Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2006
Predictive performance of a model of anaesthetic uptake with desflurane.
We have previously shown that a model of anaesthetic uptake and distribution, developed for use as a teaching tool, is able to predict end-tidal isoflurane and sevoflurane concentrations at least as well as commonly used propofol models predict blood levels of propofol. Models with good predictive performance may be useful as part of real-time prediction systems. The aim of this study was to assess the performance of this model with desflurane. ⋯ The predictive performance of this model with desflurane was poor, with considerable variability between patients. The reasons for the difference between desflurane and our previous results with isoflurane and sevoflurane are not obvious, but may provide important clues to the necessary components for such models. The data collected in this study may assist in the development and evaluation of improved models.
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The aim of this study was to define the anatomy relevant to brachial plexus regional anaesthesia and to identify the extent of variation between individuals. Surface ultrasound examination of the brachial plexus was performed on twenty volunteers. In the axilla there was considerable individual variation in the location of the median, radial and ulnar nerves in relation to the axillary artery. ⋯ In one volunteer, a vein was identified between nerve trunks in the interscalene region. These findings indicate that the anatomical variation is considerable, even within the relatively small sample studied. For this reason, use of surface ultrasound may lead to increased success of brachial plexus regional anaesthesia and a decreased risk of intravascular injection.
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Anaesth Intensive Care · Apr 2006
The neurotoxic effects of intrathecal midazolam and neostigmine in rabbits.
In parallel with improvements in understanding pain neurophysiology, many chemicals have recently been investigated for spinal anaesthesia and analgesia. However, studies discussing the effects of these drugs on neural tissue indicate that knowledge about some aspects of neurotoxicity is limited. Forty-nine New Zealand albino rabbits, weighing 2.2 +/- 0.2 kg, were randomly assigned to seven groups of seven animals each. ⋯ Transmission electron microscopic evaluations were performed on transverse spinal cord sections by a neuropathologist blinded to the group allocation. Twenty myelinated axons and neurones in the cervical and lumbar sections were investigated for the histopathological study. This study indicates that midazolam and neostigmine have different neurotoxic effects that depend on the dose and the repetition of dosing when these drugs are administered intrathecally.
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Anaesth Intensive Care · Feb 2006
Comparative StudyThe impact of an ICU liaison nurse on discharge delay in patients after prolonged ICU stay.
The mismatch between intensive care unit (ICU) bed availability and demand may be improved with timely patient discharges, however little is known about the nature and contributing factors of discharge delays. This study investigated the impact of a specific intervention--the ICU liaison nurse role--in reducing ICU discharge delay using a prospective block intervention study. One hundred and eighty-six ICUpatients (101 control and 85 liaison nurse intervention) with an ICU length of stay of three days or longer and who survived to ICU discharge were examined. ⋯ While no demographic or clinical variables were significant predictors of ICU discharge delay, those in the liaison nurse group were almost three times less likely to experience a discharge delay of at least two hours and about 2.5 times less likely to experience a delay of four or more hours. The positive effect of the liaison nurse role in reducing the discharge delay remained after adjustingforpotential confounders. We conclude that the liaison nurse role is effective in reducing the discharge delay in ICU transfer
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Anaesth Intensive Care · Feb 2006
Case ReportsLaryngotracheal hypoplasia--a rare cause of difficult intubation.
Generalized hypoplasia of the larynx and trachea is a very rare condition with only one case reported in the literature. A pregnant woman presented for an emergency laparotomy under general anaesthesia. ⋯ Subsequent investigations demonstrated generalized hypoplasia of the larynx and trachea. In this report, successful anaesthetic management of this case is discussed along with other possible options.