Anaesthesia and intensive care
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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
The provision of anaesthesia for children by non-subspecialist anaesthetists: expectations of newly qualified consultant anaesthetists and their prospective employers in Victoria.
We surveyed newly qualified consultant anaesthetists and their prospective employers in Victoria, regarding their expectations for the provision of paediatric anaesthesia by anaesthetists who have not completed subspecialty training in paediatric anaesthesia (generally-trained anaesthetists). Responses were received from 15 of 19 (79%) eligible Directors and 26 of 37 (70%) newly qualified Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. Of those responding, 80% of Directors and 82% of Fellows would expect a generally-trained anaesthetist to anaesthetise children two years of age or older Regional Directors expected generally-trained anaesthetists to anaesthetise younger children than metropolitan Directors, and Directors' expectations were not influenced by their own practice. ⋯ Only 50% agreed they still met all the requirements of the ANZCA paediatric module and only 37.5% had the level of confidence they achieved during their paediatric rotations. We suggest that current training provides capacity to routinely anaesthetise well children two years of age or older However it appears more training would be required for most anaesthetists undertaking anaesthesia for younger patients or more complex paediatric cases. This raises the question of subspecialty endorsements within ANZCA Fellowship.
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Anaesth Intensive Care · Sep 2010
Estimating the net effect of unmeasured ions in human extracellular fluid using a new mathematical model. Part I: Theoretical considerations.
A theoretical framework for the formulation of a derived variable to be used for the prediction of the net effect of unmeasured charged species present in human extracellular fluid was explored. This new variable was based on contemporary strong ion and classical buffer base theories and tested against the standard base excess using simulation. It proved to be more accurate in predicting the existence of unmeasured charged species in the extracellular fluid when disturbances of either strong ions, weak acids or both were present.
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Anaesth Intensive Care · Sep 2010
Case ReportsEstimating the net effect of unmeasured ions in human extracellular fluid using a new mathematical model. Part II: Practical issues.
Building on the theoretical considerations developed in Part I of this two-part series, a population range was established for a new extracellular fluid acid-base parameter using Monte Carlo simulation. This new parameter the unmeasured ion excess, had a normal range of +/- 2.50 mEq/l which was slightly narrower than the normal range for the standard base excess at +/- 3.20 mmol/l. In both cases, most of this variation occurred as a result of the estimation of the bicarbonate concentration. Finally, several short clinical vignettes were explored to highlight the differences between the unmeasured ion excess and the standard base excess.
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Anaesth Intensive Care · Sep 2010
Continuous central venous oxygen saturation monitoring under varying physiological conditions in an animal model.
We compared saturations from a paediatric central venous oximetry catheter with co-oximetry values with changes in drug infusions, intravascular blood volume and hypoxia in an animal model. Piglets (large white) were anaesthetised, intubated and mechanically ventilated. PediaSat oximetry catheters were placed in the superior vena cava via jugular vein cut-down and in the inferior vena cava percutaneously via the femoral vein. ⋯ During the hypoxia study there was good agreement between the co-oximeter to ScvO2-superior catheter but poor agreement with to the inferior vena cava catheter samples. In the hypovolaemic phase of the experiment there was good agreement between the measured co-oximetry value and ScvO2-superior catheter until the mean blood pressure reached 43 mmHg. The oximetry catheter is capable of identifying changes in ScvO2 under physiological conditions usually encountered in clinical medicine but was less accurate at the extremes of physiology and when placed in the inferior vena cava catheter especially during hypovolaemia and hypoxia.