Anaesthesia and intensive care
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We have identified some of the most frequently measured anaesthetic outcomes and their independent risk factors, and discussed the limitations and advantages in using various risk adjustment strategies. Many studies suggest that preoperative assessments may contribute to preventing the occurrence of anaesthetic-related morbidity and mortality, and to high levels of patient satisfaction. The use of health status measurements as a preoperative screening tool in assessing anaesthetic risk offers a potential area for future work. Research into measuring anaesthetic outcomes in a reliable and valid manner will be an important tool in improving standards of anaesthetic practice and in delivering quality anaesthesia to our patients.
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Anaesth Intensive Care · Dec 1996
The efficacy, applicability and side-effects of postoperative intravenous patient-controlled morphine analgesia: an audit of 1233 Chinese patients.
We analyzed data from 1233 Chinese patients of a wide age range who received patient-controlled analgesia (PCA) intravenous morphine for postoperative pain relief, during the period of January 1992 to May 1995. The analgesic regimen was standardized as follows: PCA bolus 1 to 1.5 mg; lock-out interval 5 minutes; one-hour maximum dose 0.075 to 0.1 mg.kg-1 and background infusion 0 or 0.5 mg.h-1. Most patients underwent major surgery that was broadly subclassified according to the anatomical area involved. ⋯ Most patients were satisfied (76.7% ranked "good") with their postoperative analgesia. The commonest reasons for dissatisfaction were inadequate pain relief, nausea and reluctance to self-control analgesic administration. It is concluded that PCA with intravenous morphine is effective and safe as a routine postoperative technique for Chinese surgical patients.
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A review of the medical records from two public hospitals in Sydney was undertaken to determine the incidence of this uncommon complication. Twenty-seven cases of uterine rupture were reported out of 31,115 deliveries with an incidence of 0.086% (versus 0.05% in the current literature). The incidence associated with previous caesarean section was 0.038% (versus 0.8% in the current literature). ⋯ Forty-eight per cent of patients with uterine rupture received epidural analgesia. The associated factors and outcomes are discussed. The current literature is reviewed in relation to this high-risk group of patients.
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To measure and compare the response times to audibly or visually presented alarms in the operating theatre. ⋯ The ability of anaesthetists to appreciate changes in patient physiology may be limited by delays in noticing information presented by monitors. The rapid response to the vast majority of alarms indicates a high level of vigilance among the anaesthetists studied. However, this study suggests that it is safer to rely on audible rather than visual alarms when time-critical information such as oxygenation, heart beat and ventilator disconnection is concerned. Visual alarms would appear to be more appropriate for conveying less urgent information.