Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2002
Comparative Study Clinical TrialAn evaluation of non-invasive blood pressure (NIBP) monitoring on the wrist: comparison with upper arm NIBP measurement.
The arm is the traditional site for application of an oscillometric non-invasive blood pressure (NIBP) cuff This study, which compares upper arm NIBP to wrist NIBP, involved 510 same arm sequential paired blood pressure (BP) measurements in 85 volunteers. Wrist NIBP consistently overestimated mean arterial, systolic and diastolic pressure by approximately 10 mmHg. Ninety per cent of the mean arterial pressure differences at the wrist were within a range of +/- 9 mmHg around a mean difference of 10.6 mmHg. ⋯ The diastolic pressure difference was 10.2 mmHg with 90% of differences between +/- 9 mmHg. With the device used and within the normal blood pressure range, compensation can be performed by subtracting 10 mmHg from the measured values or simply by elevating the wrist about 15 cm and taking the BP at face value. Wrist NIBP may be a viable clinical alternative in situations where difficulty occurs with upper arm NIBP measurement.
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Anaesth Intensive Care · Feb 2002
Non-bronchoscopic bronchoalveolar lavage in the microbiological diagnosis of pneumonia in mechanically ventilated patients.
A prospective study comparing standardized non-bronchoscopic bronchoalveolar lavage (sNB-BAL) and non-specific endotracheal aspirate (NsETA) in the microbiological diagnosis of pneumonia in mechanically ventilated patients is described. One hundred episodes in 82 mechanically ventilated patients with or without radiological and clinical diagnostic criteria of pneumonia were studied. NsETA and sNB-BAL was performed on the day of study. ⋯ Colonization rates with NsETA were significantly higher compared to sNB-BAL (P value <0.0001). No patient had complications attributable to the sNB-BAL procedure. We conlude that sNB-BAL is a safe, effective, sensitive, specific and inexpensive procedure for the serial evaluation of pneumonia in mechanically ventilated patients.
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Anaesth Intensive Care · Feb 2002
Case ReportsSystemic reperfusion injury during arm replantation requiring intraoperative amputation.
This case describes the attempted replantation of an arm following its traumatic amputation. After a five-and-a-half hour ischaemic time, perfusion of the arm was re-established. However over the ensuing hours, the patient developed hyperkalaemia, acidaemia and severe hypotension requiting high dose inotropic support. Ultimately re-amputation was necessary to treat the systemic effects of the ischaemia reperfusion syndrome.
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Anaesth Intensive Care · Feb 2002
Clinical TrialBispectral index in assessment of adequacy of general anaesthesia for lower segment caesarean section.
Awareness among parturients during general anaesthesia for caesarean section, though now uncommon, remains a concern for obstetric anaesthetists. We examined the adequacy of our general anaesthetic technique for avoiding explicit awareness by determining the depth of anaesthesia using Bispectral Index (BIS) monitoring. Twenty ASA1 parturients having general anaesthesia for lower segment caesarean section were studied. ⋯ No patient experienced intraoperative dreams, recall or awareness. Our current general anaesthetic technique appeared inadequate to reliably produce BIS values of less than 60 that are associated with a low risk of awareness. However, no patients experienced explicit awareness.
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Anaesth Intensive Care · Feb 2002
Randomized Controlled Trial Clinical TrialDetection and correction of accidental oesophageal intubation during flexible lightwand-guided intubation via the intubating laryngeal mask.
In the following two-part study, we determined the efficacy of observation of the light glow to detect correct placement of the tracheal tube after lightwand-guided tracheal intubation via the intubating laryngeal mask (ILM). We also determined the efficacy of a protocol to correct oesophageal intubation in this situation. In study 1, 80 ASA 1-3, anaesthetized, paralysed patients were randomly assigned to have a tracheal tube, preloaded with a flexible lightwand, placed into either the trachea (n=40) or oesophagus (n=40) under laryngoscope guidance. ⋯ In 40/55 (73%) patients, tracheal intubation was successful at the second attempt and in 13/55 (24%) at the third or fourth attempt. In 2/55 (4%) patients, persistent oesophageal intubation occurred. The sensitivity, specificity and positive predictive value were 95%, 92.5% and 92.7% respectively in study 1, and were all 100% in study 2.