Anaesthesia
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This audit study took place in ten outpatient pain clinics and focused on the management of low back pain and nerve-damage pain. The objective was to identify and promote appropriate changes in management. An analysis of the treatment of 1236 patients with low back pain and/or nerve-damage pain highlighted wide variations in practice. ⋯ Many changes in practice occurred after the audit intervention, with large increases in the utilisation of these three treatments. Since there is reasonable evidence to support the use of these treatments for chronic pain this represents an improvement in the process of care. The audit demonstrated that patient management can be improved by a combination of active feedback and discussions based around comparisons between centres.
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Bleeding caused by inhibitors to factor VIII is a rare medical emergency requiring immediate specialist investigation and management. Urgent initiation of therapy with high dose factor VIII concentrates may be life saving. Successful management of acute upper airway obstruction from uncontrolled haemorrhage into the oropharyngeal tissues should be achieved with fibreoptic guided nasotracheal intubation.
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Case Reports
The use of a non-invasive method to measure intrapulmonary shunt during one-lung anaesthesia.
The Non Invasive Virtual Shunt computer program has previously been described and validated. The system has subsequently been developed to give a real time, continuous trace of virtual shunt. ⋯ The equipment was used to monitor shunt before, during and after surgery in three patients. In one case, a displaced double lumen bronchial tube was detected before there was any other indication of the problem.
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Arteriovenous fistulae originating from the vertebral artery are rare. We report a patient in whom a vertebral artery-jugular venous fistula developed following insertion of a central venous catheter via the internal jugular vein. The fistula was successfully occluded surgically.