Anaesthesia and intensive care
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Pethidine (meperidine) is a unique member of the opioid family. In addition to its analgesic activity, it also has significant local anaesthetic activity. ⋯ We describe the successful use of intrathecal pethidine 1 mg/kg for an elective lower segment caesarean section in a patient presumed to be allergic to amide local anaesthetics. There were no significant adverse effects in either the mother or the newborn.
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Anaesth Intensive Care · Jan 2013
The relationship between patient data and pooled clinical management decisions.
A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. ⋯ The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics in the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient data may have utility supporting clinicians' preoperative decisions.
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Anaesth Intensive Care · Jan 2013
The anaesthetic pre-admission clinic is effective in minimising surgical cancellation rates.
Pre-admission clinics (PAC) are now well-established in most hospitals. However, there have been few studies examining the efficacy of PACs in minimising day of surgery cancellations due to anaesthetic reasons. A retrospective cross-sectional descriptive study was carried out in a metropolitan tertiary hospital over a four-year period to assess reasons for anaesthetic-related day of surgery cancellations in elective surgical patients who attended the PAC. ⋯ Clinical disagreement between anaesthetic assessment at the PAC and the attending anaesthetist on the day of surgery was low (12 patients, 21%), and clinical deterioration in a pre-existing condition (six patients, 10%) accounted for the majority of other cancellations. Although patient misadventure constituted the major cause of anaesthetic cancellations, non-adherence to fasting and medication guidelines constituted the next major reason for surgery cancellation due to anaesthetic causes. This is important as such cancellations are potentially preventable and the overall cancellation rate could potentially be improved by instituting relatively simple changes to clinic function.