Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2006
Case ReportsSuccessful resuscitation of an ASA 3 patient following ropivacaine-induced cardiac arrest.
A patient with severe myocardial disease and acute-on-chronic renal failure was undergoing a brachial plexus block for formation of an arteriovenous fistula when accidental intravascular injection of ropivacaine resulted in ventricular fibrillation. Cardiopulmonary resuscitation was instituted immediately and the advanced life support algorithm was followed until the return of sinus rhythm. Although, in comparison with bupivacaine, ropivacaine appears to be a safer local anaesthetic agent in the setting of intravenous injection, the emphasis on safety should remain a priority. Awareness of the risk of central nervous system and cardiovascular toxicity and preparation for immediate commencement of resuscitation in the event of toxicity remain of paramount importance.
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Profound hypotension and cardiac arrest after commencement of combined spinal and general anaesthesia in a patient for knee replacement surgery raised the suspicion of anaphylaxis. This seemed to be confirmed when a mast cell tryptase test taken about 90 minutes after the onset of the hypotension was elevated. ⋯ Repeat mast cell tryptase at the time showed the same elevation, which led to the correct diagnosis of mastocytosis and a secondary diagnosis that the patient's hypotension and cardiac arrest were the result of her spinal anaesthesia. If the serum tryptase is elevated during the event but no allergic agent can be identified, a further serum tryptase should be taken several weeks later to exclude a persistent elevation due to mastocytosis.
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Anaesth Intensive Care · Dec 2006
Changes in clinical research in anaesthesia and intensive care from 1974-2004.
The purpose was to identify how the quality of anaesthesia research has improved from articles published in Anaesthesia and Intensive Care over 25 years. Original papers were included during the periods 1974-1978 and 2000-2004. Each article was classified according to principal research designs and the two five-year periods were compared. ⋯ Uncontrolled clinical trials decreased from 27.27% to 12.71%, non-randomized controlled trials decreased from 50.91% to 7.63%, and randomized controlled trials increased from 21.82% to 79.66% (P<0.0001). All interventional trials criteria improved and were statistically significant except competing financial interest, method of randomization, patients accounted for; and type II error The quality of anaesthetic research has improved in Anaesthesia and Intensive Care over the past 30 years. However; there is still room for improvement.
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Anaesth Intensive Care · Dec 2006
An audit of intrathecal morphine analgesia for non-obstetric postsurgical patients in an adult tertiary hospital.
We conducted a retrospective audit of adult non-obstetric patients who had received a single dose of intrathecal morphine for postoperative analgesia. These patients were predominantly admitted to a regular postsurgical ward with strict hourly nursing observations, treatment protocols in place and supervision by an Acute Pain Service for the first 24 hours after intrathecal morphine administration. A total of 409 cases were examined for sedation score, incidence of respiratory depression and other side-effects, admission to the high dependency or intensive care unit and opioid-tolerance. ⋯ Of the total of 409 cases, only one case of respiratory depression was observed. A total of 77 patients were admitted to high dependency or intensive care unit for various reasons including management of postsurgical complications and patient co-morbidities. Our findings suggest that elderly patients who receive intrathecal morphine analgesia can be safely managed in a regular postsurgical ward.
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A survey was posted to all general practitioner anaesthetists in Australia who are currently involved in the Joint Consultative Committee on Anaesthesia (JCCA) accreditation process known as the Maintenance of Professional Standards program (MOPS). The survey was intended to gain information regarding accreditation, continuing medical education, caseloads, on call, work practices, attitudes and future work plans. The response rate was 70% (168/240). ⋯ The majority stated that specialist anaesthetists and hospital administrations were helpful and supportive. Eighty-two percent planned to continue or increase their current anaesthetic workload over the next five years. The JCCA MOPS program appears to provide a satisfactory pathway for training, accreditation and on-going education of general practitioner anaesthetists.