Anaesthesia and intensive care
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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
Anaesthesia-related haemodynamic complications in Williams syndrome patients: A review of one institution's experience.
Williams syndrome is a genetic disorder associated with cardiac pathology, including supravalvular aortic stenosis and coronary artery stenosis. Sudden cardiac death has been reported in the perioperative period and attributed to cardiovascular pathology. In this retrospective audit, case note and anaesthetic records were reviewed for all confirmed Williams syndrome patients who had received an anaesthetic in our institution between July 1974 and November 2009. ⋯ Twelve of the anaesthetics (11.1%) were associated with cardiac complications including cardiac arrest in two cases (1.85%). Of the two cardiac arrests, one patient died within the first 24 hours postanaesthetic and the other patient survived, giving an overall mortality of 0.9% (3.4%). We conclude that Williams syndrome confers a significant anaesthetic risk, which should be recognised and considered by clinicians planning procedures requiring general anaesthesia.
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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.
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Anaesth Intensive Care · Sep 2014
Sodium concentration in urine greater than in the plasma: possible biomarker of normal renal function and better outcome in critically ill patients.
Correct interpretation of the urinary sodium concentration (NaU) and its relation to renal function in critically ill patients is lacking. Our aim was to evaluate the relationship between simultaneous NaU value and serum creatinine (sCr). The hypothesis is that a NaU value greater than 140 mmol/l (normal equivalent value in plasma) is only found in patients with normal sCr. ⋯ NaU greater than normal plasma sodium is a possible biomarker of normal/improving renal function and also of better outcome. Sole NaU values below 140 mmol/l are difficult to interpret but it is possible that very low NaU values may signify some threat to normal kidney function and worse prognosis even in the presence of normal sCr. Our way to interpret NaU values in critically ill patients needs further careful evaluation.