Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2017
Biography Historical ArticleSt John's Hospital (Morton House), Launceston, Australia: A history of the hospital and Dr William Russ Pugh's first operations under ether.
On 7 June 1847, William Russ Pugh, MD, performed two operations at the St John's Hospital and Self-Supporting Dispensary, Launceston, Tasmania, while his patients were rendered insensible by the inhalation of sulphuric ether. These operations are the earliest documented surgical operations under ether in Australia. St John's Hospital officially opened on 1 September 1845. ⋯ The name Morton House may honour William T. G. Morton, MD, the Boston dentist who performed the first public demonstration of surgical etherisation on 16 October 1846.
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Anaesth Intensive Care · Mar 2017
Patient and procedural factors associated with an increased risk of harm or death in the first 4,000 incidents reported to webAIRS.
This report describes an analysis of patient and procedural factors associated with a higher proportion of harm or death versus no harm in the first 4,000 incidents reported to webAIRS. The report is supplementary to a previous cross-sectional report on the first 4,000 incidents reported to webAIRS. The aim of this analysis was to identify potential patient or procedural factors that are more common in incidents resulting in harm or death than in incidents with more benign outcomes. ⋯ In addition, the proportion of incidents associated with death was higher for incidents in which the patient's age was >80 years, the American Society of Anesthesiologists physical status was 4 or 5, incidents involving non-elective procedures, and incidents occurring after hours (1800 to 0800 hours). When faced with incidents with these potential risk factors, anaesthetists should consider earlier interventions and request assistance at an earlier stage. Educational strategies on incident prevention and management should place even further emphasis on scenarios involving these factors.
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Anaesth Intensive Care · Mar 2017
Changes in cerebral oxygen saturation and haemoglobin concentration during paediatric cardiac surgery.
Although near-infrared spectroscopy (NIRS) enables bedside assessment of cerebral oxygenation, it provides little information on the cause of deoxygenation. The authors aimed to investigate the changes in cerebral oxygenation and haemoglobin concentration and their associations during paediatric cardiac surgery in order to elucidate the physiology underlying cerebral deoxygenation. An observational retrospective study on 399 patients who underwent paediatric cardiac surgery was conducted. ⋯ On the contrary, there was no evidence for a change in [HbO2] (+0.45 μmol/l [-4.76, +5.30], P=0.42). Cerebral oxygen saturation decreased after paediatric cardiac surgery and the decrease was greater in patients of higher risk groups. The increase in [HHb] was considered to play a predominant role in the cerebral deoxygenation noted, in particular in higher RACHS-1 category groups.
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Anaesth Intensive Care · Mar 2017
Biography Historical ArticleNegative or positive? The iron lung and poliomyelitis-Zurich, 1951.
During the poliomyelitis epidemics of the last century hospitals were inundated with patients in acute respiratory failure. Between 1946 and 1949, Nandor (Ferdinand) Eichel documented the use of the iron lung in children with acute poliomyelitis at the University Children's Hospital, Zurich. The aim was to assess the effectiveness of the Iron lung and negative pressure respiratory support for this indication and to establish its role in the context of other existing therapies at the time. ⋯ N. Eichel and an update on the current status of poliomyelitis. The original dissertation was found in the home of Nandor's son and was of great interest to the current authors, Nandor's granddaughter and her colleague.
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Anaesth Intensive Care · Mar 2017
ReviewApplying the cell-based coagulation model in the management of critical bleeding.
The cell-based coagulation model was proposed 15 years ago, yet has not been applied commonly in the management of critical bleeding. Nevertheless, this alternative model may better explain the physiological basis of current coagulation management during critical bleeding. ⋯ From a practical perspective, applying the cell-based coagulation model also explains why new direct oral anticoagulants are effective systemic anticoagulants even without affecting activated partial thromboplastin time or the International Normalized Ratio in a dose-related fashion. The cell-based coagulation model represents the most cohesive scientific framework on which we can understand and manage coagulation during critical bleeding.