinely administered by 99% of respondents for gastroscopy and 100% of respondents for ERCP and colonoscopy. A maximum depth of sedation in which patients were unresponsive to painful stimulation was targeted by the majority of respondents for all procedures except for elective gastroscopy. These results may be used to facilitate comparison of practice in Australia and overseas, and give an indication of compliance by Australian anaesthetists with the relevant Australian and New Zealand College of Anaesthetists guideline.
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Anaesth Intensive Care · Jul 2016
Historical ArticleA personal history of the MASTER Trial and its link to the clinical trials network of the Australian and New Zealand College of Anaesthetists.
The aim of this paper is to link the history of the Multicentre Australian Study of Epidural Anaesthesia in high risk surgery, the MASTER Trial, the first National Health and Medical Research Council (NHMRC) funded multicentre randomised clinical trial in Australia led by anaesthetist researchers, and the decision of The Australian and New Zealand College of Anaesthetists (ANZCA) to establish a clinical trials network, in 2003, to the success of contemporary researchers in Australia and New Zealand in anaesthesia and perioperative medicine.