Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2010
What are we telling our patients? A survey of risk disclosure for anaesthesia in Australia and New Zealand.
The aim of our study was to determine the range of risks disclosed in four commonly-encountered clinical scenarios: knee arthroscopy, lumbar laminectomy, laparoscopic appendicectomy and laparotomy, and then to determine how often five commonly-disclosed risks were disclosed for each scenario. We conducted a pilot survey of consultant anaesthetists in the Auckland City Hospital, the Royal Melbourne Hospital and the Austin Hospital (response rate 59%). A web survey was then sent to 500 randomly-selected Australian and New Zealand College of Anaesthetists Fellows (response rate 29%). ⋯ While the low response rate limits the validity and generalisability of many of our findings, we can nevertheless confidently conclude that risk disclosure varies widely in Australia and New Zealand. This large variation should be of concern to all anaesthetists. More work is needed to understand the reasons for this variation, and to develop a stronger consensus among anaesthetists about what risks should be disclosed.
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Anaesth Intensive Care · Sep 2010
Comparative StudyPharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis.
With continuously increasing expenditure on health care resources, various cost containment strategies have been suggested in regard to controlling the cost of inhalational anaesthetic agents. We performed a cost identification analysis assessing inhalational anaesthetic agent expenditure at a tertiary level hospital, along with an evaluation of strategies to contain the cost of these agents. The number of bottles of isoflurane, sevoflurane and desflurane used during the financial years 1997 to 2007 was retrospectively determined and the acquisition costs and cumulative drug expenditure calculated. ⋯ Pharmacoeconomic modelling demonstrated that sevoflurane at 2 l/minute costs 19 times more than isoflurane at 0.5 l/minute. For the financial years 1997 to 2007, we found a progressive shift from the cheaper isoflurane to the more expensive agents, sevoflurane and desflurane, a shift associated with marked increases in costs. Low flow anaesthesia with isoflurane is one strategy to reduce costs.
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Anaesth Intensive Care · Sep 2010
Comparative StudyA prospective comparison between written examination and either simulation-based or oral viva examination of intensive care trainees' procedural skills.
We compared results of written assessment of intensive care trainees' procedural skills with results obtained from one of two live assessment formats for the purposes of assessing the concurrent validity of the different test methods. Forty-five Australasian senior trainees in intensive care medicine completed a written test relating to a procedural skill, as well as either a simulation format or oral viva assessment on the same procedural skill. We analysed correlation between written exam results and results obtained from simulation format or oral viva assessment. ⋯ The lack of correlation between exam formats supports multi-modal assessment, as currently it is not known which format best represents workplace performance. Correlation between written and oral viva results may indicate redundancy between those test formats, whereas limited correlation between simulation and written exams may support the use of both formats as part of an integrated assessment strategy. We hypothesise that identification of critical candidate errors in a simulation format exam that were not exposed in a written exam may indicate better predictive validity for simulation format examination of procedural skills.
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Anaesth Intensive Care · Sep 2010
Accuracy of weight and height estimation in an intensive care unit.
We report the findings from a prospective study determining the magnitude of errors in the visual estimation of weight and height of critically ill patients. Forty-two consecutive patients were weighed by a physician with a calibrated stretcher scale and length measured with a steel measuring tape. The predicted body weight was calculated using the ARDSnet formulae. ⋯ Our study shows that estimations of patient's weight made by intensive care unit staff are often inaccurate. In contrast, estimations of height made by intensive care unit staff are usually adequate. Estimated body weight of critically ill patients has implications for drug and respiratory therapy and should be used with caution.
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Anaesth Intensive Care · Sep 2010
Case ReportsIntravascular haemolysis and septicaemia due to Clostridium perfringens liver abscess.
Intravascular haemolysis is a rare but serious complication of Clostridium perfringens sepsis. The outcome is usually fatal unless treatment is started early. We describe a case of survival after haemolysis and multiple organ failure in the setting of a ruptured liver abscess and sepsis caused by C. perfringens in an immunocompetent 58-year-old male.