Anaesthesia and intensive care
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The records of six hundred and fifty-five patients treated in the Dental Day-Stay Unit over a twelve-month period were reviewed. 2.1% of 95 patients assessed as suitable for day-stay surgery, and 2.2% of 542 patients not assessed prior to anaesthesia were admitted postoperatively. As an index of outcome, 2.56% of 547 day cases were admitted postoperatively, 0.73% being attributable to anaesthesia. Forty-seven day patients were treated in the dental chair, and 108 were treated as inpatients. ⋯ Guidelines for day-care selection require that the procedure be straightforward, the patient medically fit, be discharged escorted, and live within a reasonable distance of the hospital. From our study, four specific patient groups are identified. These are: the young and healthy, the mentally handicapped, the medically compromised, and those with airway problems.
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Although sophisticated intensive care units have become universal in major public hospitals in Australia, this complex and expensive form of patient care is usually not available in independent private hospitals. Such a unit was recently established in a large private hospital which had expanded its facilities to encourage major surgery and its admission policies to include complex specialist medical problems. The unit's organisation included an appropriate physical area, comprehensive equipment, skilled nursing staff, resident medical staff, accredited medical specialists, and a common set of policies and protocols. ⋯ Unit mortality was 3.3% and hospital mortality 6%. Patients were similar in age and sex distribution to those admitted to an intensive care unit in a public hospital but their numbers, type of illness, duration of admission and mortality differed. Despite the feasibility of establishing a sophisticated intensive care unit in a private hospital, there were potential problems related to staffing (especially insufficient numbers of trained nurses), funding (especially inadequacy of hospital and medical insurance and unavailability of many drugs on the Government's Schedule of Pharmaceutical Benefits) and relations with medical staff outside the unit.
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A review of 9401 consecutive live births at the Mercy Maternity Hospital, Melbourne, was performed to determine the incidence of air leak in those with respiratory distress syndrome. Respiratory distress was detected in 552 (5.9%) infants and hyaline membrane disease was the most common cause occurring in 238 (2.5%) infants. ⋯ Ninety-five per cent of air leak developed in infants with hyaline membrane, and these were smaller, less mature and sicker than those without air leak. Eighty-seven per cent of air leak developed in infants treated with assisted ventilation and was commoner with mechanical ventilators with a more rapid rise in inspiratory pressure.