Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2012
Comparative StudyPharmacokinetics of oxycodone after subcutaneous administration in a critically ill population compared with a healthy cohort.
This study aimed to characterise and compare the absorption pharmacokinetics of a single subcutaneous dose of oxycodone in critically ill patients and healthy subjects. Blood samples taken at intervals from two minutes to eight hours after a subcutaneous dose of oxycodone in patients (5 mg) and healthy volunteers (10 mg) were assayed using high performance liquid chromatography. Data were analysed using a non-compartmental approach and presented as mean (SD). ⋯ The patients therefore had reduced exposure to subcutaneous oxycodone. This warrants further model-based analysis and experimentation. Dose regimens for subcutaneous oxycodone developed in healthy volunteers cannot be directly translated to critically ill patients.
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Anaesth Intensive Care · Mar 2012
Case ReportsPostpartum seizure and ischaemic stroke following dural puncture and epidural blood patch.
A 33-year-old parturient experienced seizures, then an ischaemic stroke after caesarean section, while undergoing an epidural blood patch for dural puncture. A diagnosis of normotensive late postpartum eclampsia, with either a posterior reversible encephalopathy syndrome or postpartum vasculopathy, leading to stroke, was made - based primarily on a temporal relationship to the postpartum period and consistent findings on magnetic resonance imaging and angiography scans and an electroencephalogram. The difficulties in definitively elucidating the cause of seizures and cerebral infarction in the postpartum period and the impact of anaesthetic interventions in this case are discussed.
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Anaesth Intensive Care · Mar 2012
An analysis of computer-assisted pre-screening prior to elective surgery.
In order to assess the potential utility of guided patient self-assessment as an early preoperative triage tool, a computer-assisted questionnaire delivered by a non-clinician via telephone was 1) compared to face-to-face interview and examination by anaesthetists in outpatient clinics and 2) evaluated as a mechanism to stream patients to day of surgery assessment. In total, 514 patients scheduled for elective surgery in two tertiary public hospitals were assessed initially by telephone and then in an outpatient clinic. Both forms of assessment were marked by panels of specialist anaesthetists, who also provided an opinion on which patients would have been suitable to bypass preoperative anaesthetic outpatient assessment based upon information provided by the telephone interview. ⋯ Panel review considered that 398 patients (60%) would not have required evaluation by an anaesthetist until the day of surgery, thus avoiding the need to separately attend a preoperative outpatient clinic. The sensitivity of telephone interview provided information to correctly classify patients as suitable for day of surgery evaluation was 98% (95% confidence interval 96 to 99%) with a specificity of 97% (95% confidence interval 92 to 98%). This study demonstrates that remote computer-assisted assessment can produce quality patient health information and enable early patient work-up and triage with the potential to reduce costs through more efficient use of resources.
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In order to review anaesthetic morbidity in our remote rural hospital, a retrospective audit of all anaesthetic records was undertaken for a five-year period between 2006 and 2010. Eight hundred and eighty-nine anaesthetic records were reviewed. The patients were all American Society of Anaesthesiologists physical status I to III. ⋯ It is our opinion that the case selection, prior experience of anaesthetic and theatre staff, stable nursing workforce and the use of protocols were important factors in determining the low rate of adverse events. However, we caution against over-interpretation of the data, given its retrospective nature, relatively small sample size, reliance on case records and the absence of agreed definitions for adverse events. We would also like to encourage all anaesthetic services, however remote, to audit their results as part of ongoing quality assurance.