Anaesthesia and intensive care
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Numbers of deceased organ donors in Australia have increased, but rates of consent to donation remain at around 60%. Increasing family consent is a key target for the Australian Organ and Tissue Authority. Reasons for donation decisions have been reported in the international literature, but little is known of reasons for Australian families' decisions. ⋯ Themes for consent to organ donation included that: donation was consistent with the deceased's explicit wishes or known values, the desire to help others or self-including themes of altruism, pragmatism, preventing others from being in the same position, consolation received from donation and aspects of the donation conversation and care that led families to believe donation was right for them. Themes for non-consent included: lack of knowledge of wishes; social, cultural and religious beliefs; factors related to the donation process and family exhaustion; and conversation factors where negative events influenced decisions. While reasons for consent were similar to those described in international literature, reasons for non-consent differed in that there was little emphasis on lack of trust of the medical profession, concerns regarding level of care provided to the potential donor, preserving the deceased's body, fears of body invasion or organ allocation fairness.
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Anaesth Intensive Care · Jan 2015
Impact of conversion from an open ward design paediatric intensive care unit environment to all isolated rooms environment on incidence of bloodstream infections and antibiotic resistance in Southern Israel (2000 to 2008).
We studied the epidemiology, microbiology, clinical aspects and outcome of bloodstream infections (BSI) in a tertiary paediatric intensive care unit. All BSI episodes were prospectively identified and analysed. The paediatric intensive care unit moved in 2006 from an open-plan unit to a new (all single room) unit. ⋯ A significant decrease was recorded during 2007 to 2008 in Enterobacteriaceae resistance to piperacillin, gentamicin and ciprofloxacin. Thirty of 299 (10%, 9 with S. pneumoniae-BSI) patients died. A significant decrease in BSI and nosocomial incidence and Enterobacteriaceae spp. antibiotic resistance was recorded following the conversion of the paediatric intensive care unit from an open ward to an all isolated rooms environment.
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Anaesth Intensive Care · Jan 2015
Near-infrared spectroscopy-based microcirculatory assessment in acute atrial fibrillation.
Near-infrared spectroscopy is a means of assessing microcirculatory function, but has not been studied in atrial fibrillation (AF). We evaluated the effect of acute AF on thenar eminence near-infrared spectroscopy-derived microcirculatory variables. Stable patients presenting to the emergency department with acute onset AF underwent dynamic near-infrared spectroscopy assessment with a three minute vascular occlusion test (VOT). ⋯ Minimum StO2 was lower (39% versus 52%, P=0.002) and the amplitude of StO2 response greater (49% versus 40%, P=0.005) in AF, but there was no significant difference in maximum StO2 or the degree of reperfusion hyperaemia. In summary, baseline and minimum StO2 were lower with a greater ischaemic decrease in StO2 during AF, reflecting reduced tissue perfusion, compared with sinus rhythm. Recovery after ischaemia was higher in AF, suggesting normalisation of capillary recruitment during ischaemia.
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Anaesth Intensive Care · Jan 2015
Minimum effective anaesthetic volume of 0.5% ropivacaine for ultrasound-guided popliteal sciatic nerve block in patients undergoing foot and ankle surgery: determination of ED50 and ED95.
Compared to nerve stimulation or classic paraesthesia techniques, ultrasound (US)-guided popliteal sciatic nerve block requires a smaller volume of local anaesthetic. The up-and-down method was used to determine the minimum effective anaesthetic volume of 0.5% ropivacaine necessary for US-guided popliteal sciatic nerve block to achieve successful surgical anaesthesia for foot and ankle surgery. The study included 32 patients receiving an US-guided popliteal sciatic nerve bock. ⋯ The success rates of sensory blockade of the tibial nerve and common peroneal nerve were 69% and 88%, respectively. The success rates of motor blockade of these nerves were 75% and 90%, respectively. The ED50 and ED95 of 0.5% ropivacaine for US-guided popliteal sciatic nerve block were 6 ml and 16 ml, respectively.