Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1999
Review Case ReportsSurgical emphysema following percutaneous tracheostomy.
We report two patients in whom a Portex GWDFT was complicated by surgical emphysema. Subsequent examination revealed posterior tracheal wall tears in these patients. The exact aetiology of these tears is unknown, although the tracheostomy tube introducer may have been implicated. We suggest a management plan for this complication.
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Pethidine is an effective epidural opioid for the treatment of acute pain. Its use has been well described in Australian and New Zealand practice, particularly in the field of obstetric anaesthesia. ⋯ Because of its intermediate lipid solubility, pethidine may have advantages over many other epidural opioids. However, potential for accumulation of norpethidine limits its use to relatively short durations of treatment.
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Anaesth Intensive Care · Apr 1998
ReviewIntrathecal pethidine: pharmacology and clinical applications.
Pethidine is the only member of the opioid family that has clinically important local anaesthetic activity in the dose range normally used for analgesia. Pethidine is unique as the only opioid in current use that is effective as the sole agent for spinal anaesthesia. ⋯ Articles reviewed include those identified by a Medline search using keywords "intrathecal" or "spinal anaesthesia/ anesthesia" and "pethidine" or "meperidine". Reference lists from identified papers were scrutinized to identify further relevant articles.
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Anaesth Intensive Care · Dec 1997
Review Comparative StudyOpioid requirements and responses in Asians.
The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. ⋯ An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
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Anaesth Intensive Care · Oct 1997
ReviewAcute weakness syndromes in critically ill patients--a reappraisal.
Over the last twenty years, increasing numbers of critically ill, mechanically ventilated patients who develop acute profound muscle weakness have been described. These acute weakness syndromes have not been well understood and they have been given many names including: acute steroid myopathy, acute quadriplegic myopathy, the floppy person syndrome, critical illness polyneuropathy, critical illness polyneuromyopathy, and prolonged neurogenic weakness. Many of these "syndromes" either overlap or represent the same disease process in different patients. ⋯ Neuropathies are divided into critical illness polyneuropathy and acute motor neuropathy. The anterior horn cell injury in Hopkins syndrome should also be considered in this group. Polyneuromyopathies include various combinations of neuropathy and myopathy in the same patients.