Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2010
The use of ProSeal laryngeal mask airway in caesarean section--experience in 3000 cases.
In this single biggest study to date of 3,000 women undergoing elective Caesarean section under general anaesthesia with the LMA ® ProSeal™, there was only one case of regurgitation, and no aspiration.
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Anaesth Intensive Care · Nov 2010
Case ReportsUltrasound-guided axillary plexus block in a child with dystrophic epidermolysis bullosa.
We report the use of ultrasound-guided axillary brachial plexus block in a child with dystrophic epidermolysis bullosa needing surgical treatment of the right hand. The regional anaesthesia was used in association with sedation/ anaesthesia. This technique is suitable for these difficult patients because it can minimise the risk of new bullae formation due to palpation of landmarks or unintentional intra- or subcutaneous injections. ⋯ This management plan provided good surgical conditions, early postoperative analgesia, minimised stress for the patient and avoided the need to manipulate the airway with instruments and the associated risk of mucosal bullae. The classification and breadth of clinical manifestation of epidermolysis bullosa is complex and briefly summarised. The anaesthetist should clarify the details of a particular patient's form of epidermolysis bullosa, especially in terms of mucosal involvement, as this may greatly influence planning for a procedure.
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Anaesth Intensive Care · Nov 2010
Comparative StudyA comparison of electronic and handwritten anaesthetic records for completeness of information.
Complete documentation in anaesthetic records is important for patient management, research and quality assurance and has medicolegal implications. This study compares the completeness of information contained in electronic versus handwritten intraoperative anaesthetic records. A sample of 70 handwritten records was randomly selected from anaesthesia performed in the month prior to implementation of the Integrated Injectable Drug Administration and Automated Anaesthesia Record System and compared to a similar sample of electronic records generated eight months later. ⋯ There was no overall difference in the completeness of electronic versus handwritten records. Several differences did exist however, highlighting both clinically important advantages and deficiencies in the electronic system. Records from both systems sometimes lacked important information.
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Anaesth Intensive Care · Nov 2010
Influence of leg position on the depth and sonographic appearance of the sciatic nerve in volunteers.
We investigated the effect of leg position on the depth of the sciatic nerve and quality of ultrasound images taken at the proximal and mid-thigh level. Twenty-one volunteers with average body mass index were recruited to represent the younger population receiving sciatic nerve blocks for sports injury surgery. The volunteers were placed in the lateral position, with the hip flexed and with the hip in a neutral (extended) position. ⋯ More clinicians favoured the proximal sciatic image with the leg in the neutral position. Although statistically significant, the depth difference is probably not a major clinical consideration in most patients with an average body mass index. We suggest clinicians place the leg in the most ergonomically favourable position when performing sciatic nerve blocks in the proximal thigh in these patients.
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Anaesth Intensive Care · Nov 2010
Can learning to sustain life be BASIC? Teaching for the initial management of the critically ill in Australia and New Zealand.
Commonly in Australia and New Zealand, initial intensive care support of critically ill patients is by non-intensive care trained medical and nursing staff Basic Assessment and Support in Intensive Care (BASIC) is an internationally run short course to assist practitioners to gain knowledge and skills to manage the early hours of critical illness. The aim of this study was to assess the performance and acceptance of the BASIC course as conducted in an Australian metropolitan teaching hospital and a major regional centre in New Zealand. Performance on pre- and post-course multiple choice examinations and the overall course assessment by all participants attending between 2005 and 2009 was analysed. ⋯ The post-course examination score was predicted by pre-course examination score (beta = 0.22, 95% confidence interval 0.17 to 0.27), nursing occupation, (beta = -3.96, 95% confidence interval -5.03 to -2.90) and the availability of a scenario-based simulation module (beta = 0.22, 95% confidence interval 0.17 to 0.27, R2 = 0.38, P < 0.001). Participants generally found they had learned a great deal from the program and that the course material was of an appropriate level. The BASIC course was found to be a positive learning experience for health care practitioners inexperienced in the management of the critically ill.