Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2012
Laptops and smartphones in the operating theatre - how does our knowledge of vigilance, multi-tasking and anaesthetist performance help us in our approach to this new distraction?
There has been no research performed concerning the effects of the use of laptops and smartphones in the operating theatre on anaesthetist performance, yet these devices are now in frequent use. This article explores the implications of this phenomenon. The cognitive and environmental factors that support or detract from vigilance and multi-tasking are explored and core anaesthetic literature on the nature of anaesthetic work and operating theatre distractions is reviewed. ⋯ All anaesthetists need to be mindful of the limits to the human attention span which requires observation and limiting distractions. Trainees have less experience and less 'attentional' safety margin, so should avoid adding additional distractions such as discretionary use of laptops or smartphones to their operating theatre work. We provide recommendations for future research on the specific advantages and disadvantages of pervasive computing in the operative theatre.
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The aim of this study was to explore the degree and determinants of satisfaction of family members of patients being cared for in an Australasian intensive care unit. This was a prospective observational study that took place within a mixed medical/surgical, level three intensive care unit. One hundred and eight family members of patients staying in the intensive care for more than 48 hours were identified. ⋯ Families who had meetings with the social worker or medical staff were less likely to report dissatisfaction (relative risk 0.14; confidence interval 0.03 to 0.59; P=0.08; relative risk 0.23; confidence interval 0.07 to 0.81; P=0.02). Our study found that the majority of families are happy with their care in the intensive care unit. Social work and medical meetings with the family reduce dissatisfaction.
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Anaesth Intensive Care · Jan 2012
Incidence of difficult intubation in intensive care patients: analysis of contributing factors.
Difficulties in endotracheal intubation increase morbidity and mortality in intensive care patients. We studied the problem in surgical intensive care patients with the aim of risk reduction. Patients intubated in the intensive care unit were evaluated. ⋯ Every intubation in the ICU setting should be considered potentially difficult. The existing algorithm should be modified to incorporate the American Society of Anesthesiologists difficult airway algorithm adapted to the needs of the intensive care unit. A training program for alternative methods of airway management for difficult intubations should be established.
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Anaesth Intensive Care · Jan 2012
Emergency surgery in the elderly: a retrospective observational study.
We conducted a retrospective observational study in a regional hospital on patients aged 80 years or over undergoing emergency procedures. We included 202 emergency procedures performed on 178 patients over 185 separate admissions. The aim was to obtain a 'snapshot' of the risks of emergency surgery in the elderly and to analyse functional status both as a risk factor and as an outcome in this patient group. ⋯ Increasing age, higher American Society of Anesthesiologists physical status score and poorer pre-admission functional status appeared to be associated with increased complications and mortality. Although two-thirds of both functionally independent and partially dependent patients were discharged at their original level of function, 28% of partially dependent patients required discharge to a high-level care nursing home, whereas only 5% of the initially independent patients had this poor outcome. Improvement in our ability to stratify risk in this enlarging patient group should help improve our clinical decision-making, which may have benefits both for patients and resource allocation.
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Anaesth Intensive Care · Jan 2012
Plasma free cortisol and B-type natriuretic peptide in septic shock.
Previous studies of patients with septic shock have independently demonstrated alterations in plasma concentrations of B-type natriuretic peptide and plasma free cortisol. Previous data suggest that a reciprocal relationship might exist. However, the relationship between these hormones in patients with septic shock is unclear. ⋯ A model incorporating both variables explained 68% of variation in plasma free cortisol (R-square=0.682). This study of patients with septic shock demonstrates a previously unappreciated positive correlation between plasma free cortisol and b-type natriuretic peptide concentration. Acute Physiology and Chronic Health Evaluation III score and noradrenaline dose were independent predictors of plasma free cortisol.