Anaesthesia and intensive care
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An integrative review of the literature specific to leadership within the intensive care unit was planned to guide future research. Four databases were searched. Study selection was based on predetermined inclusion and exclusion criteria and a quality check was done. ⋯ Personal individual factors seem the biggest enablers and barriers to leadership within the intensive care unit. Training is considered to be a facilitator of leadership within the intensive care unit. This study highlights the current literature on leadership in intensive care medicine and provides a basis for future research on interventions to improve leadership in the intensive care unit.
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Anaesth Intensive Care · Jul 2020
Outcomes following grade V subarachnoid haemorrhage: A single-centre retrospective study.
SummaryGrade V subarachnoid haemorrhage is associated with high mortality and morbidity, yet there are few contemporary reports on the treatment provided and outcomes of these patients. In this single-centre retrospective cohort study, we primarily sought to determine the 12-month mortality of patients admitted to the Royal Adelaide Hospital intensive care unit between 2006 and 2016 with grade V subarachnoid haemorrhage. Secondary objectives were to describe treatments provided, patient destination following hospital discharge, organ donation and hospital financial costs. ⋯ Of the 87 patients who died in hospital, 45 (52%) donated organs. The total hospital cost of managing this cohort was A$8.3 million, with a median cost of A$41,824 (interquartile range A$9,933-A$97,332) per patient. Grade V subarachnoid haemorrhage has a high mortality rate, with one-third of patients alive after one year.
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Anaesth Intensive Care · Jul 2020
Case ReportsIntensive care management of a rare case of pyrexia of unknown origin (Kikuchi-Fujimoto disease).
Kikuchi-Fujimoto disease is a rare, benign cause of necrotising lymphadenitis often presenting with fever. We describe a case of a 17-year-old boy with non-verbal autism presenting to our intensive care unit with prolonged fever of unknown cause. This case highlights the role of the intensive care unit in cases of diagnostic dilemma. The critical care community should be aware of Kikuchi-Fujimoto disease as although it is usually benign, it can rarely lead to acute airway compromise.
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Anaesth Intensive Care · Jul 2020
A survey of neuraxial analgesic preferences in open and laparoscopic major abdominal surgery amongst anaesthetists in Australia and New Zealand.
Practising anaesthetists who are Fellows of the Australian and New Zealand College of Anaesthetists were surveyed with the objective of gaining insight into current analgesic preferences, with particular regard to neuraxial techniques, when managing patients having major open and laparoscopic abdominal surgery. Major abdominal surgery is common and effective analgesia is fundamental to optimal postoperative recovery. A multitude of analgesic options exist, with epidurals recommended in recent Enhanced Recovery After Surgery protocols. ⋯ Less than half of the respondents used epidural or spinal analgesia in open surgery (48% versus 49% of respondents, respectively). A minority (16%) of respondents use a neuraxial technique in major laparoscopic surgery, with a strong preference for intrathecal morphine (74%) when they choose to do so. Further investigation of the role of intrathecal analgesia is warranted given the shift towards laparoscopic major abdominal surgery, the perceived benefits of neuraxial techniques and the need for opioid-sparing analgesic strategies.
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Anaesth Intensive Care · Jul 2020
The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study.
SummaryReducing maternal mortality remains a global priority, particularly in low- and middle-income countries (LMICs). The Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia (OB) course is a three-day refresher course for trained anaesthesia providers addressing common causes of maternal mortality in LMICs. This aim of this study was to investigate the impact of SAFE training for a cohort of anaesthesia providers in Ethiopia. ⋯ Improvements in MCQs and skills were maintained at follow-up 3-11 months post-training compared to baseline (P = 0.0006, < 0.0001 respectively). Participants reported improved confidence, teamwork and communication at follow-up. This study suggests that the SAFE-OB course can have a sustained impact on knowledge and skills and can improve the confidence of anaesthesia providers and communication within surgical teams.