Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
Prediction of successful defibrillation in human victims of out-of-hospital cardiac arrest: a retrospective electrocardiographic analysis.
In the present study we sought to examine the efficacy of an electrocardiographic parameter, 'amplitude spectrum area' (AMSA), to predict the likelihood that any one electrical shock would restore a perfusing rhythm during cardiopulmonary resuscitation in human victims of out-of-hospital cardiac arrest. AMSA analysis is not invalidated by artefacts produced by chest compression and thus it can be performed during CPR, avoiding detrimental interruptions of chest compression and ventilation. We hypothesised that a threshold value of AMSA could be identified as an indicator of successful defibrillation in human victims of cardiac arrest. ⋯ An AMSA value of 12 mV-Hz was able to predict the success of each defibrillation attempt with a sensitivity of 0.91 and a specificity of 0.97. In conclusion, AMSA analysis represents a clinically applicable method, which provides a real-time prediction of the success of defibrillation attempts. AMSA may minimise the delivery of futile and detrimental electrical shocks, reducing thereby post-resuscitation myocardial injury.
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Anaesth Intensive Care · Mar 2008
Communication during induction of paediatric anaesthesia: an observational study.
We aimed to identify and categorise advanced communication skills used by experienced consultant paediatric anaesthetists to facilitate the induction of paediatric anaesthesia. The communication techniques were both verbal and non-verbal. Communications with potentially negative effects were also noted. ⋯ Paediatric anaesthetists utilise a wide range of communication techniques in a highly flexible manner when inducing anaesthesia in children. Many of these communications can be characterised as hypnotherapeutic. Our observations suggest that formal structured training in communication skills and further research is warranted.
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Anaesth Intensive Care · Mar 2008
Generalisability of behavioural skills in simulated anaesthetic emergencies.
A reliable assessment of clinical performance requires multiple cases, as performance varies between cases depending on previous experiences and knowledge of the case. However, behavioural attributes, including communication and teamwork, may be expected to be less dependent on specific case knowledge and thus be more stable across cases. This has implications for training and assessment design. ⋯ Twenty anaesthesia trainees were rated in three simulated emergencies by four assessors. The psychometric properties of scores for behaviour were determined and were compared with scores for medical management and overall performance. We found that scores for behaviour were less dependent on the specific clinical context than the scores for overall performance and medical management, implying transferability of crisis management behaviours between cases.
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Anaesth Intensive Care · Jul 2008
Sequential organ failure assessment score and comorbidity: valuable prognostic indicators in chronically critically ill patients.
Chronically critically ill patients are defined as those who survive initial life-threatening, possibly reversible organ failure(s) but are unable to recover rapidly to a point at which they are fully independent of life support. Accordingly, these patients require mechanical ventilation and medical resources for a long time in an intensive care unit (ICU). The present study analysed demographic, clinical and survival data of chronically critically ill patients, to identify condition(s) related to poor prognosis. ⋯ Non-survivors had a significantly higher Sequential Organ Failure Assessment (SOFA) score than survivors on day 21 of ICU admission, as well as having significantly lower changes of SOFA scores between days three and 21. Multivariate analysis demonstrated that the SOFA score on day 21 and the Charlson Comorbidity Index were the best predictor of survival for six months after hospital discharge. The SOFA score on day 21 and comorbidity in the ICU appears to be a valuable prognostic indicators in chronically critically ill patients.
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Anaesth Intensive Care · Nov 2008
Effect of open-chest surgery in the lateral position on blood propofol concentration during target-controlled infusion of propofol.
Our research hypothesis was that single lung ventilation during thoracic surgery in the lateral position increases the blood concentration of propofol during target-controlled infusion. Thirty adult patients in two tertiary referral hospitals undergoing open-chest surgery were studied. Anaesthesia was induced and maintained with propofol using a Diprifusor (Graseby 3500) computer-controlled pump set to deliver a blood concentration of 4 tg.ml(-1). ⋯ Repeated measures ANOVA showed an F value 1.9, lambda 5.5 and P value 0.15. Post hoc analysis did not identify a significant difference between the sample times. During target-controlled infusion of propofol, mean blood propofol concentrations did not change significantly from those obtained with the patient supine after up to 50 minutes in the lateral position during thoracic surgery, or 20 minutes after commencing one-lung ventilation.