Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2008
Immediate management of inadvertent dural puncture during insertion of a labour epidural: a survey of Australian obstetric anaesthetists.
Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. ⋯ The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
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Anaesth Intensive Care · Nov 2008
Effect of recruitment and body positioning on lung volume and oxygenation in acute lung injury model.
The mechanism of oxygenation improvement after recruitment manoeuvres or prone positioning in acute lung injury or acute respiratory distress syndrome is still unclear. We tried to determine the mechanism responsible for the effects of recruitment manoeuvres or prone positioning on lung aeration using a whole lung computed tomography scan in an oleic acid induced acute lung injury canine model. Twelve adult mongrel dogs were allocated into either the supine group (n=6) or the prone group (n=6). ⋯ Prone positioning increased oxygenation (P=0.004) that also correlated with increase of the poorly- and well-aerated dorsal (nondependent) lung volume (r=0.787, P<0.001). However, the recruitment manoeuvre in the prone position had no effect on oxygenation despite an increase in ventral (dependent) lung volume. The increase in PaO2 after recruitment manoeuvres in the supine position or after prone positioning is related to the increase of the poorly- and well-aerated dorsal lung.
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Anaesth Intensive Care · May 2008
Australian anaesthetists' practice of sedation for gastrointestinal endoscopy in adult patients.
A wide spectrum of practice in sedation for gastrointestinal endoscopy in adult patients is documented overseas, but a current profile of the practice of Australian anaesthetists is unavailable. We therefore surveyed 200 Fellows of the Australian and New Zealand College of Anaesthetists on the choice of drugs and monitoring, use of analgesic throat spray and prophylactic intravenous fluids and the depth of sedation for gastrointestinal endoscopy. Our response rate was 57% and endoscopy formed a significant part of most respondents' practices. ⋯ However over 20% of patients having gastroscopy or colonoscopy did not have non-invasive blood pressure monitoring. A maximum depth of sedation during which the patient was unresponsive to painful stimulation (commensurate with general anaesthesia) was targeted by 54% of respondents. Significant variations exist in the practice of sedation and monitoring for endoscopy in adult patients by anaesthetists in Australia.
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Anaesth Intensive Care · May 2008
The Glostavent: evolution of an anaesthetic machine for developing countries.
The sophisticated anaesthetic machines designed for use in modem hospitals are not appropriate for many parts of the developing world, as they are reliant on regular servicing by skilled engineers and an uninterrupted supply of electricity and compressed gases, which are not always available. The Glostavent has been designed specifically to meet the challenges faced by anaesthetists working in these countries. ⋯ Feedback from widespread use throughout the developing world over the last 10 years has led to significant improvements to the original design. This article describes the basic components of the original version and the modifications which have been introduced as a result of practical experience in the developing world.