Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1999
Case ReportsAntenatal and preoperative genetic and clinical assessment in myotonic dystrophy.
The antenatal investigation of an obstetric patient with a history of myotonia is described. The smooth and striated muscle dysfunction in myotonic dystrophy renders these patients, as a group, liable to surgical correction and exposure to anaesthesia. A caesarean section is reported to illustrate the preferred timing of diagnosis and peripartum management. While regional anaesthesia is preferred, myotonic dystrophy is not a contraindication to general anaesthesia, provided risks are anticipated and steps taken to minimize complications.
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Anaesth Intensive Care · Apr 1999
Comparative StudyAn audit of deaths occurring in hospital after discharge from the intensive care unit.
The aim of the study was to conduct an audit of patients who died in the ward after discharge from the intensive care unit (ICU). Clinical records of those who died in the ward following discharge between 1991 and 1997 were reviewed. Patients were retrospectively grouped according to whether death was expected, unexpected or likely to die within one year. ⋯ Of the remaining 34 patients, 65% were debilitated with more than one organ disease and 62% eventually had some treatment withdrawn on the ward. After discharge from ICU, no obvious ward treatment deficiencies were found to contribute to death. However, of those who were admitted to the ICU from the ward and who later died when back in the ward, there seemed to be avoidable events pre-ICU admission in eight (36%) patients, some of which may have contributed to the later death of the patient.
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Anaesth Intensive Care · Apr 1999
Randomized Controlled Trial Comparative Study Clinical TrialSub-Tenon's block: the effect of hyaluronidase on speed of onset and block quality.
The role of hyaluronidase on the onset time and quality of single quadrant sub-Tenon's block was studied in a prospective, randomized, double-blind controlled manner. One hundred and twenty consecutive patients undergoing cataract surgery under local anaesthesia received a sub-Tenon's block with either of two local anaesthetic solutions. One consisted of 2% plain lignocaine 3 ml with 0.5% plain bupivacaine 2 ml. ⋯ Akinesia scores were lower at all time intervals and were significantly lower (P < 0.05) up to 9 minutes after block in the hyaluronidase group. However, block quality as assessed by the surgeon was not significantly different between the groups. The addition of 150 IU hyaluronidase significantly speeds up the onset of surgical anaesthesia produced by a sub-Tenon's block.