Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2003
Outcome prediction in a surgical ICU using automatically calculated SAPS II scores.
The objective of this study was to establish a complete computerized calculation of the Simplified Acute Physiology Score (SAPS) II within 24 hours after admission to a surgical intensive care unit (ICU) based only on routine data recorded with a patient data management system (PDMS) without any additional manual data entry. Score calculation programs were developed using SQL scripts (Structured Query Language) to retrospectively compute the SAPS II scores of 524 patients who stayed in ICU for at least 24 hours between April 1, 1999 and March 31, 2000 out of the PDMS database. The main outcome measure was survival status at ICU discharge. ⋯ The Hosmer-Lemeshow goodness-of-fit statistics showed good calibration (H = 5.55, P = 0.59, 7 degrees of freedom; C = 5.55, P = 0.68, 8 degrees of freedom). The technique used in this study for complete automatic data sampling of the SAPS II score seems to be suitable for predicting mortality rate during stay in a surgical ICU. The advantage of the described method is that no additional manual data recording is required for score calculation.
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Anaesth Intensive Care · Oct 2003
Case ReportsTerlipressin infusion in catecholamine-resistant shock.
Catecholamine-resistant shock is not uncommon in intensive care. Bolus dose terlipressin (a vasopressin analogue) has been used successfully in this setting allowing cessation of other vasopressor agents. ⋯ We describe a case report where the use of a continuous terlipressin infusion was associated with a dramatic improvement. To our knowledge there have been no previous reports of the use of terlipressin by continuous infusion for the treatment of catecholamine-resistant shock.
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Anaesth Intensive Care · Oct 2003
Case ReportsInadvertent subdural spread complicating cervical epidural steroid injection with local anaesthetic agent.
Although cervical epidural steroid injection with local anaesthetic is considered a safe technique and widely practiced, complications may occur. We report a patient experiencing unexpected delayed high block, moderate hypotension and unconsciousness eight to ten minutes after an apparently normal cervical epidural steroid injection. ⋯ Anatomical peculiarities of the epidural and subdural space in the cervical region increase the risk of subdural spread during cervical epidural injection. Fluoroscopic guidance is important during cervical epidural injection to increase certainty of correct needle placement, thus minimizing the risk of complications.
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Anaesth Intensive Care · Oct 2003
Case ReportsFailed extubation of a double-lumen tube requiring a cricoid split.
Following a five-hour procedure, it was not possible to remove a double-lumen endobronchial tube that had been placed to facilitate the removal of a massive spleen from a 45-year-old female. The tube had been passed easily at the start of surgery, but was firmly stuck at the level of the cricoid at the end of surgery. Surgical removal of the tube by a cricoid split was required 48 hours later. Consideration of previous airway manipulations, careful choice of airway devices and regular checks of airway patency around tracheal tubes during lengthy procedures may prevent similar events in the future.
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Anaesth Intensive Care · Oct 2003
Randomized Controlled Trial Comparative Study Clinical TrialEpidural catheter migration: a comparison of tunnelling against a new technique of catheter fixation.
We investigated the efficacy of a new technique of epidural catheter fixation that relies on a strip of adhesive foam transfixed by a securing suture. We compared this technique to a tunnelled technique in a prospective, randomized trial (n = 25 in each group). Epidural catheter depth was recorded at the time of insertion and at the time of removal. ⋯ Clinically significant movement was noted in eight patients (32%) in the tunnelled group and seven patients (28%) in the sutured group (P = 0.75). Movement of the epidural catheter did not correlate with analgesic failure. The sutured technique provided similar protection against migration to tunnelling but any potential advantages were offset by concerns about a significantly higher incidence of erythema around the catheter exist site in the sutured group (1 vs 6 patients, P = 0.04).