Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1999
Estimation of alveolar deadspace fraction using arterial and end-tidal CO2: a factor analysis using a physiological simulation.
The alveolar deadspace as a fraction of alveolar ventilation (VDalv/VTalv), while technically difficult to measure, is an objective monitor of pulmonary disease progression and a predictor of successful weaning from mechanical ventilation. The aim of the study was to examine the relationship between the arterial to end-tidal PCO2 gradient (Pa-E'CO2) and VDalv/VTalv and between (Pa-E'CO2)/PaCO2 and VDalv/VTalv using the Nottingham Physiology Simulator, an original, validated physiology simulation. ⋯ The relationship between (Pa-E'CO2)/PaCO2 and VDalv/VTalv (best fit: VDalv VTalv = 1.135 x (Pa-E'CO2)/PaCO2-0.005) during normal physiological conditions was approximately linear and less influenced by physiological variation. Shunt and anatomical deadspace caused some inaccuracy, although they are unlikely to prevent the clinical usefulness of this formula.
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Anaesth Intensive Care · Oct 1999
Case ReportsRemifentanil in emergency caesarean section in pre-eclampsia complicated by thrombocytopenia and abnormal liver function.
We describe the use of remifentanil in a woman with severe pre-eclampsia who presented for emergency caesarean section. Remifentanil was effective in obtunding the hypertensive response to laryngoscopy and intubation. ⋯ With its short duration of action, the use of this new opioid has several potential advantages in the above setting. Further studies are required to explore the use of remifentanil as an adjunct to obstetric general anaesthesia.
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Anaesth Intensive Care · Oct 1999
Biography Historical ArticleRupert Walter Hornabrook--Australia's first full-time anaesthetist.
Rupert Walter Hornabrook, born in 1871, was the first physician in Australia to devote his medical practice solely to anaesthesia. He was appointed to the Royal Melbourne Hospital in 1909, after an adventurous earlier career which ranged from service in plague hospitals in India to the Boer War in South Africa. Hornabrook was a colourful character whose work in anaesthesia included popularizing the use of the ethyl chloride-ether sequence in the early 1900s, when chloroform and closed inhalers were the norm. He was also a vigorous campaigner for the recognition of anaesthesia as a branch of medicine in its own right.
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Anaesth Intensive Care · Oct 1999
Ruptured abdominal aortic aneurysm--outcome in a community teaching hospital intensive care unit.
Ruptured abdominal aortic aneurysm (RAAA) is a surgical emergency associated with a high mortality often requiring postoperative intensive care. Our objectives were to assess the outcome of RAAA management in a nontertiary community hospital intensive care unit (ICU) and to compare this with historical data from tertiary hospitals. We also sought to identify variables related to outcome and evaluate the potential of an organ failure score to identify patients at increased risk of death. ⋯ A trend was also found between mortality rate and the number of failed systems after 48 hours intensive care stay. Mortality for a patient with zero failed systems was 38%, one failed system 42%, two 58% and three 67%. Based on these results, management of RAAA in a non-tertiary setting appears appropriate with postoperative care occurring in an ICU where there is adequate equipment and medical and nursing staff experienced in the care of complex critical illness.
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Anaesth Intensive Care · Oct 1999
Reduction of preoperative investigations with the introduction of an anaesthetist-led preoperative assessment clinic.
Preoperative investigations, when used to screen for disease not clinically evident, have been shown to be unnecessary. The aim of this study was to rationalize the ordering of preoperative investigations by introducing guidelines and screening all investigations ordered at a new Day of Surgery Admissions clinic. Two hundred and one elective general and ear, nose and throat (ENT) patients attending this clinic at Sir Charles Gairdner Hospital from July to September 1997 were induced in a prospective study group. ⋯ There were significant reductions in most types of investigations (electrocardiogram, chest X-ray, liver function tests, urea and electrolytes, full blood examination, coagulation profile) ordered with the Day of Surgery Admissions clinic intervention. This resulted in an estimated reduction of preoperative investigation costs by 38%. It was concluded that the clinic intervention was associated with a reduction in indiscriminate preoperative investigation ordering patterns.