Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
Prediction of successful defibrillation in human victims of out-of-hospital cardiac arrest: a retrospective electrocardiographic analysis.
In the present study we sought to examine the efficacy of an electrocardiographic parameter, 'amplitude spectrum area' (AMSA), to predict the likelihood that any one electrical shock would restore a perfusing rhythm during cardiopulmonary resuscitation in human victims of out-of-hospital cardiac arrest. AMSA analysis is not invalidated by artefacts produced by chest compression and thus it can be performed during CPR, avoiding detrimental interruptions of chest compression and ventilation. We hypothesised that a threshold value of AMSA could be identified as an indicator of successful defibrillation in human victims of cardiac arrest. ⋯ An AMSA value of 12 mV-Hz was able to predict the success of each defibrillation attempt with a sensitivity of 0.91 and a specificity of 0.97. In conclusion, AMSA analysis represents a clinically applicable method, which provides a real-time prediction of the success of defibrillation attempts. AMSA may minimise the delivery of futile and detrimental electrical shocks, reducing thereby post-resuscitation myocardial injury.
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Anaesth Intensive Care · Jan 2008
Case ReportsAnaesthesia for excision of an intraoral mass in a neonate: use of a laryngeal mask during removal of congenital epulis.
Congenital epulis is a rare intraoral tumour of the newborn arising from gingival mucosa, most commonly from the alveolar ridge. It may interfere with normal feeding or potentially compromise respiration. ⋯ The lesion was removed one day after delivery, under general anaesthesia using a laryngeal mask airway to control the infant's airway. The rationale for this management plan and alternatives to this strategy are discussed.
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Anaesth Intensive Care · Jan 2008
The influence of passive leg elevation on the cross-sectional area of the internal jugular vein and the subclavian vein in awake adults.
The aim of this study was to evaluate the influence of passive leg elevation and Trendelenburg position on the cross-sectional area (CSA) of the internal jugular (II) and subclavian veins (SCV). Ultrasound imaging was used for the following measurements of both the IJV and SCV baseline in the supine position (control); Trendelenburg position 15 degrees; reverse Trendelenburg position 15 degrees and passive leg elevation 50 degrees. Twenty healthy male volunteers were studied. ⋯ Mean CSA of the SCV was 0.92 +/- 0.23 cm2 in control, 0.98 +/- 0.17 cm2 in the Trendelenburg position, 0.86 +/- 0.21 cm2 in the reverse Trendelenburg position and 0.93 +/- 0.18 cm2 during passive leg elevation. The results indicate that passive leg elevation increases the CSA of the IJV, but has little effect on the SCV. The CSA of the IJV appears to be influenced more by gravitational factors than the SCV.
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Anaesth Intensive Care · Jan 2008
Immediate management of inadvertent dural puncture during insertion of a labour epidural: a survey of Australian obstetric anaesthetists.
Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. ⋯ The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
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Anaesth Intensive Care · Jan 2008
Bayesian approach to predict hospital mortality of intensive care readmissions during the same hospitalisation.
No specific prognostic model has been developed for patients readmitted to the intensive care unit (ICU) during the same hospitalisation. This study assesses the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II predicted mortality measured at the time of ICU readmission and whether incorporating information prior to the readmission will improve its performance to predict hospital mortality of patients readmitted to ICU during the same hospitalisation. A total of 602 readmissions during the same hospitalisation between 1987 and 2002 were identified. ⋯ In the subgroups of patients readmitted within seven days of discharge, the readmission APACHE II predicted mortality was also significantly better than the first admission APACHE II predicted mortality in discriminating between survivors and non-survivors (area under the receiver operating characteristic curve: 0.785 vs. 0.676, z statistic = 2.93; P = 0.003). Incorporating the first admission APACHE II predicted mortality to the readmission APACHE II predicted mortality, either by multilevel likelihood ratios or logistic regression, did not significantly improve its discrimination (area under the receiver operating characteristic curve: 0.792 vs. 0.785, z statistic = 0.52; P = 0.603). Our results suggested that information on prior ICU admission during the same hospitalisation is not as important as the severity of illness measured at the time of readmission in determining the mortality of intensive care readmissions during the same hospitalisation.