Anaesthesia
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Comment Letter Case Reports
Blocked epidural catheter: time to look beyond the catheter.
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomised crossover comparison of patient-controlled sedation and patient-maintained sedation using propofol.
This randomised, crossover study compared patient-controlled sedation using boluses of propofol and patient-maintained sedation using a target-controlled infusion of propofol. Twenty-three patients aged 18-35 years having surgical removal of bilateral third molar teeth under local anaesthesia during two separate visits were studied. In the majority of patients, both techniques provided moderate sedation, good operating conditions, stable physiological parameters and a high degree of patient satisfaction. ⋯ The time taken for titration to adequate sedation was longer with patient-maintained sedation than with patient-controlled sedation [mean (SD) = 8.6 (3.7) min vs. 5.7 (3.1) min, p < 0.005]. The mean overall propofol consumption was similar with both techniques. The majority of patients preferred patient-maintained sedation to patient-controlled sedation, p < 0.05.
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A postal survey was sent to specialist anaesthetists in Australia looking at aspects of job satisfaction, dissatisfaction and stress. Burnout was measured using the Maslach Burnout Inventory. The response rate was 60% (422/700) with the majority of respondents being male (83%). ⋯ Private practitioners rated time issues of high importance compared with public hospital doctors, whereas public hospital doctors rated communication problems as being more significant than with private specialists. Although burnout levels are high in anaesthetists, they compare favourably with other medical groups. There are, however, aspects of the anaesthetist's job that warrant further attention to improve job satisfaction and stress.
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Using average number of patients expected in a year, average length of stay and a target occupancy level to calculate the number of critical care beds needed is mathematically incorrect because of nonlinearity and variability in the factors that control length of stay. For a target occupancy in excess of 80%, this simple calculation will typically underestimate the number of beds required. ⋯ The combination of appropriately analysing raw data and detailed mathematical modelling provides a much better method for estimating numbers of beds required. We describe this modelling approach together with evidence of its performance.