Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2007
Comparative StudyInvestigation of a new echogenic needle for use with ultrasound peripheral nerve blocks.
A new 'texturing method' has been developed for nerve block needles in an attempt to improve the ultrasonic image of the needles. Using a synthetic phantom, these textured needles were compared to currently available needles. The textured needle had improved visibility under ultrasound. This type of needle may assist the anaesthetist perform ultrasound-guided regional anaesthesia.
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Anaesth Intensive Care · Aug 2007
Comparative StudyCombining sequential organ failure assessment (SOFA) score with acute physiology and chronic health evaluation (APACHE) II score to predict hospital mortality of critically ill patients.
The ability to accurately adjust for the severity of illness in outcome studies of critically ill patients is essential. Previous studies have showed that Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE) II score can predict hospital mortality of critically ill patients. The effects of combining these two scores to predict hospital mortality of critically ill patients has not been evaluated. ⋯ The APACHE II, Admission SOFA, Delta SOFA and maximum SOFA score were all related to hospital survival in the univariate analyses. Combining Max SOFA (area under receiver operating characteristic curve 0.875 vs. 0.858, P = 0.014; Nagelkerke R2: 0.411 vs. 0.371; Brier Score: 0.086 vs. 0.090) or Delta SOFA score (area under receiver operating characteristic curve 0.874 vs. 0.858, P = 0.003; Nagelkerke R2: 0.412 vs. 0.371; Brier Score: 0.086 vs. 0.090) with the APACHE II score improved the discrimination and overall performance of the predictions when compared with using the APACHE II score alone, especially in the emergency ICU admissions. Combining Max SOFA or Delta SOFA score with the APACHE II score may improve the accuracy of risk adjustment in outcome studies of critically ill patients.
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Anaesth Intensive Care · Aug 2007
In-hospital cardiac arrest: different wards show different survival patterns.
The purpose of the study was to investigate the characteristics and outcomes of in-hospital cardiac arrests that occurred outside of the hospital critical care areas. A prospective register of adult in-hospital cardiac arrests occurring in non-critical care areas of Christchurch Hospital, Christchurch, New Zealand, from January 2001 to December 2004 was compiled. Two-hundred-and-forty-three cardiac arrests were recorded in this period. ⋯ The analysis of outcomes across different clinical areas at Christchurch Hospital revealed differences in outcomes and therefore the clinical experience of staff in those areas. These differences have implications for the resuscitation training of health professionals. The further development of national resuscitation registries may allow more specific analysis of outcomes in different clinical areas.
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Anaesth Intensive Care · Aug 2007
Comparative StudyRopivacaine 0.25% is as effective as bupivacaine 0.25% in providing surgical anaesthesia for lumbar plexus and sciatic nerve block in high-risk patients: preliminary report.
Ropivacaine is potentially less cardiotoxic and neurotoxic than bupivacaine. The aim of this study was to compare the effectiveness of ropivacaine 0.25% and bupivacaine 0.25% for surgical anaesthesia and postoperative analgesia during lumbar plexus and sciatic nerve block in high-risk patients. We performed combined lumbar plexus and sciatic nerve blockade on 62 consecutive ASA III or IV patients undergoing unilateral hip or femur surgery. ⋯ The time from the end of the surgery to the first analgesic requirement was similar between the two groups (10.3 +/- 5.2 hours for ropivacaine, 11.2 +/- 4.6 hours for bupivacaine). There was no statistically significant difference between the two groups in any of the measured variables (P > 0.05). The results of this preliminary study suggest that ropivacaine 0.25% is as effective as bupivacaine 0.25% when used for blocking lumbar plexus and sciatic nerve in high-risk patients undergoing hip or femur surgery.