Anaesthesia and intensive care
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Anaesth Intensive Care · Aug 2007
Systemic anticoagulant effect of low-dose subcutaneous unfractionated heparin as determined using thrombelastography.
In an observational study using heparinase-modified thrombelastography, we investigated the percentage of elective cardiothoracic surgical patients receiving low-dose unfractionated heparin (5000 IU 12 hourly subcutaneously) who had a demonstrable systemic heparin effect. Blood samples were obtained at induction from 40 adult elective cardiothoracic surgical patients who had received 5000 IU unfractionated heparin subcutaneously within six hours. Simultaneous kaolin and heparinase-modified thrombelastographies were run on all samples. ⋯ In a post hoc analysis, there was little correlation between the extent of the prolongation and patient age (r = 0.02), weight (r = -0.31), preoperative creatinine (r = -0.17), or time since administration of heparin (r = 0.14). These results indicate that about one third of patients who have received low-dose unfractionated heparin subcutaneously within six hours have a demonstrable heparin effect. The potential for this effect should be considered if central neural blockade is planned.
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Anaesth Intensive Care · Aug 2007
Patients' knowledge of the qualifications and roles of anaesthetists.
Patients' knowledge of anaesthetists' qualifications and roles remains inaccurate despite the efforts of professional bodies worldwide. However, patients have not been surveyed on this subject in Australia for more than 20 years. We therefore surveyed 200 patients attending the pre-admission clinic prior to elective non-cardiothoracic surgery in an Australian teaching hospital to determine current knowledge. ⋯ Younger age, an English-speaking background and previous experience with surgery predicted knowledge of anaesthetists' qualifications. Most patients believed that anaesthetists work in the operating theatre and are continually present during surgery, but few recognised their leading role in the care of patients during surgery or their other roles outside the operating theatre. Increased efforts are required to inform patients about the roles of anaesthetists in their care.
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We undertook an audit of 49 consecutive hemipelvectomies performed for primary or secondary malignancy. Combined epidural and general anaesthesia was used in 41 patients. The operations were long (range 90 to 600 minutes). ⋯ There was significant utilisation of resources involving anaesthesia, surgery, intensive care and blood transfusion services. Anaesthesia for hemipelvectomy is challenging because of the extensive tissue trauma involved, the potential for massive blood loss and the potential for severe postoperative pain. The perioperative management necessitates care from a well coordinated, directed and focused healthcare team.
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Anaesth Intensive Care · Aug 2007
Patterns of sevoflurane use in a children's hospital: the effects of a simple educational intervention.
We conducted a prospective observational study of sevoflurane use over a four-week period at our tertiary referral children's hospital. Sevoflurane vaporisers were weighed before and after all general anaesthesia sessions and anaesthesia time intervals recorded. Midway through the audit, the initial findings were presented to the department with a brief reminder of ways to reduce sevoflurane use. ⋯ Clinicians can be relatively complacent about financial accountability. In this study, a simple educational reminder halved sevoflurane use in the short term. This study suggests that specific reminders or recommendations about anaesthetic technique in the induction rooms may be indicated.
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Anaesth Intensive Care · Aug 2007
Continuous venovenous haemofiltration using a citrate buffered substitution fluid.
Different methods of regional anticoagulation using citrate in continuous renal replacement therapy have been described in the past. However, these procedures were usually very complex or did not reach modem requirements for effective continuous renal replacement therapy. Furthermore, little is known about long-term acid-base stability and citrate levels during the treatment. ⋯ Predilution, citrate-based substitution fluid provides both anticoagulation within the extracorporeal circuit and control of acid-base balance in critically ill patients at risk of bleeding in acute renal failure. It is easy to apply and safe. Clearance can be varied as long as a constant ratio between blood and substitution flow is maintained.