Anaesthesia and intensive care
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Anaesth Intensive Care · May 2013
How do anaesthetists in New Zealand disseminate critical airway information?
The communication of information concerning patients with difficult airways is universally recognised as an important component in avoiding future airway management difficulties. A range of options is available to impart this information; little is known however, about the follow-up patterns of anaesthetists following the identification and management of a difficult airway. In this study, 158 anaesthetists were contacted and asked to comment on their follow-up patterns regarding a number of difficult airway scenarios. ⋯ Comments from our survey were critical of multiple difficult airway databases and alert systems, which are not linked and do not lead automatically to a single source of information. We suggest that a custom-designed MedicAlert New Zealand difficult airway/intubation registry could be established, with easy access for medical practitioners and patients. This registry could be accessed through the National Health Index database and linked to the MedicAlert international registry and their nine international affiliates.
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Anaesth Intensive Care · May 2013
The prevalence of anaemia, hypochromia and microcytosis in preoperative cardiac surgical patients.
This retrospective study aimed to determine the prevalence of preoperative anaemia, hypochromia and microcytosis in cardiac surgery patients. Data was analysed for 943 patients (over a two-year period) undergoing coronary artery bypass graft, valve or combined coronary artery bypass graft and valve surgery at a tertiary hospital in South Australia. Overall prevalence of preoperative anaemia was 25.2%, greater in males than females (27.6 vs 19.9%, P <0.01). ⋯ Anaemic patients with low red cell indices had lower preoperative haemoglobin than anaemic patients without low red cell indices (median haemoglobin 112 vs 120 g/l, P=0.008). Compared to non-anaemic patients, anaemic patients had higher transfusion rates (79.8 vs 46.4%, P <0.0001), which were greater in those with reduced red cell indices compared to those with normal red cell indices (93.5 vs 76.6%, P=0.01). This study demonstrated a high prevalence of preoperative anaemia, microcytosis and hypochromia in cardiac surgical patients.
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Anaesth Intensive Care · May 2013
National anaesthesia mortality reporting in Australia from 1985-2008.
This article summarises the Australian national anaesthesia mortality data from 1985-2008, previously published in eight consecutive triennial reports and covering an estimated 50 million anaesthetics. The data were obtained using consistent definitions and methodology over a 24-year period. Anaesthesia-related mortality in Australia fell from about 1:36,000 anaesthetics in the 1985-1987 triennium to about 1:55,000 for the most recent reported 2006-2008 triennium. ⋯ The percentage of anaesthesia-related deaths considered non-preventable (no correctable anaesthetic factor identified) increased from about 4% in the 1991-1993 triennium to about 50% in the 2006-2008 triennium. There was also an increase in the proportion of deaths in which the patient's medical condition was considered a significant factor in the death over this period. While the trends are encouraging, they nevertheless suggest that additional efforts are required to further reduce 'preventable' anaesthetic deaths, and that continuing research and development into safer agents, techniques and approaches are required to reduce the incidence of deaths currently considered 'non-preventable'.
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Anaesth Intensive Care · May 2013
The association between sedation practices and duration of mechanical ventilation in intensive care.
Choice of sedation agent may influence duration of mechanical ventilation in the intensive care unit (ICU). We conducted a retrospective observational analysis of 2102 consecutive mechanically ventilated ICU patients over an eight-year period at a Melbourne metropolitan hospital with a ten-bed general ICU to determine if propofol was associated with shorter duration of mechanical ventilation (MV) than midazolam. Data were extracted from the hospital administrative database, pharmacy supply order records and ICU database, to calculate rates of MV and tracheostomy, length-of-stay, propofol and midazolam infusion doses, illness severity and casemix and use of 'sedation scores' and 'sedation break' respectively. ⋯ Over the eight-year observation period there were significant increases in the numbers of annual MV admissions and long-term (>96 hours) MV patients, but a decline in median duration of MV, tracheostomy rate, median ICU length-of-stay and median hospital length-of-stay. All temporal trends were significant (P <0.05). The temporal association with changes in sedation management practice, including primary sedative agent choice during MV, may explain these findings.
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Anaesth Intensive Care · May 2013
Spontaneous intracranial hypotension and epidural blood patch: a report involving seven cases.
Spontaneous intracranial hypotension is a rare condition caused by spontaneous cerebrospinal fluid leak. It is characterised by orthostatic headache, diffuse pachymeningeal enhancement on brain imaging and low cerebrospinal fluid pressure. ⋯ Clinical improvement coincided with a dramatic reduction of pachymeningeal enhancement. The aetiology and brain imaging findings, and the technique and effectiveness of EBP are discussed.