Anaesthesia and intensive care
-
Anaesth Intensive Care · Dec 1994
Training, skills and approach to potentially difficult anaesthesia in general practitioner anaesthetists.
Seventy-six of the 92 practising South Australian rural general practitioner anaesthetists responded to a questionnaire on anaesthetic training, skills and approach to potentially difficult anaesthesia. The mean training period in anaesthesia was 7.5 months, 24% at registrar level. Eight per cent had no training, and 40% had 3 months or less. ⋯ Patients classified as ASA grade 3 to 5, disease states such as unstable angina, severe asthma, and risk factors such as skeletal myopathy, were avoided by most general practitioners. The failed intubation rate was 50/10,000. The conclusion is that South Australian general practitioner anaesthetists exhibit a generally safe approach to selection of patients for anaesthesia, although in some instances the approach to potentially difficult anaesthesia should be more conservative.
-
Anaesth Intensive Care · Dec 1994
Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography.
Using both conventional laboratory clotting profile and thrombelastography, coagulation status was monitored intraoperatively during liver transplantation in the first 75 cases performed at the Austin Hospital between June 1988 and October 1992. Superimposed on a baseline coagulopathy due to liver disease is a specific pattern of coagulation disturbance which occurs during a liver transplant. Fibrinolysis occurs in the anhepatic stage, worsens with early reperfusion and then spontaneously resolves. ⋯ It is particularly useful in liver transplant surgery. In combination with clinical bleeding assessment it facilitates selective use of component therapy (fresh frozen plasma, platelets and cryoprecipitate) and specific drug treatment only when it is appropriate. It also acts as a liver function test, being especially useful in assessing the graft after reperfusion.
-
Anaesth Intensive Care · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialComparison of patient-controlled analgesia and nurse-controlled infusion analgesia after cardiac surgery.
A randomized, controlled clinical trial was conducted on 72 patients undergoing elective cardiac surgery to compare patient-controlled analgesia (PCA) to nurse-titrated infusion of morphine. Pain and nausea scores were assessed at 5, 20, 32 and 44 hours after cardiopulmonary bypass. Serum cortisol estimations were performed at 24 and 48 hours, and morphine consumption was measured at 0-24 and 24-48 hours. ⋯ There was a significant association between pain and serum cortisol at 48 hours (P = 0.023). This study also found a tenfold difference in the amount of morphine used (range = 11 to 108 mg), with no significant association with patient age or sex. We could find no significant benefit from the routine use of PCA in cardiac surgical patients.
-
It is now clear that "seizure activity", excitatory phenomena, and/or a disorder of muscle tone are potential complications of the use of propofol. Whether this "seizure activity" is primarily, secondarily, or not at all a cerebral cortical event is still to be elucidated. Clearly propofol does have anticonvulsant activity, and also clearly it can produce an involuntary movement disorder, in certain patients, under certain conditions. ⋯ In the clinical setting, the reporting of seizures possibly related to propofol should include--medical history, including personal or family history of epilepsy and movement disorders; a history of previous anaesthetics and whether propofol was used; regular medications; use of drugs or alcohol; history of chemical dependency; emotional state prior to induction; presence of hyperventilation or fever; a description of the alleged seizure, including rate of administration of propofol and amount given, time of onset of seizure in relation to time of drug administration, speed of onset of signs, quality of the abnormal movements, part of body involved, duration, any indication of a postictal state, any cardiovascular changes which may have accompanied the seizure, and any other possible triggers for the reaction such as other drugs used, including premedication; post seizure investigations including temperature, blood sugar, electrolytes, arterial gas analysis, neurological examination, EEG and CT scan. These actions and these investigations concerning propofol should not be delayed. It would appear appropriate to recommend to patients who experience apparent convulsive phenomena after propofol that they not be re-exposed to the drug.