Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2010
Comparative StudyPharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis.
With continuously increasing expenditure on health care resources, various cost containment strategies have been suggested in regard to controlling the cost of inhalational anaesthetic agents. We performed a cost identification analysis assessing inhalational anaesthetic agent expenditure at a tertiary level hospital, along with an evaluation of strategies to contain the cost of these agents. The number of bottles of isoflurane, sevoflurane and desflurane used during the financial years 1997 to 2007 was retrospectively determined and the acquisition costs and cumulative drug expenditure calculated. ⋯ Pharmacoeconomic modelling demonstrated that sevoflurane at 2 l/minute costs 19 times more than isoflurane at 0.5 l/minute. For the financial years 1997 to 2007, we found a progressive shift from the cheaper isoflurane to the more expensive agents, sevoflurane and desflurane, a shift associated with marked increases in costs. Low flow anaesthesia with isoflurane is one strategy to reduce costs.
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Anaesth Intensive Care · Sep 2010
Comparative StudyA prospective comparison between written examination and either simulation-based or oral viva examination of intensive care trainees' procedural skills.
We compared results of written assessment of intensive care trainees' procedural skills with results obtained from one of two live assessment formats for the purposes of assessing the concurrent validity of the different test methods. Forty-five Australasian senior trainees in intensive care medicine completed a written test relating to a procedural skill, as well as either a simulation format or oral viva assessment on the same procedural skill. We analysed correlation between written exam results and results obtained from simulation format or oral viva assessment. ⋯ The lack of correlation between exam formats supports multi-modal assessment, as currently it is not known which format best represents workplace performance. Correlation between written and oral viva results may indicate redundancy between those test formats, whereas limited correlation between simulation and written exams may support the use of both formats as part of an integrated assessment strategy. We hypothesise that identification of critical candidate errors in a simulation format exam that were not exposed in a written exam may indicate better predictive validity for simulation format examination of procedural skills.
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Anaesth Intensive Care · Sep 2010
Case ReportsAcute subdural haematoma in the presence of an intrathecal catheter placed for the prevention of post-dural puncture headache.
A 31-year-old term primigravid woman had an intrathecal catheter placed following a dural puncture during attempted epidural analgesia during labour. After 23 hours she developed sudden loss of consciousness and an urgent brain computed tomography scan demonstrated a large left hyper-acute subdural haematoma. ⋯ Although subdural haematoma is a recognised complication of dural puncture, it has not been reported in the presence of an intrathecal catheter. An intrathecal catheter may not always prevent cerebrospinal fluid efflux, so subdural haematoma remains a potential complication of inadvertent dural puncture.
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Anaesth Intensive Care · Sep 2010
Case ReportsUltrasound-guided bilateral superior laryngeal nerve block to aid awake endotracheal intubation in a patient with cervical spine disease for emergency surgery.
Ultrasound has been widely used to locate nerves for various nerve blocks. The potential advantages of using ultrasound imaging for nerve blocks include reduction in the amount of local anaesthetic required, improved success rate, reduced time to perform the block and reduced complication rate. We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibreoptic intubation in a patient presenting for emergency surgery on the cervical spine.
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Anaesth Intensive Care · Sep 2010
Risk factors and outcomes of high-dependency patients requiring intensive care unit admission: a nested case-control study.
Intermediate-care or high-dependency units can provide a level of care that lies between the intensive care unit (ICU) and general ward, but the patients who are most likely to benefit from such level of care remains uncertain. This nested case-control study assessed the incidence and risk factors of high-dependency patients requiring ICU admission and whether these admissions were associated with a worse outcome when compared to other emergency ICU admissions. Seventy-seven consecutive high-dependency patients requiring ICU admission (cases) were compared with 77 patients who did not require ICU admission (controls) and also 928 emergency ICU admissions from other areas. ⋯ High-dependency admissions from the ward (odds ratio 4.46, 95% confidence interval 1.55 to 12.78) or emergency department (odds ratio 4.48, 95% confidence interval 1.54 to 13.0) and a need for concurrent non-invasive ventilation, inotrope infusion and acute kidney injury (odds ratio 14.90, 95% confidence interval 3.79 to 58.3) was associated with a higher risk of ICU admission. Hospital mortality of the high-dependency patients requiring ICU admission was not significantly different from other emergency ICU admissions (odds ratio 1.08, 95% confidence interval 0.55 to 2.11). In summary, high-dependency patients requiring ICU admission were uncommon unless they had multi-organ failure and their hospital mortality was not significantly different from other emergency ICU admissions.