Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2006
Case ReportsAnaesthetic management of a patient with relapsing polychondritis undergoing laparoscopic surgery.
We describe the anaesthetic management of a patient with relapsing polychondritis who underwent laparoscopic cholecystectomy. We failed to secure a patent airway with a ProSeal laryngeal mask airway, probably because of the deformity of the larynx. ⋯ Positive pressure ventilation with 5 cm H2O positive end-expiratory pressure and surgery were safely performed. In relapsing polychondritis, recurrent inflammation and destruction of laryngeal and tracheobronchial cartilage causes airway obstruction, and various sizes of tracheal tubes and other airway manipulation devices should be prepared.
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Anaesth Intensive Care · Jun 2006
Biography Historical ArticleBrian Dwyer and the St. Vincent's Pain Clinic 1962 to 1989.
Brian Dwyer was the Director of the Department of Anaesthetics at St. Vincent's Hospital in Sydney from 1955 to 1985. He developed a major interest in the management of intractable pain and was most impressed by the multidisciplinary pain clinic which was commissioned at the University of Washington in Seattle by John Bonica in 1960. ⋯ As a result of his work, Brian Dwyer received international recognition as a pioneer in the field of chronic pain management and the St. Vincent's Pain Clinic served as a model for the establishment of similar units, both in Australia and overseas. Brian Dwyer was the first chairman of the Clinic and remained in that position until his retirement in 1989.
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Anaesth Intensive Care · Jun 2006
A pilot study to test the use of a checklist in a tertiary intensive care unit as a method of ensuring quality processes of care.
This pilot study aimed to test the use of a checklist as a method of ensuring that certain processes of care are performed routinely and systematically in a tertiary intensive care unit. The pilot involved the development of a process indicator checklist, its implementation and review. The checklist contained 16 items sourced from the literature or deemed important by local clinicians. ⋯ Results demonstrated good compliance in completing the checklist (81%) and that when checked, certain aspects of care were not always delivered when appropriate. At the conclusion of the study the majority of medical staff believed that care in the intensive care unit actually improved with the use of the checklist, and all thought that it assisted in ensuring that good quality care was delivered. The checklist is a useful tool that can be readily applied to facilitate best practice and quality in everyday clinical care, ultimately leading to better health outcomes for patients.
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By exposing the mu-receptor (MOP-R) to more than one exogenous ligand, the administration during general anaesthesia of more than one opioid with principal action on the receptor may confound and lead to complications or unexpected outcomes. The giving of such a 'mixed message' can result in respiratory depression, excess sedation and delayed recovery to an unusual degree. We present a case of apparent extreme opioid sensitivity and discuss a possible mechanism. Such occurrences may be more common than previously realised.
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We aimed to assess elective day surgery patients' understanding of the reason for pre-operative fasting. One hundred adult patients presenting to the peri-operative unit for day procedures requiring general anaesthesia were surveyed before discharge. All day-stay, adult patients able to complete a questionnaire in English were included. ⋯ Two per cent (95%CI [0.2,7]) of patients reported actual non-compliance, and 4% (95%CI [1,10]) stated they would consider misrepresenting their fasting status if it was inconvenient for them to have their surgery postponed. The results of this study suggest a need to better inform day surgery patients about the reason for pre-operative fasting. A better understanding of the need for pre-operative fasting may lead to improved compliance and patient safety.