Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2014
An assessment of two Doppler-based monitors to track cardiac output changes in anaesthetised patients undergoing major surgery.
Minimally-invasive cardiac output (CO) monitoring to follow changes in CO would be helpful in anaesthesia practice. Two Doppler systems marketed for this purpose include the CardioQ (Deltex Medical Group, Chichester, United Kingdom), which uses an oesophageal probe, and the USCOM (USCOM Ltd., Sydney, NSW, Australia), which uses a hand-held probe. The aim of the study was to assess the ability of these two methods to track CO during major surgery and to determine their relationship. ⋯ Regression line data supported the hypothesis that CardioQ under-reads at low CO and over-reads at high CO in respect to the USCOM. However, the precision between the two CO readings was poor with wide limits of agreement and a percentage error of ± 37%. These findings indicate that these devices individually track changes in CO in many patients but cannot be relied upon to provide the same values.
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Anaesth Intensive Care · Sep 2014
Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals.
Evidence-based choices of volatile agents can increase health cost efficiencies. In this pharmaco-economic study, we evaluated the trends and costs of volatile agent use in Australian public hospitals. The total number of volatile agent (isoflurane, sevoflurane and desflurane) bottles ordered and inflation-adjusted costs were collected from 65 Victorian public hospitals from 2005 to 2011. ⋯ Bottles of desflurane increased by 726/year (99% CI: 288 to 1,164); costs increased by $171,578/year (99% CI: $136,951 to $206,205). The amount of calculated greenhouse gas emissions released into the atmosphere over this period was 37,000 tonnes of carbon dioxide equivalents, with isoflurane contributing 6%, sevoflurane 17%, and desflurane 77% of this total. In conclusion, isoflurane is no longer being used in the majority of Victorian public hospitals, with sevoflurane and desflurane remaining as the primary volatile agents, utilised respectively at a ratio of 2.2 to 1, and costs at 0.8 to 1.