Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2017
Review Case ReportsDelivery of anoxic gas mixtures in anaesthesia: case report and review of the struggle towards safer standards of care.
In 1983 a patient at The Alfred Hospital, Melbourne died during general anaesthesia for emergency surgery, in the weeks following maintenance to the operating theatre gas supply. In the ensuing investigation, it was revealed that he had been given 100% nitrous oxide throughout the anaesthetic due to the inadvertent crossing of the nitrous oxide and oxygen pipelines during the repair work. In this article we review the published literature on the delivery of hypoxic and anoxic gas mixtures, and the associated morbidity and mortality. ⋯ We consider the risks to patient safety when technological advances outpaced the implementation of essential safety standards. We investigate the events that pushed the development of safer standards of anaesthetic practice and patient monitoring, which have contributed to modern day theatre practice. Finally, we consider the risks that still exist in the hospital environment, and the need for on-going vigilance.
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Anaesth Intensive Care · Mar 2017
Randomized Controlled TrialValidation of a difficult endotracheal intubation simulator designed for use in anaesthesia training.
There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. ⋯ The time for the novice and intermediate groups improved significantly by the fourth attempt, novice 15 seconds (CI 5.4, 24.6, P=0.002) and intermediate 10 seconds (CI 1.0, 19.0, P=0.03). Other aspects of validity were also satisfied during this study. A high degree of validity was established for these modifications, which can be retrofitted to an existing manikin and then used for teaching or assessment.
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Anaesth Intensive Care · Mar 2017
A clinical audit to assess the efficacy of the Coolsense® Pain Numbing Applicator for intravenous cannulation in children.
The Coolsense® device is a topical applicator that is used to anaesthetise the skin before a painful procedure. It is a handheld device with a temperature-controlled head that acts on application, without chemicals, to cool and anaesthetise the site of injection. This prospective observational audit of 100 children and adolescents aged six to 18 years studied the analgesic efficacy and patient and carer satisfaction rating of the device during intravenous cannulation and complications arising from its use. ⋯ The incidence of complications using the device was low. The Coolsense device appears to be a useful tool that provides effective analgesia for intravenous cannulation in children with minimal complications. Comparative studies with topical local anaesthesia creams are warranted.
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Anaesth Intensive Care · Mar 2017
Case ReportsBuprenorphine-related complications in elderly hospitalised patients: a case series.
We report a case series of buprenorphine-related respiratory and neurological depression in opioid-naïve elderly hospitalised patients who received buprenorphine for acute pain management at our institution over a 24-month period. All six patients had risk factors for respiratory depression such as advanced age, concurrent comorbidities, or the ingestion of other potential central nervous system depressants. All patients required escalation of management with additional monitoring, with some transferred to a high dependency or intensive care unit. ⋯ Difficulties with buprenorphine's reversal using naloxone are described. We recommend additional caution when considering buprenorphine for acute pain management in elderly opioid-naïve patients, especially if they have comorbidities or are taking other central nervous system depressants. When buprenorphine is used in patients with risk factors, we recommend additional monitoring and education about potential adverse respiratory effects and their management.