Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2002
Accuracy of portable infusers under hyperbaric oxygenation conditions.
Three types of portable infusers with different infusion mechanisms were evaluated with regard to their accuracy during a hyperbaric oxygenation protocoL The power driving the pump is provided by either a balloon, a spring or a vacuum mechanism. Performance during hyperbaric oxygenation (HBO) varied between the devices, probably due to the difference in driving mechanism. ⋯ We suggest that other devices are more suitable for use in this clinical situation. We conclude that it is desirable to check the performance of any infuser intended for use during hyperbaric oxygenation and to be mindful of potential differences among such devices.
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Anaesth Intensive Care · Feb 2002
The peripherally inserted central catheter (PICC): a prospective study of its natural history after cubital fossa insertion.
A prospective cohort study was undertaken to describe the natural history of the cubital fossa peripherally inserted central catheter (PICC), determine which factors influenced the hazard of complication and develop a standard methodology for evaluation of a PICC service. A total of 4349 patient days of PICC observation were analysed using survival analysis techniques. The median time to PICC removal for a complication was 60 days. ⋯ Size 3 French gauge catheters had a complication rate of 7.3 per 1,000 line days compared to 14.2 for 4 French catheters (hazard rate 1.26 90% CI 1.02 to 1.55). PICCs requiring two or more attempts at insertion were more likely to develop complications than those inserted at the first attempt: 20 per 1,000 line days vs 10.5 but the confidence intervals were wide (hazard rate 1.91, 90% CI 0.90 to 4.05). Operator (amongst the four experienced operators who inserted all PICCs), arm of placement, or medial or lateral placement in the cubitalfossa did not influence PICC survivaL
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Anaesth Intensive Care · Feb 2002
The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population.
The use of a modified Cormack-Lehane scoring system (MCLS) of laryngoscopic views, as previously introduced in the Western population, was investigated during direct laryngoscopy in the Asian population. We studied the distribution of the different grades of MCLS, the predictive factors and rate of difficult laryngoscopy, and the association with difficult intubation. Six hundred and five patients requiring tracheal intubation during general anaesthesia were prospectively studied. ⋯ The rates of difficult laryngoscopy and intubation were 5.1% and 6.9% respectively. The Mallampati classification and thyromental distance were associated with low predictive value for difficult laryngoscopy. The MCLS better delineates the difficulty experienced during laryngoscopy than the original Cormack-Lehane grading
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We present a case of acute lithium intoxication in a 51-year-old woman on chronic lithium therapy. Her serum lithium level was 10.6 mmol/l 13 hours after ingestion and 5.8 mmol/l at 24 hours. ⋯ Clinical features of toxicity are more important than a spot lithium level. A combination of clinical toxicity, the duration of exposure and a serial profile of serum lithium levels should guide dialytic therapy for removal of lithium.