Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1996
Biography Historical ArticleCrawford Williamson Long (1815-1878).
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Anaesth Intensive Care · Jun 1996
Comparative StudyPostoperative nausea and vomiting. Propofol or thiopentone: does choice of induction agent affect outcome?
Postoperative nausea and vomiting (PONV) has many causes, including anaesthetic drugs. Choice of induction agent may affect the incidence of PONV, though the evidence is conflicting. ⋯ Propofol, when compared to thiopentone for induction of anaesthesia, resulted in an 18% reduction in PONV (OR = 0.82, P = 0.03). The likely postoperative benefits of propofol may outweigh concerns about its additional cost.
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Induced hypothermia as adjunctive therapy has been the subject of considerable research interest and debate for over fifty years. Recently the first prospective randomized controlled trials were undertaken in humans with severe traumatic brain injury, with supportive results. Another prospective controlled study of induced hypothermia in severe septic adult respiratory distress syndrome also suggested improved outcome. ⋯ In addition, hypokalaemia, prolonged clotting times and neutropenia may occur. The evidence that induced hypothermia may be hazardous is mostly drawn from the literature on accidental hypothermia occurring in trauma, or patients with sepsis. It is likely that further trials will be conducted and if benefit is confirmed, induced hypothermia may become more widely used in selected patients in the intensive care unit.
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Anaesth Intensive Care · Jun 1996
The Australian Incident Monitoring Study in Intensive Care: AIMS-ICU. An analysis of the first year of reporting.
The AIMS-ICU project is a national study set up to develop, introduce and evaluate an anonymous voluntary incident reporting system for intensive care. ICU staff members reported events which could have reduced, or did reduce, the safety margin for the patient. Seven ICUs contributed 536 reports, which identified 610 incidents involving the airway (20%), procedures (23%), drugs (28%), patient environment (21%), and ICU management (9%). ⋯ No ill effects or only minor ones were experienced by most patients (short-term 76%, long-term 92%) as a result of the incident. Multiple contributing factors were identified, 33% system-based and 66% human factor-based. Incident monitoring promises to be a useful technique for improving patient safety in the ICU, when sufficient data have been collected to allow analysis of sets of incidents in defined "clinical situations".