Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 1996
ReviewAnaesthetic machine and breathing system contamination and the efficacy of bacterial/viral filters.
Contamination of the anaesthetic machine and breathing system by the environment and by patient exposure has been shown to occur. Outside the intensive care setting, however, it is difficult to demonstrate that the anaesthetic machine and breathing system are a vector for patient cross-infection. ⋯ Several instances of patient morbidity are a direct consequence of filter use. The use of bacterial/viral filters may represent another step towards defensive medical practice.
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The hepatitis C virus (HCV) genome was isolated during the late 1980s using molecular cloning techniques. It is recognized as the cause of most cases of percutaneously transmitted non-A, non-B hepatitis. Prevalence of antibodies to HCV(anti-HCV) in the general Australian population is 0.3%. ⋯ Treatment strategies for HCV, utilizing recombinant interferons, are proving useful in patients with mild to moderate liver disease, but fare less well in patients with cirrhosis. Currently, there is no vaccine for hepatitis C, so pre-exposure prophylaxis is not possible. Equally, no post-exposure intervention, for example with gamma globulin, has been shown to be beneficial, though there may be a role for early interferon therapy.
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Anaesth Intensive Care · Apr 1996
Comparative StudyDisposable and autoclavable anaesthetic circuits: the future is now.
The potential transmission of disease by anaesthetic and ventilator breathing circuits has resulted in the widespread use of filters. Convincing scientific evidence of their complete efficacy is lacking particularly in regard to viruses. ⋯ These have been overcome by the development of disposable and autoclavable carbon dioxide absorbers and breathing circuits. Disposable equipment is more expensive than filters but autoclavable circuits and absorbers are of comparable cost or cheaper.
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A fixed-wing aircraft (Beechcraft KingAir B200 C) fitted as an airborne intensive care facility is described. It completed 2000 missions from 1987-1992 for distances up to 1300 km. Features include: 1. ⋯ Provision of 24Ov AC (alternating current) and 28v DC (direct current) electrical energy. 8. Pressurization and climate control. 9. Satisfactory aviation performance for conditions encountered, with single-pilot operation.
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Anaesth Intensive Care · Apr 1996
Revision of the anaesthetic aspects of an infection control policy following reporting of hepatitis C nosocomial infection.
Following the report by the N. S. ⋯ Review of the existing policies of other organizations and the published scientific data in this area was the basis of the revision. The final policy as it pertains to anaesthesia requires universal precautions, disposal or decontamination and high level disinfection of instruments and apparatus that come into contact with patients or blood or body substances and protection of the breathing circuit by a filter with disposal or high-level disinfection of all parts of the circuit not so protected for every patient.