Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialPropofol maintenance to reduce postoperative emesis in thyroidectomy patients: a group sequential comparison with isoflurane/nitrous oxide.
The clinical benefit of propofol anaesthesia in the prevention of postoperative nausea and vomiting (PONV) is still being elucidated despite many studies to date. In this study 64 adult female patients scheduled for thyroidectomy received, in a randomized double-blind fashion, propofol with air or isoflurane with nitrous oxide for maintenance of anaesthesia. The primary response variable was the presence or absence of vomiting in the first six hours. ⋯ There was no significant difference detected in the 6 to 24 hour interval. In this group of female patients, total intravenous anaesthesia (TIVA) with propofol is associated with an early reduction in early postoperative vomiting compared with standard inhalational techniques. This reduction in vomiting does not appear to persist beyond the first six hours.
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Anaesth Intensive Care · Dec 1998
Case ReportsDifficult pulmonary artery catheterization in a patient with persistent left superior vena cava.
A persistent left superior vena cava is an uncommon congenital abnormality. It arises when the left anterior cardinal vein fails to regress during the embryonic period. ⋯ The anaesthetist may encounter difficulty in the insertion of pulmonary artery catheters. Other implications in the management of these patients in the operating theatre or intensive care unit are discussed.
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Anaesth Intensive Care · Dec 1998
The use of antimicrobials in ten Australian and New Zealand intensive care units. The Australian and New Zealand Intensive Care Multicentre Studies Group Investigators.
A prospective standardized collection of clinical, microbiological and pharmaceutical information on antibiotic use was conducted in Australia and New Zealand intensive care units (ICUs) involving 481 consecutive critically ill patients who were receiving antibiotics for any reason while in ICU. Patients had a mean SAPS II score of 34.1 +/- 17.8 with an expected mortality of 15.6% (actual mortality 12%). Of these, 292 (60.8%) were admitted to the ICU within 72 hours of surgery. ⋯ Forty-one patients had a documented infection (positive culture) with a gram-negative organism. Of these, 17 received therapy with a single antibiotic and 24 received therapy with two antibiotics. Despite similar illness severity, there were six deaths in the former group and only two in the latter.
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Anaesth Intensive Care · Dec 1998
Case ReportsDisconnect alarm failure in detection of common gas outlet disconnection.
This laboratory study was prompted by two paediatric cases where low pressure alarms and capnography failed to detect common gas outlet disconnection when using a T-piece pump ventilator. A carbon dioxide producing model lung was ventilated using the Clare ventilator (a T-piece pump type ventilator) via an Ayres T-piece. The T-piece used has 3 mm diameter fresh gas tubing. ⋯ End-tidal CO2 rose, whilst inspired CO2 remained at zero. This experiment demonstrates that the Clare ventilator's low pressure alarm detects common gas outlet disconnection poorly when used with an Ayres T-piece with narrow fresh gas tubing. Graphical representation of airway oxygen content has merit as an alerting monitor for common gas outlet disconnection.
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Anaesth Intensive Care · Dec 1998
Management and outcomes of patients with brain trauma in a tertiary referral trauma hospital without neurosurgeons on site.
Waikato Hospital is a tertiary hospital of over 700 beds receiving large numbers of trauma patients, but has no neurosurgeon closer than 130 kilometres. Over the 10 years ending July 1997, 831 cases of brain trauma were admitted to the Intensive Care Unit. Of these, 191 died before leaving hospital (overall mortality 23%). ⋯ These mortality rates are acceptable when compared with other reports (average 37%, over 12 adult series). Using brain AIS scores, our mortality figures also compared favorably with those in the literature, and suggest that the quality of brain trauma care is adequate in this non-neurosurgical centre with intensive care, backed by CT scanning and general surgeons able to do urgent burr holes. Six percent of the brain trauma patients (approximately five per year), required interhospital transfer for definitive neurosurgical care.