Anaesthesia and intensive care
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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
Randomized Controlled Trial Clinical TrialCorrelation and linear regression between blood pressure decreases after a test dose injection of propofol and that following anaesthesia induction.
Propofol reduces systemic vascular resistance and suppresses cardiac function when injected rapidly. In this study we investigated whether blood pressure decrease after a minimal dose (test-dose) injection of propofol correlates with that after an induction-dose injection. Patients were randomly divided into two groups; anaesthesia was induced in group A (n = 60) using 1.5 mg/kg propofol and in group B (n = 61) using 2.0 mg/kg. ⋯ In both groups, blood pressure after induction was significantly lower than the control value (P < 0.05). In both groups, a positive correlation was observed between blood pressure reduction after the minimal dose injection and that after the induction-dose injection [P < 0.01, R value for systolic blood pressure correlation in group A 0.712 (P < 0.01) and in group B 0.758 (P < 0.01)]. We concluded there was a positive correlation between blood pressure reduction after a minimal (test-dose) injection and that after an induction-dose injection.
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The ability of intensive care to replace or support vital organ function has resulted in some patients surviving for long periods of time without improvement or a terminal event. In patients with no realistic chance of survival, decisions to withdraw or withhold life-sustaining therapies are commonly made. Withdrawal of life support at the patient's request is lawful at common law and, in some states of Australia, by legal statute. ⋯ However much weight is frequently placed on the wishes of the family. Disagreements between family and clinicians over decisions to withdraw therapy are unusual and generally resolve over time. However if disagreement persists, it may be advisable to apply to the courts for a declaratory judgement, given the tenuous legal basis of withdrawal of life-sustaining therapy in Australia and the uncertainty over the courts' view of the role of the patient's family in the decision-making process.
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Anaesth Intensive Care · Oct 2003
Withholding and withdrawal of therapy in patients with acute renal injury: a retrospective cohort study.
The incidence of withholding and withdrawal of therapy in the setting of multi-organ failure in critically ill patients has increased. Epidemiological data on the decision-making process of withholding or withdrawal of therapy from Australian and New Zealand intensive care units is sparse. We examined the clinical and electronic records of 179 consecutive patients, admitted to the ICU between 1st January 2000 and 31st December 2001, who had acute renal injury. ⋯ This was likely to be due to an older age of our cohort, rapid progressive nature of the acute disease, a different clinical approach to treating critically ill elderly patients, or a combination of these factors. This pattern of practice was quite different from those reported from ICUs in other parts of the world. A prospective multi-centre observational study will clarify the pattern of practice in this important area of intensive care practice in Australasia.
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Anaesth Intensive Care · Oct 2003
Incident reporting in anaesthesia: a survey of practice in New Zealand.
A postal survey of anaesthetists practising in New Zealand assessed their practice and attitudes to anaesthetic incident reporting. 136 replies were received (57% response rate). Respondents indicated a high awareness of the Anaesthetic Incident Monitoring Study (AIMS) based incident monitoring yet individual utilization may be declining due to a perception that this system is ineffective. Seventy-five per cent of respondents used AIMS forms in their current institute, whilst 87% had at some time completed an AIMS form. ⋯ Almost half the anaesthetists felt that the AIMS reporting system had changed their practice. Common concerns with the system included a need to simplify the reporting process and to ensure that information is managed to provide a useful outcome. This study suggests that incident reporting in its present form needs to be re-evaluated in light of changing priorities in anaesthesia quality improvement activities.