Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2006
Data linkage enables evaluation of long-term survival after intensive care.
Outcomes of intensive care are important to the patient and for assessment of benefit. Short-term outcomes after critical illness are well described, but less is known about long-term outcomes. This study describes the use of data linkage, combining intensive care unit (ICU) clinical data with administrative morbidity and mortality data, to assess long-term outcomes after treatment in ICU. ⋯ Age, type of admission, severity of illness (measured by Acute Physiologic and Chronic Health Evaluation (APACHE) II and the presence of organ failure), ICU length of stay, comorbidity (Chronic Health Evaluation and Charlson comorbidity index) and ICU admission diagnosis, were all associated with survival at 1, 3, 5, 10, and 15 year follow-up (P<0.001 at all time points). Linkage of clinical and administrative data provides a feasible method for ascertaining long-term survival after critical illness. Age, admission severity of illness, diagnosis and comorbidity influenced long-term unadjusted survival.
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Anaesth Intensive Care · Jun 2006
Biography Historical ArticleBrian Dwyer and the St. Vincent's Pain Clinic 1962 to 1989.
Brian Dwyer was the Director of the Department of Anaesthetics at St. Vincent's Hospital in Sydney from 1955 to 1985. He developed a major interest in the management of intractable pain and was most impressed by the multidisciplinary pain clinic which was commissioned at the University of Washington in Seattle by John Bonica in 1960. ⋯ As a result of his work, Brian Dwyer received international recognition as a pioneer in the field of chronic pain management and the St. Vincent's Pain Clinic served as a model for the establishment of similar units, both in Australia and overseas. Brian Dwyer was the first chairman of the Clinic and remained in that position until his retirement in 1989.
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Anaesth Intensive Care · Jun 2006
Randomized Controlled Trial Comparative StudyComparison of remifentanil and fentanyl in anaesthesia for elective cardioversion.
This prospective, randomized, double-blind study was designed to compare the recovery characteristics of remifentanil and fentanyl in combination with propofol for direct current cardioversion. Patients undergoing elective cardioversion received either intravenous fentanyl 1 microg/kg (n=33) or remifentanil 0.25 microg/kg (n=30) and propofol was titrated to a Ramsay sedation score of 5 by slow intravenous injection. ⋯ Side-effects and patient discomfort were similar for both groups. Remifentanil can be used as a suitable supplement to propofol for direct current cardioversion and may provide a faster recovery profile than fentanyl.
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Anaesth Intensive Care · Jun 2006
Randomized Controlled Trial Comparative StudyRecovery after prolonged anaesthesia for acoustic neuroma surgery: desflurane versus isoflurane.
In this study, 33 patients were randomly assigned to receive desflurane (D) or isoflurane (I) for acoustic neuroma surgery. The time from end of the procedure to spontaneous breathing, extubation, eye-opening, hand-squeezing to command, and ability to state name, birthdate and phone number were recorded. The Steward recovery score was also recorded every five minutes during the first 20 minutes postoperatively and then every 10 to 15 minutes. ⋯ Steward recovery scores were also better during the first postoperative hour in the D group (D: 40 min vs I: 90 min, P<0.005 for 100% of patients with Steward score of 6). The results indicate that desflurane is associated with similar operating conditions and faster postoperative recovery following acoustic neuroma surgery. The faster recovery following desflurane may be desirable after long surgical procedures, enabling the patient's full cooperation and facilitating early diagnosis of any potential neurological deficit.