Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2008
Comparative StudyComparison of intensive care outcome prediction models based on admission scores with those based on 24-hour data.
We compared the performance of six outcome prediction models--three based on 24-hour data and three based on admission-only data--in a metropolitan university-affiliated teaching hospital with a 10-bed intensive care unit. The Acute Physiology and Chronic Health Evaluation models, version II (APACHE II) and version III-J, and the Simplified Acute Physiology Score version II (SAPS II) are based on 24-hour data and were compared with the Mortality Prediction Model version II and the SAPS version III using international and Australian coefficients (SAPS IIIA). Data were collected prospectively according to the standard methodologies for each model. ⋯ The SAPS II and SAPS IIIA models fulfilled and the APACHE II model failed all criteria. The other models satisfied the discrimination criterion but significantly over-predicted mortality risk and require recalibration. Outcome prediction models based on admission-only data compared favourably to those based on 24-hour data.
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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.
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Anaesth Intensive Care · Jan 2008
The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients.
Central venous catheters are used in various hospital wards. An anterior-posterior chest X-ray is usually obtained soon after cannulation to assess the location of the catheter tip. This prospective clinical study was designed to determine the radiographic catheter tip position after central venous cannulation by various routes, to identify clinical problems possibly associated with the use of malpositioned catheters and to make a cost-benefit analysis of routine chest X-ray with respect to catheter malposition. ⋯ No case of malposition was associated with vascular perforation, local venous thrombosis or cerebral symptoms. We conclude that the radiographic incidence of central venous catheter malpositioning is low and that clinical use of malpositioned catheters is associated with few complications. However, determination of the catheter position by chest X-ray should be considered when mechanical complications cannot be excluded, aspiration of venous blood is not possible, or the catheter is intended for central venous pressure monitoring, high flow use or infusion of local irritant drugs.
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Anaesth Intensive Care · May 2008
Identification of genetic mutations in Australian malignant hyperthermia families using sequencing of RYR1 hotspots.
Advances in analysis of the RYR1 gene (which encodes the skeletal muscle ryanodine receptor) show that genetic examination is a useful adjunct to the in vitro contracture test in the diagnosis of malignant hyperthermia, as defects in RYR1 have been shown to be responsible for malignant hyperthermia susceptibility. DNA from 34 malignant hyperthermia susceptible individuals and four malignant hyperthermia equivocal subjects was examined using direct sequencing of 'hot-spots' in the RYR1 gene to identify mutations associated with malignant hyperthermia. Seven different causative mutations (as defined by the European Malignant Hyperthermia Group) in nine malignant hyperthermia susceptible individuals were identified. ⋯ Based on the number of relatives presenting to our unit in the study period, the muscle biopsy rate would have decreased by 25%. That we only identified a genetic defect in RYR1 in 47% of in vitro contracture test positive individuals suggests that there are other areas in RYR1 where pathogenic mutations may occur and that RYR1 may not be the sole gene associated with malignant hyperthermia. It may also reflect a less than 100% specificity of the in vitro contracture test.
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Anaesth Intensive Care · May 2008
The accuracy of reporting of general anaesthesia for childbirth: a validation study.
Administrative population health data, such as hospital discharge data, are a potentially valuable resource for determining anaesthesia and analgesia use in childbirth at a population level. However the reliability of general anaesthesia reporting is unknown. This study aimed to determine the accuracy of the reporting of peripartum general anaesthesia in single and linked population health data. ⋯ Limiting analysis to caesarean sections resulted in very accurate identification of general anaesthesia for delivery (sensitivity 97.0%, specificity 99.8%) while limiting to vaginal births was moderately accurate for identifying postpartum general anaesthesia (sensitivity 73.2%, specificity 99.8%). General anaesthesia for delivery is reported with a high level of accuracy in birth and linked birth-hospital data, but not in hospital discharge data alone. Population health data are a reliable source for examining general anaesthesia for delivery.