Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2011
Comparative StudyComparison of predicted and perceived pain from epidural and spinal puncture in patients undergoing elective caesarean section.
The intensity of pain expected by patients before an epidural and/or a spinal puncture is uncertain. The main purpose of this study was to identify and compare the intensity of pain predicted and perceived by patients having an epidural and a spinal procedure. After screening for relevant exclusion criteria, 50 women who were undergoing elective caesarean section under combined spinal-epidural anaesthesia (double-segment technique) were enrolled in the study. ⋯ Predicted pain for epidural and spinal insertion (epidural 60.6 +/- 20.5 mm, spinal: 55.1 +/- 24 mm) was significantly higher than the pain perceived (epidural 36.3 +/- 20 mm, spinal 46.1 +/- 23.2 mm) (epidural P < 0.001, spinal P = 0.031). Patients who were scheduled for an elective caesarean section under combined spinal-epidural anaesthesia predicted 1.2- to 1.7-fold stronger pain intensity than they perceived during the procedure. Patients should be informed that a regional anaesthetic, especially epidural, procedure is often less painful than the patient's expectation.
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Anaesth Intensive Care · Jul 2011
Case ReportsIntraoperative thrombolysis in a patient with cardiopulmonary arrest undergoing caesarean delivery.
Thromboembolic events during pregnancy remain a major cause of morbidity and mortality with possible catastrophic sequelae for the patient. The decision whether to use high-risk therapeutic thrombolytics during pregnancy or perinatally is complicated and many considerations pertain. We report on the thrombolytic management of a 34-year-old woman who had an asystolic cardiac arrest secondary to massive pulmonary embolism while undergoing emergency caesarean delivery. ⋯ Return of spontaneous circulation was accompanied by massive uterine bleeding. Instead of performing a postpartum hysterectomy, the uterus was preserved through continuous manual pressure and packing for four hours by the obstetric team until haemostasis was achieved. The patient survived and was later discharged without any major neurological deficit.
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Anaesth Intensive Care · Jul 2011
Case ReportsFailure to ventilate with supraglottic airways after drowning.
We report the failure of an i-gel and an Ambu AuraOnce supraglottic airway to ventilate a drowning victim. Failure was attributed to changes in lung physiology following submersion and inhalation of water that may have required ventilation pressures up to 40 cmH2O to treat the victim's hypoxaemia. The ease of use and rapid insertion of supraglottic airways without interrupting cardiac compression has prompted recommendations for their use during resuscitation. The relatively low leak pressures attainable from many supraglottic airways, however may cause inadequate lung ventilation and entrainment of air into the stomach when these devices are used in drowning victims.
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Anaesth Intensive Care · Jul 2011
Changing patterns in endotracheal intubation for anaesthesia trainees: a retrospective analysis of 80,000 cases over 10 years.
Several overseas studies have suggested that opportunities for anaesthesia trainees to learn and practise endotracheal intubation have decreased over time. We analysed the operating theatre data collection system at a large Australian metropolitan teaching hospital from 1998 to 2008 to determine if numbers for trainees' caseloads in general, and endotracheal intubation in particular had changed. The total caseload per trainee of approximately 800 cases per year was stable throughout the study period. ⋯ The mean number of endotracheal intubations per trainee per year fell by 10% and of supraglottic devices by 16%, neither of which was statistically significant. Endotracheal intubation for caesarean sections did however fall significantly from an average of nine to an average of six cases per trainee per year. Our findings contrast with other reports of much larger decreases in the number of endotracheal intubations performed by trainees over the last decade, but suggest that our local practice is similar to the international experience of decreasing opportunities for endotracheal intubation in obstetric anaesthesia.
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Anaesth Intensive Care · Jul 2011
Biography Historical ArticleWilliam Russ Pugh's remarkable life: natural scientist, innovative anaesthetist and founding member of the Royal Society of Tasmania.
While well known in anaesthetic circles for being the first to provide ether anaesthesia for a surgical procedure in June 1847 in Launceston, Tasmania, William Russ Pugh's achievements in the field of natural history are less well known. He personally assisted Count Peter de Strzelecki in the chemical analysis of Australian coal and mineral samples and provided the laboratory space and equipment. His analytic skills were utilised by coroners in cases of poisoning. ⋯ He was a founding member of the Tasmanian Society and subsequently of the Royal Society of Tasmania. He made many presentations on geology, zoology, botany, mineralogy and meteorology to meetings of both Societies. These scientific interests may have provided the knowledge and motivation which encouraged Pugh to proceed so confidently with the introduction of ether anaesthesia.