Anaesthesia and intensive care
-
Anaesth Intensive Care · Jul 2008
Biography Historical ArticleDr Corlette and the first textbook of regional anaesthesia in Australia.
The first Australian textbook on regional anaesthesia was published in 1948 by a surgeon, Dr Cyril Corlette. He was 80 years old at the time but had lectured, published and strongly promoted regional anaesthesia his whole career. ⋯ He also published controversial work on heat loss under anaesthesia and anaesthetic mortality. This textbook, "A Surgeon's Guide to Local Anaesthesia", subtitled "A Manual of Shockless Surgery", helped to promote the concept of regional anaesthesia in Australia.
-
Anaesth Intensive Care · Jul 2008
Sedation and delirium in the intensive care unit: an Australian and New Zealand perspective.
A survey was conducted to determine sedation and delirium practices in Australian and New Zealand intensive care units. The survey was in two parts, comprising an online survey of reported sedation and delirium management (unit survey) and a collection of de-identified data about each patient in a unit at a given time on a specified day (patient snapshot survey). All intensive care units throughout Australia and New Zealand were invited by email to participate in the survey. ⋯ Failed and self-extubation rates were low: 3.2% and 0.5% respectively. In Australian and New Zealand intensive care units, routine use of sedation scales is common but not universal, while routine delirium assessment is rare. The use of a sedation protocol is valuable and should be encouraged.
-
Anaesth Intensive Care · Jul 2008
Relative reliability of the auditory evoked potential and Bispectral Index for monitoring sedation level in surgical intensive care patients.
Sedation is an important adjunct therapy for patients in the intensive care unit. The objective of the present study was to observe correlation between an established subjective measure, the Ramsay Sedation Scale, and two objective tools for monitoring critically ill patients: the Bispectral Index (BIS) and auditory evoked potential. Ninety patients undergoing major surgery scheduled for postoperative mechanical ventilation and continuous sedation with propofol and fentanyl were selected. ⋯ In conclusion, the auditory evoked potential and BIS monitors revealed an acceptable correlation with the Ramsay Sedation Scale. However, the BIS and auditory evoked potential monitors do not perform adequately as a substitute in the assessment of sedated intensive care unit patients. These monitors could be used as part of an integrated approach for the evaluation of those patients especially when the subjective scales do not work well in the setting of neuromuscular blockade or may not be sufficiently sensitive to evaluate very deep sedation.
-
Historically, anaesthetic equipment manufacturers used a number of differently-sized connectors in anaesthetic breathing systems. This gave rise to the potentially dangerous possibility of mismatched taper connections and a failure to create a gas-tight breathing system capable of ventilating a patient. ⋯ The problem was aggravated by a move to adopt a slightly different International Standards Organisation design. By the time that universally-interchangeable connectors were widespread twenty years later disposable breathing systems had replaced the old, heavy metal connectors.
-
Education and expertise in airway skills are central components of anaesthesia training, yet there is no formal monitoring of the airway experience or level of competence that registrars actually obtain. An audit was performed in two phases to prospectively document the airway management experience of registrars in one teaching hospital department. ⋯ The overall registrar group performed a mean of 18 laryngeal mask airways and 19 endotracheal intubations in the study month. Our findings indicate that the airway experience of anaesthesia trainees may be inadequate and therefore warrants further investigation.