Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2004
Barriers to effective perioperative communication in indigenous Australians: an audit of progress since 1996.
This prospective study was designed to elucidate barriers limiting effective perioperative communication between indigenous Australians and anaesthetists, and to identify strategies for improving communication. A questionnaire was used to collect data on 1040 consecutive patients undergoing anaesthesia at Royal Darwin Hospital between February and March 2003. 27.1% of these patients described themselves as Aboriginal. Aboriginal patients were more likely to undergo emergency surgery and were more likely to be classified as ASA 3, 4 or 5 than non-indigenous patients. ⋯ Unfortunately, the anaesthetic team utilized the Aboriginal interpreter service in only a minority of cases. Communication difficulty in indigenous Australians is pervasive and often goes unrecognized. The results suggest that heath care providers may need staff training in cross-cultural communication and that protocols need to be developed within the health care system so that interpreters are called upon automatically early in the admission process.
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Amiodarone, a class III antiarrhythmic, has been widely used to treat both ventricular and supraventricular arrhythmias. Despite the multitude of side-effects seen with this drug, no case of amiodarone anaphylaxis (confirmed by mast cell tryptase levels and skin testing) has been reported in the medical literature. We report a case of anaphylaxis to intravenous amiodarone in a 77-year-old patient.
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Anaesth Intensive Care · Aug 2004
Effect of laryngoscopy and tracheal intubation on pulse pressure and influence of age on this response.
The study objective was to measure the change in pulse pressure associated with laryngoscopy and tracheal intubation and to relate these changes to trends in systolic, diastolic and mean blood pressure. The rationale was that the rise in systolic and diastolic blood pressure may be disproportionate and may result in either increase or decrease in pulse pressure. We also looked at the influence of age on this response. ⋯ No pulse pressure change occurred in the young group despite of a significant increase in both systolic and diastolic blood pressures. The middle aged group showed an average rise of +18 mm of Hg in pulse pressure (taken at 1 minute post-intubation) compared to the baseline measurement (P<0.0001). These changes in pulse pressure during anaesthesia may indicate an additional pulsatile stress in vulnerable patients in addition to the changes associated with resistance alone and need to be studied further.
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Entropy is a new EEG based technology developed as a measure of depth of anaesthesia. The Entropy algorithm quantifies the degree of disorder in the EEG. During anaesthesia the disorder of the EEG, or entropy, falls. ⋯ The correlation was less for infants. This study demonstrates that, in children, Entropy is lower during anaesthesia when compared to awake values. Further evaluation in the paediatric population is worthwhile.
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Anaesth Intensive Care · Aug 2004
The use of the novel calcium sensitizer levosimendan in critically ill patients.
Levosimendan, a novel calcium sensitizer, enhances cardiac contractility by increasing myocyte sensitivity to calcium, and induces vasodilation. In this prospective observational study the haemodynamic effects of levosimendan in postoperative critically ill patients are reported. Twelve patients with the need for inotropic support were studied. ⋯ In postoperative critically ill patients, infusion of levosimendan exerted favourable haemodynamic responses. Levosimendan increased cardiac output by increasing stroke volume, which might be attributed primarily to its inotropic properties. Due to its cyclic adenosine monophosphate independent positive inotropic effects, levosimendan may be of value as adjunctive therapy to other inotropic drugs in critically ill patients.