Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2013
The anaesthetic pre-admission clinic is effective in minimising surgical cancellation rates.
Pre-admission clinics (PAC) are now well-established in most hospitals. However, there have been few studies examining the efficacy of PACs in minimising day of surgery cancellations due to anaesthetic reasons. A retrospective cross-sectional descriptive study was carried out in a metropolitan tertiary hospital over a four-year period to assess reasons for anaesthetic-related day of surgery cancellations in elective surgical patients who attended the PAC. ⋯ Clinical disagreement between anaesthetic assessment at the PAC and the attending anaesthetist on the day of surgery was low (12 patients, 21%), and clinical deterioration in a pre-existing condition (six patients, 10%) accounted for the majority of other cancellations. Although patient misadventure constituted the major cause of anaesthetic cancellations, non-adherence to fasting and medication guidelines constituted the next major reason for surgery cancellation due to anaesthetic causes. This is important as such cancellations are potentially preventable and the overall cancellation rate could potentially be improved by instituting relatively simple changes to clinic function.
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Anaesth Intensive Care · Jan 2013
Case ReportsSystemic mastocytosis presenting as intraoperative anaphylaxis with atypical features: a report of two cases.
Two cases of perioperative cardiovascular collapse are presented that were associated with markedly elevated mast cell tryptase levels shortly after the event, leading to the assumption that an immunoglobin E-mediated, drug-induced anaphylaxis had occurred. However, the clinical picture in both cases was atypical and subsequent skin testing failed to identify a triggering drug. ⋯ We present evidence and speculate that mast cell degranulation was triggered by tourniquet release in the first case and by exposure to peanuts in the second. An atypical presentation of anaphylaxis should alert the anaesthetist to the possibility of previously undiagnosed mastocytosis.
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Anaesth Intensive Care · Jan 2013
Letter Randomized Controlled TrialUse of a modified bite-block to facilitate mask ventilation in edentulous elderly patients.