Anaesthesia and intensive care
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Anaesth Intensive Care · May 2010
Intrahospital transfer of critically ill patients; a prospective audit within Flinders Medical Centre.
A prospective observational audit of 32 intrahospital transfers of critically ill patients was undertaken within Flinders Medical Centre. The aim was to assess the adherence of recommended staffing and equipment required during intrahospital transfer according to the "Minimum standards for intrahospital transport of critically ill patients" (PS39) published in 2003 by the Joint Faculty of Intensive Care Medicine, the Australian and New Zealand College of Anaesthetists and Australasian College for Emergency Medicine. ⋯ Oxygen saturation and blood pressure monitoring were present in 97%, heart rate monitoring in 90.5%, electrocardiogram monitoring in 84.5% and capnometry monitoring in 75% of the intrahospital transfers observed. Overall, 44% of transfers resulted in incident occurrence, many of which were preventable with careful planning and increased communication between staff Intensive care units are encouraged to continually evaluate their intrahospital transportation of critically ill patients and to identify system problems contributing to failure of adherence to the current guidelines.
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Anaesth Intensive Care · May 2010
Case ReportsTorsade de pointes in a patient with acute prolonged QT syndrome and poorly controlled diabetes during sevoflurane anaesthesia.
We report a case of torsade de pointes secondary to acute QT interval prolongation in a patient with poorly controlled diabetes mellitus towards the end of a laparoscopic nephrectomy under sevoflurane anaesthesia. The patient was successfully resuscitated and made a complete recovery. Our case suggests that acute QT interval prolongation should be considered in any patient with poor glycaemic control during prolonged procedures.
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Anaesth Intensive Care · May 2010
Definition, risk factors and outcome of prolonged surgical intensive care unit stay.
There is no generally accepted definition for a "prolonged surgical intensive care unit (SICU) stay". The aims of the current study were to: (1) define prolonged SICU stay; (2) identify risk factors of prolonged SICU stay; and (3) identify risk factors of hospital mortality in patients with a prolonged SICU stay. All SICU patients aged >16 years and with an intensive care unit (ICU) stay longer than three days without ICU readmission between 1 January 2004 and 30 November 2006 at the National Taiwan University Hospital were recruited to the study. ⋯ A multivariate logistic regression model identified factors associated with ICU mortality in patients with ICU stay >16 days, including renal replacement therapy (odds ratio 4.780, 95% confidence interval 2.687 to 8.504). An ICU stay >16 days could be used to define prolonged SICU stay when hospital and one-year mortality rates are considered. Prevention of organ failure requiring renal replacement therapy might prove a useful goal to avoid prolonged ICU stay and even hospital mortality.
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Anaesth Intensive Care · May 2010
The development and implementation of an obstetric cell salvage service.
Cell salvage in obstetric haemorrhage is now endorsed by a number of organisations. Most of the literature has focused on isolated case series and safety. We describe how cell salvage, including a quality assurance process conducted prior to clinical implementation, was introduced to our stand-alone obstetric hospital which had no previous experience of this technique. ⋯ We recommend that in units that already provide intraoperative cell salvage in a non-obstetric setting, extending the service into obstetric situations should be considered. Units that routinely care for high-risk obstetric patients should also consider the introduction of such a service. Post transfusion Kleihauer testing should be performed as soon as possible in Rhesus-negative mothers who deliver a Rhesus-positive foetus, so that appropriate anti-D prophylaxis can be administered.
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Anaesth Intensive Care · May 2010
Relative hypotension in the beach-chair position: effects on middle cerebral artery blood velocity.
When anaesthetising patients for arthroscopic shoulder surgery, it is common practice to sit the patient in the beachchair position and to optimise arthroscopy by allowing relative hypotension. There is little published information regarding the cerebral haemodynamic effects of hypotension in the sitting position during general anaesthesia. In this study, 19 patients scheduled for shoulder surgery were anaesthetised with desflurane. ⋯ In the beach-chair position, systolic pressure was 96 +/- 10 mmHg in the arm and 76 +/- 10 mmHg at the auditory meatus (P < 0.0001). Both resistance area product and apparent zero flow pressure decreased, suggesting decreases in cerebrovascular resistance and critical closing pressure. Although there was some evidence of an autoregulatory response, middle cerebral artery blood velocity decreased when relative hypotension was induced in patients anaesthetised with desflurane in the beach-chair position.