Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2011
Compliance with processes of care in intensive care units in Australia and New Zealand--a point prevalence study.
There are indications that compliance with routine clinical practices in intensive care units (ICU) varies widely internationally, but it is currently unknown whether this is the case throughout Australia and New Zealand. A one-day point prevalence study measured the prevalence of routine care processes being delivered in Australian and New Zealand ICUs including the assessment and/or management of: nutrition, pain, sedation, weaning from mechanical ventilation, head of bed elevation, deep venous thrombosis prophylaxis, stress ulcer prophylaxis, blood glucose, pressure areas and bowel action. Using a sample of 50 adult ICUs, prevalence data were collected for 662 patients with a median age of 65 years and a median Acute Physiology and Chronic Health Evaluation II score of 18. ⋯ Care components that were delivered more consistently included nutrition delivery (100%, IQR 100 to 100%), deep venous thrombosis (96%, IQR 89 to 100%) and stress ulcer (90%, IQR 78 to 100%) prophylaxis, and checking blood sugar levels (93%, IQR 88 to 100%). This point prevalence study demonstrated variability in the delivery of 'routine' cares in Australian and New Zealand ICUs. This may be driven in part by lack of consensus on what is best practice in intensive care units, prompting the need for further research in this area.
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Anaesth Intensive Care · Sep 2011
Randomized Controlled TrialProphylactic use of midazolam or propofol at the end of surgery may reduce the incidence of emergence agitation after sevoflurane anaesthesia.
Sevoflurane is associated with a high incidence of emergence agitation in children. Midazolam and propofol have been examined with the aim of reducing emergence agitation after sevoflurane anaesthesia. However the effect of both drugs on emergence agitation is still controversial. ⋯ The emergence time was prolonged for patients in groups M and P compared to group S. There was no significant difference in the incidence of emergence agitation or in emergence times between the groups P and M. We conclude that propofol or midazolam administration before the end of surgery may be effective in reducing the incidence of emergence agitation in children undergoing strabismus surgery under sevoflurane anaesthesia.
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Anaesth Intensive Care · Sep 2011
The association between intraoperative electroencephalogram-based measures and pain severity in the post-anaesthesia care unit.
This observational study aimed to identify simple electroencephalogram indices of inadequate intraoperative opioid-mediated nociceptive blockade and to compare these indices with routinely used clinical predictors of severe postoperative pain in adults. Intraoperative trend and waveform data (electrocardiogram, pulse oximetry and electroencephalogram) were collected, pain intensity in the post-anaesthesia care unit was quantified using an 11-point Verbal Rating Score, and opioid administration was recorded. ⋯ Fifty-two patients had moderate or severe pain (Verbal Rating Score > or = 5). State entropy was lower (46.5 +/- 2.9 vs 43.1 +/- 1.9, P = 0.04) and spindle-like activity higher (0.42 +/- 0.03 vs 0.50 +/- 0.02, P = 0.03) in the moderate/severe pain group. [corrected] These findings suggest that there is a modest association between electroencephalogram measures near the end of surgery and the severity of postoperative pain.