Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 1999
Case ReportsBilevel non-invasive ventilation in malignant large airways obstruction during chemotherapy and radiotherapy.
A case is described of acute respiratory failure secondary to variable intrathoracic large airway obstruction due to a lung neoplasm. Successful ventilation was achieved with facemask bilevel non-invasive ventilatory assistance allowing radiotherapy and chemotherapy to be undertaken.
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Anaesth Intensive Care · Jun 1999
Case ReportsRecent experiences with hexadimethrine for neutralizing heparin after cardiopulmonary bypass.
Hexadimethrine bromide was used for the neutralization of heparin during cardiac surgery in the late 1950s. For some years, this institution has used it for patients who may be allergic to protamine. In view of the recent renewal of interest in hexadimethrine, we present four cases outlining its use during cardiac procedures in such patients. Other drugs for reversing the action of heparin such as heparinase or platelet factor IV are not yet widely available.
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Anaesth Intensive Care · Jun 1999
Anaesthetic assistants: their role in the development and resolution of anaesthetic incidents.
Trained anaesthetic assistants are considered essential for the safe conduct of anaesthesia. Data from 5837 AIMS (Anaesthetic Incident Monitoring Study) reports were evaluated for issues concerning anaesthetic assistants in the generation and resolution of anaesthetic incidents. "Inadequate assistance" as a contributing factor was identified in 187 reports, whilst "skilled assistance" which minimized the incident was present in 808 cases. One hundred and seventy-two reports specifically commented on anaesthetic assistants in the narrative section of the AIMS form. ⋯ Although the majority of outcomes from the reports were uneventful, prolonged stay, awareness and ICU admission did ensue in a small number of cases. The most common incidents were related to problems with equipment, communication and inadequate staffing levels (number and/or skill mix). Results from this study have implications for anaesthetic assistant staffing levels and the orientation of course content.
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Anaesth Intensive Care · Jun 1999
Auditory recall and response to command during recovery from propofol anaesthesia.
Most studies of awareness under general anaesthesia use the ability to respond to a verbal command as the primary measure of consciousness. The aim of this pilot study was to discover whether it was possible for subjects recovering from a propofol general anaesthetic to experience conscious awareness without the capability of responding to verbal command. Ten healthy volunteers received an intravenous propofol infusion (1500 mg/hr) until they were no longer conscious. ⋯ Seven of the subjects were able to remember numbers corresponding to times 10 to 40 seconds before they responded to verbal command. In none of these subjects was there recall of the number 30 minutes later. We concluded that there is an ability to have conscious awareness of auditory input without necessarily being able to demonstrate this by responding to verbal command.
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Anaesth Intensive Care · Jun 1999
Case ReportsAntenatal and preoperative genetic and clinical assessment in myotonic dystrophy.
The antenatal investigation of an obstetric patient with a history of myotonia is described. The smooth and striated muscle dysfunction in myotonic dystrophy renders these patients, as a group, liable to surgical correction and exposure to anaesthesia. A caesarean section is reported to illustrate the preferred timing of diagnosis and peripartum management. While regional anaesthesia is preferred, myotonic dystrophy is not a contraindication to general anaesthesia, provided risks are anticipated and steps taken to minimize complications.