Anaesthesia and intensive care
-
Anaesth Intensive Care · Apr 2005
A novel technique for post-pyloric feeding tube placement in critically ill patients: a pilot study.
Delivery of enteral nutrition in critically ill patients is often hampered by gastric stasis necessitating direct feeding into the small intestine. Current techniques for placement of post-pyloric feeding catheters are complex, time consuming or both, and improvements in feeding tube placement techniques are required. The Cathlocator is a novel device that permits real time localisation of the end of feeding tubes via detection of a magnetic field generated by a small electric current in a coil incorporated in the tip of the tube. ⋯ The Cathlocator accurately determined the position of both tubes without complication in all cases. The Cathlocator allows placement and location of an enteral feeding tube in real time in critically ill patients with slow gastric emptying. These findings warrant further studies into the application of this technique for placement of post-pyloric feeding tubes.
-
Anaesth Intensive Care · Apr 2005
Recombinant activated factor VIIa use in massive transfusion and coagulopathy unresponsive to conventional therapy.
We report a retrospective analysis of patients admitted to a tertiary intensive care unit who received recombinant activated factor VIIa (rFVIIa) in an effort to control life-threatening haemorrhage and coagulopathy. Data extracted included: demographics, diagnoses and clinical course, dosage of rFVIIa, blood product requirements and coagulation tests prior to and after rFVIIa, pH, base deficit and temperature. During the study period rFVIIa was given to nine patients with refractory coagulopathy in imminent danger of death. ⋯ Reduced requirements for red blood cells, fresh frozen plasma, platelets and cryoprecipitate followed rFVIIa administration in eight cases. One patient died after 48 hours of complications unrelated to the initial pathology. Seven patients were discharged from hospital; one remains in hospital. rFVIIa provided improvement in coagulopathy unresponsive to conventional therapy.
-
Anaesth Intensive Care · Apr 2005
Diagnosis and outcome from suspected mesenteric ischaemia following cardiac surgery.
A three-year retrospective chart review was undertaken of all post-cardiothoracic ICU patients who underwent laparotomy for suspected mesenteric ischaemia, or who had the diagnosis confirmed at post mortem. The aim was to compare the clinical and diagnostic characteristics of cardiothoracic patients with suspected mesenteric ischaemia with patients who had a confirmed diagnosis. There were 3024 admissions to the cardiothoracic ICU over the three-year period. ⋯ Neither routine clinical investigations nor plain abdominal radiography reliably diagnose mesenteric ischaemia when the diagnosis is suspected clinically. Early laparotomy is recommended in these patients and further investigation may delay this procedure unnecessarily. The presence of mesenteric ischaemia identifies a cohort of patients with high mortality.
-
A questionnaire investigating substance abuse was sent to 128 anaesthetic departments in Australia and New Zealand of which 100 (78%) replied. Forty-four cases of substance abuse were reported. Abusers were more likely to be male, aged between 25 and 35 years and abusing opioids. ⋯ More than one precipitating cause was identified in 51% of cases, the most frequently reported were mental health and family problems. The pattern of substances abused was similar to that reported in the previous Australasian survey ten years ago. However, in keeping with an international trend, there appears to be an increased use of anaesthetic agents.
-
Anaesth Intensive Care · Apr 2005
Editorial CommentSubstance abuse a decade on: so little and so far.