Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2008
Case ReportsFracture of an epidural catheter inserted for labour analgesia.
A primiparous 28-year-old woman undergoing augmentation of labour requested epidural analgesia. During the apparently uneventful insertion, the catheter snapped and a fragment was retained in her back. The management options for labour analgesia, the optimal methods of locating the retained fragment and the indications for surgical removal are discussed.
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Anaesth Intensive Care · Mar 2008
Review Historical ArticleThe role of extracorporeal membrane oxygenation for treatment of the adult respiratory distress syndrome: review and quantitative analysis.
The role of extracorporeal membrane oxygenation (ECMO) has not been formally validated for patients with adult respiratory distress syndrome. In anticipation of publication of the conventional ventilation versus ECMO in severe adult respiratory failure (CESAR) trial, the role of ECMO in this setting was reviewed. An electronic search for studies reporting the use of ECMO for the treatment of adult respiratory distress syndrome revealed two randomised controlled trials and three non-controlled trials. ⋯ ECMO, as rescue therapy for adult respiratory distress syndrome, appears to be an unvalidated rescue treatment option. Analysis and review of trial data does not support its application; however the body of reported cases suggests otherwise. Until the CESAR trial provides an authoritative answer ECMO will continue to be offered on a case by case basis.
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Anaesth Intensive Care · Mar 2008
The use of Lee and co-workers' index to assist a risk adjusted audit of perioperative cardiac outcome.
Lee and co-workers' revised cardiac risk index was used to study the perioperative cardiac outcome of 296 patients. The index uses a history of ischaemic heart disease, congestive cardiac failure, diabetes treated with insulin, a creatinine greater than 180 micromol/l, cerebrovascular disease and high risk surgery as the risk factors involved in predicting a perioperative cardiac event. ⋯ In our audit of 296 patients we observed a cardiac event rate of 0.8% (95% CI 0 to 2.3%), 6.7% (95% CI 1.6 to 10%) and 2% (95% CI 0 to 5.9%), in patients with one, two and three or more risk factors respectively. The more frequent use of ECGs and troponin levels in the routine postoperative care of high risk patients undergoing major noncardiac surgery is recommended on the basis of the frequency of a positive result and the impact of a positive result on a patient's management.
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Anaesth Intensive Care · Mar 2008
Assessment of an unplanned admission to the intensive care unit as a global safety indicator in surgical patients.
An unplanned intensive care unit admission within 24 hours of a procedure with an anaesthetist in attendance (UIA) is a recommended clinical indicator It is designed to identify preventable iatrogenic complications. Often understood as a specific anaesthetic outcome, its value has been repeatedly questioned. Iatrogenic complications however often result from successive mishaps. ⋯ All other cases related to the combination of anaesthesia and surgery or surgery alone. Of these, 74% to 92% of complications were found to be preventable. Despite intrinsic limitations of the retrospective chart review method, UIA can be considered as a valuable tool to detect avoidable iatrogenic complications related to both surgical and anaesthetic care.
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Anaesth Intensive Care · Mar 2008
Review of procedures for investigation of anaesthesia-associated anaphylaxis in Newcastle, Australia.
The procedures, results and outcomes of investigation of 50 patients with clinical episodes of anaesthesia-associated anaphylaxis were retrospectively reviewed. Assessment was performed by measurement of serum tryptase and specific IgE and a combination of skin prick and intradermal skin testing. Testing was performed both for agents received during the anaesthetic and for agents the patient may encounter in future procedures. ⋯ The results reaffirm that neuromuscular blocking agents are the most common cause of anaphylaxis during anaesthesia. The importance of serum tryptase measurement at the time of the acute episode needs to be emphasised. Investigation should include screening for chlorhexidine and latex in all patients, as exposure to both these agents is common and may be overlooked.