Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 2005
Postoperative pain management following bilateral lung volume reduction surgery for severe emphysema.
This study was conducted to audit the clinical management of a continuous local anaesthetic infusion delivered by a fluoroscopically placed thoracic epidural catheter in conjunction with supplemental intravenous opioid patient controlled analgesia for postoperative pain control following bilateral lung volume reduction surgery for severe emphysema. This retrospective case series involved a random sample of 43 patients from a possible 65 patients. The mean dose of epidural bupivacaine 0.15% was 6.7 ml/h (SD 1.5), while the mean daily dose of morphine or hydromorphone was 22.5 mg/day (SD 17.9) and 4.3 mg/day (SD 3.1), respectively. ⋯ The incidence of atrial fibrillation (n = 6), premature epidural catheter dislodgement (n=6) or respiratory failure (n=3) appeared to be greater among patients who had inadequate analgesia at some stage. One patient developed excessive sedation; otherwise, there were no major complications. The use of an epidural bupivacaine infusion in conjunction with intravenous opioid patient controlled analgesia proved to be a safe and effective pain medication regimen when accompanied by individual titration of these agents in response to acute exacerbations of postoperative pain.
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Anaesth Intensive Care · Oct 2005
Clinical TrialCost-effectiveness of basal flow sevoflurane anaesthesia using the Komesaroff vaporizer inside the circle system.
After ethics committee approval, 51 consenting ASA physical status 1 or 2 adult patients were given basal flow sevoflurane anaesthesia using fresh gas flows of 150 to 300 ml x min(-1) oxygen. A Komesaroff vaporizer was placed on the inspiratory limb of the circle system. Basal flows were introduced immediately following intravenous induction of anaesthesia. ⋯ The trends in FSI and the expired sevoflurane concentrations were significantly different (P<0.05) between the mechanically ventilated patients (n=21) and the spontaneously ventilating patients (n =30) and demonstrated a more gradual build-up in the former group. The consumption of sevoflurane was found to be 9.2 (2.8) ml x h(-1). This represented a 52.5% cost saving over the clinical application of the Mapleson's ideal fresh gas flow sequence for low-flow anaesthesia.
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Anaesth Intensive Care · Oct 2005
Case ReportsDifficult intubation managed using standard laryngeal mask airway, flexible fibreoptic bronchoscope and wire guided enteral feeding tube.
This case report describes an alternative method of achieving trans-oral intubation in a patient with a difficult airway who was apnoeic secondary to the therapeutic administration of a non-depolarizing neuromuscular blocking drug given to aid laryngoscopy. After attempts to intubate were unsuccessful by means of direct laryngoscopy utilizing various aids including bougies, a standard laryngeal mask airway was used to ventilate the patient and subsequently, with a swivel Y-connector attached in order to maintain PEEP, to aid the passage of a bronchoscope. ⋯ The technique described permitted the continuous application of positive airway pressure, which dramatically improved the bronchoscopic view during the crucial step of placing the guide-wire into the trachea. Passing the feeding tube over the guide-wire aided the subsequent passage of the endotracheal tube, by acting as a stiffer and larger diameter guide through the glottis.
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Anaesth Intensive Care · Oct 2005
The frequency of and indications for general anaesthesia in children in Western Australia 2002-2003.
We conducted a retrospective database search of the Hospital Morbidity Data System at the Health Department of Western Australia to determine the number of anaesthetics given to children aged 16 years or less in Western Australia over a twelve-month period. Information was also collected to assess the types of surgery for which anaesthesia was being provided, and the categories of hospital in which children were being anaesthetized. We found that 28,522 anaesthetics were given to 24,981 children, and 2,462 (9.9%) children had more than one anaesthetic. ⋯ The most common category of hospital that children were anaesthetized in was private metropolitan (40%) followed by tertiary (38%), rural (14%) and public metropolitan (8%). One thousand, seven hundred and seven children aged less than one year were given an anaesthetic. These anaesthetics were most frequently given to children in tertiary hospitals (62%) followed by private metropolitan (30%), public metropolitan (6%) and rural hospitals (2%).
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The Western Australian Anaesthetic Mortality Committee has collected data since 1980. During this time, reporting of anaesthesia mortality has been mandatory in Western Australia, confidentiality and legal protection have been ensured, consistent definitions and classifications have been used, and reasonable estimates have been available for the number of surgical procedures performed. ⋯ At present, the rates are extremely low (< 1:50, 000 surgical procedures per annum), and similar to rates reported from other Australian states. While these figures are encouraging, their main function is to serve as the baseline for further improvements.