Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2016
Survey of anaesthetists' practice of sedation for gastrointestinal endoscopy.
We conducted a survey of Australian specialist anaesthetists about their practice of sedation for elective and emergency gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. A 24-item survey was emailed to 1,000 anaesthetists in August 2015. Responses were received from 409 anaesthetists (response rate=41%) with responses from 395 anaesthetists analysed. ⋯ Propofol was routinely administered by 99% of respondents for gastroscopy and 100% of respondents for ERCP and colonoscopy. A maximum depth of sedation in which patients were unresponsive to painful stimulation was targeted by the majority of respondents for all procedures except for elective gastroscopy. These results may be used to facilitate comparison of practice in Australia and overseas, and give an indication of compliance by Australian anaesthetists with the relevant Australian and New Zealand College of Anaesthetists guideline.
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Anaesth Intensive Care · Jul 2016
Systemic anticoagulation related to heparin locking of non-tunnelled venous dialysis catheters in intensive care patients.
Heparin locking of venous dialysis catheters is routinely performed in intensive care to maintain catheter patency when the catheters are not being used. Leakage of heparin into the circulation can potentially cause systemic anticoagulation and may present a risk to intensive care patients. To assess the effect of 5000 units per millilitre heparin locking of non-tunnelled dialysis catheters on systemic anticoagulation, we performed a prospective observational study of ten intensive care patients receiving heparin locking of dialysis catheters in an adult tertiary intensive care unit between July and September 2015. ⋯ The median rise was by 56 seconds (interquartile range 30-166.5). Following heparin locking, 80% of patients had APTT values within or above the range associated with therapeutic anticoagulation. Heparin locking of non-tunnelled venous dialysis catheters can cause systemic anticoagulation in intensive care patients and therefore poses a potential risk to patient safety.
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Anaesth Intensive Care · Jul 2016
Historical ArticleAdvances in the diagnosis of shock, its assessment and resuscitation during the Great War.
The Great War of 1914-1918 ushered in a new era of technology on the battlefield resulting in casualties on an unprecedented scale. There had been progress in many related areas of medicine before the outbreak of hostilities but these had not been applied or fully developed in clinical practice. This is particularly true for the management of haemorrhagic shock and resuscitation. This article discusses the history and development of medical treatment of shock and trauma patients during the conflict.
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Anaesth Intensive Care · Jul 2016
Historical ArticleAnaesthesia on the Western Front-perspectives a century later.
This year, 2016, marks the centenary of some of the worst battles of World War I. It is timely to reflect on the experiences of those who lived through those events, and the significant effects on the development of anaesthesia that occurred as a result. ⋯ The challenges of the Western Front, with its massive numbers of injured, saw progress in the understanding and management of trauma and shock, and significant improvement in the provision of anaesthesia and the training of anaesthesia providers. The result was increased anaesthetic safety for the civilian population after the war and further development of anaesthesia and resuscitation as a specialised area of medicine.