Anaesthesia and intensive care
-
Anaesth Intensive Care · Jan 2010
Randomized Controlled TrialFentanyl dosage and timing when inserting the laryngeal mask airway.
The study objective was to show that fentanyl given five minutes prior to induction improved insertion conditions for the Classic Laryngeal Mask Airway. Previous work had shown fentanyl at 90 seconds to be unpredictable. A probit analysis design was used in which success/failure rates of different doses of fentanyl were measured and dose-response curves drawn from which the ED50 and ED95 with 95% confidence intervals were determined. ⋯ Commonly used fentanyl doses of 1 to 2 microg x kg(-1) only prevented patients responding to insertion in 70 to 80% of cases. When using propofol 2.5 mg x kg(-1), administering fentanyl five minutes before laryngeal mask insertion does not provide ideal insertion conditions in 95% of cases unless excessively large doses are used. An ideal dose of fentanyl that produces optimum insertion conditions could not be determined.
-
Anaesth Intensive Care · Jan 2010
A unique snapshot of intensive care resources in Australia and New Zealand.
The objective of this study was to analyse and report on the distribution and attributes of intensive care services in Australia and New Zealand for the 2005/2006 financial year A survey was mailed to 155 Australian and 26 New Zealand intensive care units (ICU) listed on the database of the Australian and New Zealand Intensive Care Society. A descriptive analytical approach was used. ⋯ These units contain 1485 available beds in the public sector and 538 available beds in the private sector Calculations to determine beds per 100,000 population, medical specialists per 1000 patient days and registered nurses per 1000 patient days showed wide variation. International comparisons are limited by lack of data; however it does appear that intensive care patients in Australia and New Zealand have very good outcomes.
-
Anaesth Intensive Care · Jan 2010
Review Meta AnalysisAn overview of evidence from systematic reviews evaluating early enteral nutrition in critically ill patients: more convincing evidence is needed.
International quality improvement initiatives such as Fast-Hug bring a focus on improving the delivery of early enteral nutrition to critically ill patients, however surveys demonstrate current practice remains variable. One way to reduce variability in practice is to provide strong evidence to convince clinicians to change. The purpose of this overview was to identify current best evidence supporting the delivery of early enteral nutrition in critical illness. ⋯ The results of this overview highlight the variability in the evidence regarding the benefits of early enteral nutrition in critically ill patient populations. The inconsistent delivery to critically ill patients may be explained by the lack of convincing evidence. Better evidence may be needed to reduce the irregularity in the provision of early enteral nutrition to critically ill patients.
-
There are a number of case reports describing accidental subdural block during the performance of subarachnoid or epidural anaesthesia. However it appears that subdural drug deposition remains a poorly understood complication of neuraxial anaesthesia. The clinical presentation may often be attributed to other causes. ⋯ High suspicion in the presence of predisposing factors and early detection could prevent further complications. This review aims at increasing awareness amongst anaesthetists about inadvertent subdural block. It reviews the relevant anatomy, incidence, predisposing factors, presentation, diagnosis and management of unintentional subdural block during the performance of neuraxial anaesthesia.