Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2008
Comparative StudyContinuous interscalene analgesia for rotator cuff repair: a retrospective comparison of effectiveness and cost in 205 patients from a multi-provider private practice setting.
Several barriers exist to the routine use of continuous interscalene block (CISB) for postoperative analgesia following rotator cuff repair There is a perception that the technique is feasible only for single operators exposed to a high volume case load. The aim of this retrospective review was to compare the three commonly employed analgesic techniques following rotator cuff repair in a multi-provider setting. The techniques studied were CISB, combined single injection interscalene block with postoperative intermittent intra-articular local anaesthetic infiltration (SSISB/IA) and intermittent intra-articular only local anaesthetic infiltration (IA). ⋯ The proportion of subjects requiring more than one antiemetic for the same period was 1.9% in the CISB group, 16.4% for the SSISB/IA group and 36.1% for the IA group (P < 0.0001). Costs related to the analgesic technique were similar in each group. CISB following rotator cuff repair in a multi-provider setting was associated with reduced total opioid/tramadol and antiemetic consumption, and occurred without a significant increase in the monetary cost.
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Anaesth Intensive Care · Nov 2008
Comparative StudyComparison of stress in anaesthetic trainees between Hong Kong and Victoria, Australia.
A postal survey was sent to anaesthetic trainees in Hong Kong and Victoria, Australia to compare work-related stress levels. Demographic data were collected. Anaesthetist-specific stressors, Maslach Burnout Inventory and Global Job Satisfaction scores were used for psychological testing. ⋯ Despite the complex nature of stress, its antecedents and manifestations, an inverse relationship between emotional exhaustion and job satisfaction was evident in correlation analysis (P < 0.001). This survey suggests that stress was present in some trainees in both areas. Hong Kong trainees may benefit from local development to address mental wellbeing as being important to fulfil this highly competitive training program.
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Anaesth Intensive Care · Nov 2008
Performance of BIS in children using the paediatric BIS Quattro sensor.
The Bispectral Index (BIS) is one of the most frequently used electroencephalogram-derived depth of anaesthesia monitors. Previous studies in children have suggested BIS performs well in older children, however these studies have used earlier versions of the BIS device. The aim of this study was to compare the performance of BIS over different age groups using the BIS paediatric Quattro sensor (Aspect Medical Systems, Norwood, MA, U. ⋯ When combining all age groups taking a BIS value of 50 or greater provided 100% sensitivity to detect wakefulness. This study found no evidence for any substantial difference in performance between ages one and 13 years. If BIS is used in children to detect wakefulness occurring with lightening of anaesthesia, then this study suggests that if the BIS is maintained below 50 then wakefulness is unlikely to have occurred.
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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.
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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.