Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 1995
Randomized Controlled Trial Clinical TrialIs there a role for selective decontamination of the digestive tract in primarily infected patients in the ICU?
The role of selective decontamination of the digestive tract (SDD) for the prevention of nosocomial infection in critically ill patients remains controversial, and the efficacy of this technique in patients who are already infected on presentation to the intensive care unit has not previously been assessed. We performed a double-blind randomized placebo controlled trial of SDD (parenteral cefotaxime, six-hourly oral and enteral polymyxin E, tobramycin, and amphotericin B vs placebo) for all infected patients presenting to the ICU requiring mechanical ventilation for more than 48 hours and ICU stay of more than 5 days. Daily clinical and microbiological monitoring for secondary infection was undertaken until hospital discharge. ⋯ The number of patients receiving SDD who developed nosocomial infections was significantly reduced (P = 0.048), and there were no infections caused by the enterobacteriaceae or Candida spp in this group. No difference in ICU (17.5 vs 18.8 days) or hospital stay (32.7 vs 34.2 days) or mortality (17% vs 22.3%) was shown. Critically ill, primarily infected patients are protected from nosocomial infection by the use of SDD.
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Anaesth Intensive Care · Apr 1995
Randomized Controlled Trial Clinical TrialCorrection of splanchnic oxygen deficit in the intensive care unit: dopexamine and colloid versus placebo.
Correction of the splanchnic oxygen deficit indicated by low gastric intramucosal pH (pHi < 7.35) appears to reduce ICU mortality. Dopexamine hydrochloride is in clinical use for this purpose but its efficacy has not been fully investigated. We report the results of a prospective, randomized, placebo-controlled study with a crossover design to assess the efficacy of dopexamine in correcting low pHi. ⋯ There was no difference in pHi between treatments despite cardiovascular effects during dopexamine infusion. There was, however, a time-related increase in pHi suggesting a beneficial effect of conventional therapy. Dopexamine hydrochloride at 4-6 micrograms/kg/min in conjunction with colloid is not a clinically useful therapy to correct the splanchnic oxygen deficit indicated by low pHi.
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Anaesth Intensive Care · Apr 1995
Inguinal field block for adult inguinal hernia repair using a short-bevel needle. Description and clinical experience in Solomon Islands and an Australian teaching hospital.
One of the limitations of an inguinal field block is that it does not reliably produce complete anaesthesia. The purpose of this study was to describe a modified short-bevel needle technique, facilitating correct needle placement, for inguinal hernia repair. Anaesthetists from two different institutions performed the described infiltration blocks. ⋯ Results of the modified inguinal field block showed a 97% ability to achieve a "fair" block or better. Intraoperative and postoperative data showed high surgeon and patient satisfaction for the block. The described block using a short-bevel needle is recommended as a suitable method for adult patients undergoing inguinal hernia repair.
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A survey of the incidence of postoperative vomiting in 1476 children was conducted over a two-month period as part of our quality assurance programme. The incidence of vomiting was 24%, and was highest in children over three years of age and in those receiving opioids. The incidence is lower than that recorded in an earlier (1981) survey in our hospital. Changes in anaesthetic practices may have contributed to this decrease.
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The concept of a Medical Emergency Team was developed in order to rapidly identify and manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions. The aim of this study was to describe the utilization and outcome of Medical Emergency Team interventions over a one-year period at a teaching hospital in South Western Sydney. ⋯ Alerting the team using the specific condition criteria occurred in 253/522 (48%) calls and on physiological/pathological abnormality criteria in 121/522 (23%) calls. Survival rate to hospital discharge following cardiopulmonary arrest was low (29%), compared with other medical emergencies (76%).