Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2012
Repeated intrathecal administration of ropivacaine causes neurotoxicity in rats.
Previous studies have shown that ropivacaine is the least neurotoxic local anaesthetic. Most of the data derive from short-term ropivacaine injection into the subarachnoid space. Intrathecal administration for a prolonged period, and the histological changes and behavioural effects of repeated intrathecal administration, have not previously been investigated. ⋯ There were no significant differences in motor function as a result of different concentrations of ropivacaine. Repeated intrathecal injection of ropivacaine 1% can induce neurotoxicity in rats. Our data suggests that expression of protein kinase B might be involved in this neurotoxicity.
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Anaesth Intensive Care · Sep 2012
Blood culture collection in patients with acute kidney injury receiving renal replacement therapy: an observational study.
Critically ill patients receiving renal replacement therapy (RRT) for acute kidney injury (AKI) have high reported intensive care unit (ICU) mortality. Blood culture (BC) collection practices in this population have to date been poorly characterised, specifically in regards to the influence of RRT on the clinical triggers for such an investigation. Utilising our electronic clinical information system, we conducted a retrospective observational study of patients admitted to a 30-bed tertiary level ICU and requiring RRT over a four-year period. ⋯ We also observed a predominance of candidaemia in this cohort, despite the absence of neutropenia. This study provides unique data describing BC collection rates in a cohort of critically ill patients receiving RRT for AKI and at high risk of dying. Further study of temperature alteration, detection of bloodstream infection and outcome in patients receiving RRT is now warranted.
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Anaesth Intensive Care · Sep 2012
A survey of anaesthetists' understanding of Australian mandatory reporting laws.
Australian mandatory reporting laws for healthcare practitioners were introduced nationally in July 2010. We distributed an online survey to specialist anaesthetists and anaesthesia trainees in our institution with the aim of assessing anaesthetists' awareness, understanding and interpretation of the new laws. One hundred and three completed responses were received (response rate 67%). ⋯ Some anaesthetists believed the laws would deter them from seeking medical help themselves if they were impaired (39%). Mandatory reporting laws aim to improve patient safety while being fair to doctors who are reported and protecting those who report. Our survey indicates that there are differences among anaesthetists about the type of conduct they would report and their perception of the consequences of making a report.
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Anaesth Intensive Care · Sep 2012
Association between perioperative glucose levels and adverse outcomes in infants receiving open-heart surgery with cardiopulmonary bypass for congenital heart disease.
There is no consensus that hyperglycaemia is an independent predictor of morbidity-mortality in children. This retrospective observational study aimed to assess the association between abnormal perioperative glucose levels and adverse outcomes in infants receiving open-heart surgery with cardiopulmonary bypass. The records of a total of 233 infants who underwent cardiopulmonary bypass for a variety of congenital cardiac procedures between January and December 2010 were reviewed. ⋯ After adjusting for other potential variables, lower weight at surgery, longer surgery time and hospital length-of-stay are the independent predictors of morbidity-mortality. Our findings suggest that perioperative hyperglycaemia and mild transient hypoglycaemia do not appear to be detrimental to infants with congenital heart disease, although we did not assess neurological outcomes. Nevertheless, due to the limitations of the retrospective design of this study and its limited power, more thorough clinical randomised controlled trials are needed.
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Anaesth Intensive Care · Sep 2012
Case ReportsThe tyranny of distance: telemedicine for the critically ill in rural Australia.
A case of severe sepsis with multi-organ failure needing complex support was deemed too ill for transfer to a major centre. Telemedicine allowed direct patient review, collaborative advice and collegial support with maintained healthcare standards while avoiding long distance transfer from his home and family.