Anaesthesia and intensive care
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All female members and a randomly selected group of male members of the Australian Society of Anaesthetists (n = 488) were surveyed by questionnaire as part of a broader study of gender issues in anaesthesia. This paper reports on reasons for career choice and the importance of role models. Responses were received from 199 women and 98 men (60.9% of those surveyed), representing all States and one Territory. ⋯ Other important factors in career choice were the application of physiology and pharmacology in patient care, practical and procedural aspects of practice, and chance. A majority of women (56%) and men (55%) named specific role models who were influential and encouraging in their choice. These results are similar to those of other studies.
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Anaesth Intensive Care · Jun 2002
Review Comparative StudyHigh dependency units: issues to consider in their planning.
This review discusses the issues to be considered in establishing new or extending existing high dependency unit (HDU) services. A defined high dependency service becomes cost-effective when patient care requires more than one nurse for three patients. Professional guidelines for HDUs vary and there are no national accreditation criteria. ⋯ Establishing a new HDU service requires changes to care delivery. Many potential HDU patients are currently managed in general wards or in the intensive care unit. The service should be discussed widely and marketed within the institution, and the development of defined working relationships with the ICU and primary care teams on the wards is mandatory.
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Anaesth Intensive Care · Jun 2002
Randomized Controlled Trial Comparative Study Clinical TrialRopivacaine 7.5 mg/ml versus bupivacaine 5 mg/ml for interscalene brachial plexus block--a comparative study.
We investigated ropivacaine 75 mg/ml in comparison with bupivacaine 5 mg/ml in patients receiving interscalene brachial plexus block (ISB) and general anaesthesia. In this randomized, double-blind, prospective clinical trial, each patient received an ISB block according to the technique originally described by Winnie and a catheter technique as per Meier. The rapidity of onset and the quality of sensory and motor block were determined. ⋯ There were no significant differences in terms of onset and quality of sensory or motor block during the intraoperative and early postoperative period. In addition we did not identify any side-effects related to the administration of the local anaesthetics. Ropivacaine 7.5 mg/ml and bupivacaine 5mg/ml proved to be nearly indistinguishable when administered for interscalene brachial plexus block.
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Anaesth Intensive Care · Jun 2002
Comparative StudyImplementation and evaluation of guidelines for preoperative testing in a tertiary hospital.
The aim of this study was to determine the extent of unnecessary investigation performed as part of the preoperative preparation of elective surgical patients in a teaching hospital and to audit the effect of guidelines and education designed to reduce unnecessary investigation. Guidelines were developed for preoperative anaesthetic investigation for elective surgical procedures in patients over one year of age according to internationally accepted criteria, with some adjustment for local differences in patient morbidity. Forrms outlining these criteria were placed in all operating theatres and anaesthetists were asked to determine whether tests performed were indicated or not, according to these criteria, over a two-week period, in each patient undergoing elective surgery. ⋯ The audit was repeated six months later and results compared. The incidence of over-investigation decreased from 13.8% to 11.6% (P = 0.03) without a significant increase in under-investigation (0.7 v 1.0%; P = 0.2). This study highlights the incidence of unwarranted screening tests in patients presenting for elective surgery and the role of protocols and ongoing education in reducing this incidence.
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Ketamine hydrochloride is a safe and rapid-acting non-opioid, lipid soluble anaesthetic with a short elimination half-life that is used for medical and veterinary purposes. It produces a state of "dissociative anaesthesia", probably from action on N-methyl-D-aspartate (NMDA) receptors. The psychotropic effects of ketamine range from dissociation and depersonalization to psychotic experiences and include a sensation of feeling light, body distortion, absence of time sense, novel experiences of cosmic oneness and out-of-body experiences. ⋯ This case demonstrates the effects of large doses of ketamine in a person with polysubstance abuse. The case also highlights development of significant tolerance to ketamine without prominent withdrawal symptoms. Caution in use of ketamine is reiterated in light of its abuse liability.