Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2005
ReviewProvision for major obstetric haemorrhage: an Australian and New Zealand survey and review.
Obstetric haemorrhage is a leading cause of maternal death and the most common contributor to serious obstetric morbidity. Maternal mortality audit data suggest that appropriate preparation and good emergency management leads to improved outcome. The aim of this study was to assess facilities relevant to major obstetric haemorrhage management in all units in Australia and New Zealand that offer operative obstetric services. ⋯ Haemorrhage responds well to appropriate treatment, although careful preparation and anticipation of problems is required. In our region geographical factors and different systems of healthcare complicate provision of obstetric services. Where facilities are limited, women should be offered antenatal transfer to a larger centre.
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Anaesth Intensive Care · Dec 2005
Anaesthetists' knowledge of the QT interval in a teaching hospital.
Many drugs used in anaesthesia may prolong the QT interval of the electrocardiogram (ECG), and recent U. S. Food and Drug Administration guidelines mandate monitoring of the ECG before, during and after droperidol administration. ⋯ When asked to name drugs that altered the QT interval, droperidol was included by 11 of the 40 respondents (28%); trainees 10% vs consultants 45%, OR 7.4 (95% CI: 1.3-41), P=0.013. Torsades de Pointes was correctly identified as a possible consequence of a prolonged QT interval by 65% of trainees and 70% of consultants, P=0.83. The results suggest that QT interval measurement is not widely practised by anaesthetists, although its clinical significance is well known, and interpretation would be unreliable without further education.
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Anaesth Intensive Care · Dec 2005
Comparative StudyEvaluation of the SLIPA (streamlined liner of the pharynx airway), a single use supraglottic airway device, in 60 anaesthetized patients undergoing minor surgical procedures.
The Streamlined Liner of the Pharyngeal Airway, SLIPA (Hudson RCI) is a new disposable supraglottic airway device that has no inflatable cuff and has features designed to reduce aspiration risk. This study aimed to assess the insertion success and effectiveness of the SLIPA in 60 patients who presented for elective surgery. Ethics committee approval was obtained. ⋯ Group B reported that use of the device was very easy in 16%, easy in 76%, difficult in 5%, and very difficult in 3%. The SLIPA proved to be a reliable airway providing adequate ventilation in both spontaneous breathing and assisted respiration. Most users found the SLIPA to be easy or very easy to use.
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Anaesth Intensive Care · Dec 2005
Case ReportsAnaphylaxis to cisatracurium following negative skin testing.
General anaesthesia for the patient with a history of anaesthesia-related anaphylaxis is challenging. Precautions against anaphylaxis and the use of skin test negative drugs can reduce but not eliminate the risk. ⋯ However, the absence of a clearly identified triggering agent increases the difficulties facing the anaesthetist. We present a case of anaphylaxis to cisatracurium following a negative skin test.
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Anaesth Intensive Care · Dec 2005
Comparative StudyPrecise control of end-tidal carbon dioxide levels using sequential rebreathing circuits.
Anaesthesiologists have traditionally been consulted to help design breathing circuits to attain and maintain target end-tidal carbon dioxide (P(ET)CO2). The methodology has recently been simplified by breathing circuits that sequentially deliver fresh gas (not containing carbon dioxide (CO2)) and reserve gas (containing CO2). Our aim was to determine the roles of fresh gas flow, reserve gas PCO2 and minute ventilation in the determination of P(ET)CO2. ⋯ The optimal settings to maintain P(ET)CO2 independently of minute ventilation are 1) fresh gas flow equal to minute ventilation minus anatomical deadspace ventilation, and 2) reserve gas PCO2 equal to alveolar PCO2. We provide an equation to assist in identifying gas settings to attain a target PCO2. The ability to precisely attain and maintain a target PCO2 (isocapnia) using a sequential gas delivery circuit has multiple therapeutic and scientific applications.