Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2005
Case ReportsAn unexpected cause of an acute hypersensitivity reaction during recovery from anaesthesia.
Acute hypersensitivity reactions to chlorhexidine in the operating room are probably more likely to occur during the early phases of anaesthesia because chlorhexidine is often used for cleaning the surgical field or during placement of indwelling catheters. We report a case of an acute hypersensitivity reaction that occurred in the post anaesthetic care unit. Subsequent skin testing suggested sensitivity to chlorhexidine, which had been applied over the vaginal mucosa at the end of surgery. Relevant issues in the investigation of acute hypersensitivity reactions in the post anaesthetic period are discussed.
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Anaesth Intensive Care · Aug 2005
Case ReportsRetrosternal block use in the treatment for dyspnoea.
We present a technique of retrosternal block for symptomatic treatment for dyspnoea of various aetiologies. In our experience with 20 patients, a retrosternal block using lignocaine improved symptoms within minutes. The block was easy to perform and was helpful when the patients' symptoms were not relieved by conventional therapy. Prospective controlled studies are needed to further assess this simple and promising treatment.
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Anaesth Intensive Care · Aug 2005
Case ReportsBaclofen withdrawal: a cause of prolonged fever in the intensive care unit.
We report a case of baclofen withdrawal syndrome resulting from oral baclofen underdosing. A 24-year-old woman with type 1 neurofibromatosis receiving long-term baclofen therapy was admitted with presumed pneumonia which was successfully treated with antibiotics. The patient continued to have fever and autonomic instability without evidence of infection which entirely resolved within 24 hours of reinstitution of full preadmission dosing of oral baclofen. Baclofen withdrawal syndrome resulting from underdosing of oral baclofen should be considered as a potential source of prolonged fever in the intensive care unit.
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Anaesth Intensive Care · Aug 2005
Transthoracic echocardiography: impact on diagnosis and management in tertiary care intensive care units.
The purpose of this study was to evaluate the utility of transthoracic echocardiography (TTE) in an intensive care unit by determining its impact on diagnosis and management. Over a six-month time period, we performed a prospective observational study on all patients admitted to either the medical or the surgical intensive care unit. Structured interviews were conducted with referring physicians before and after the TTE to determine the referring physicians' pre-TTE diagnosis, reasons for requesting the TTE, and whether the TTE resulted in a change in diagnosis and/or management. ⋯ Management was changed in 34/99 (34%) of studies with adequate clinical data and in 21/36 (58%) of studies with inadequate clinical data (P=0.017). Of the 62 management changes, 57/62 (92%) changes were minor, and 5/62 (8%) were major. In conclusion we have found that TTE frequently resulted in a change in the diagnosis and management.
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The ability of experienced anaesthetists to discern oxygen saturation by listening to the tones of a Datex AS3 pulse oximeter was examined. Five-second samples were recorded using a high fidelity patient simulator and replayed singly and in pairs. Whilst the lower saturations were generally recognized as lower, the perceived range was greatly compressed. ⋯ This may lead to underestimation of the severity if the auditory signal is relied on in isolation. A non-linear (musical) scale may prove more appropriate and should be investigated. Testing experienced anaesthetists demonstrated that most could detect the direction, but not the magnitude of a change in saturation by listening to the change in pitch of a Datex AS3 pulse oximeter tone.