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 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.
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Anaesth Intensive Care · Mar 2008
Case ReportsA series of five adult cases of respiratory syncytial virus-related acute respiratory distress syndrome.
Respiratory syncytial virus is a common cause of respiratory tract disease in children, predominantly presenting with mild symptoms. We present five cases of respiratory syncytial virus infection of the lower respiratory tract in immunocompromised adults suffering from severe respiratory insufficiency leading to bilateral pneumonia and fulfilling the criteria for acute respiratory distress syndrome. ⋯ Respiratory syncytial virus was implicated as a direct cause of respiratory failure. Respiratory syncytial virus may be an underestimated cause of severe respiratory failure and acute respiratory distress syndrome in the immunocompromised adult admitted to the intensive care unit.
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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.