Anaesthesia and intensive care
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Anaesth Intensive Care · May 2013
Comparative StudyBench performance of ventilators during simulated paediatric ventilation.
This study compares the accuracy and capabilities of various ventilators using a paediatric acute respiratory distress syndrome lung model. Various compliance settings and respiratory rate settings were used. The study was done in three parts: tidal volume and FiO2 accuracy; pressure control accuracy and positive end-expiratory pressure (PEEP) accuracy. ⋯ However, three ventilators delivered, at times, PEEPs over 20% higher. In conclusion, as lung compliance decreases, especially in paediatric patients, some ventilators perform better than others. This study highlights situations where ventilators may not be able to deliver, nor adequately measure, set tidal volumes, pressure, PEEP or FiO2.
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Anaesth Intensive Care · May 2013
Case ReportsPost-cardiac surgery thrombotic thrombocytopenic purpura with digital ischaemia.
We report a case of thrombotic thrombocytopenic purpura in a woman post mitral valve repair who presented with unexplained thrombocytopenia, intermittent fever, acute renal failure and severe digital ischaemia. The diagnosis of thrombotic thrombocytopenic purpura was confirmed after exclusion of many of the aetiological factors of postoperative digital ischaemia, a positive haemolytic screen and blood film examination which showed schistocytes and fragmented red cells. ⋯ In order to increase the awareness of this rare multisystem process, we report our experience in managing this life-threatening condition. Our discussion covers the diagnostic challenges, theories on aetiology, pathogenesis and treatment of this condition in the context of cardiac surgery.
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Anaesth Intensive Care · May 2013
A survey of patient understanding and expectations of sedation/anaesthesia for colonoscopy.
One hundred and fifty-nine adult patients undergoing elective colonoscopy in a major regional hospital were surveyed regarding their perceptions and expectations of sedation/anaesthesia for this procedure. The survey was undertaken on the day of the procedure, but before their assessment by the anaesthetist. Most of our patients expected to be completely unconscious and few understood that there was any chance of being aware during any part of their colonoscopy procedure. ⋯ However, those patients who recognised the potential for procedural awareness reported significantly less concern about this potential occurrence than patients who were unaware of the possibility. Our findings suggest that explicit discussion of the possibility of procedural awareness during colonoscopy should be considered by clinicians who administer sedation or anaesthesia for colonoscopy. Knowledge of this potential source of patient confusion and anxiety may enable clinicians to better target the pre-procedural discussion, in order to more appropriately inform patient expectations.
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Anaesth Intensive Care · May 2013
Letter Case ReportsDelirium and Takotsubo cardiomyopathy following cardiac surgery.