Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2010
Assessment of a cardiac output device using arterial pulse waveform analysis, Vigileo, in cardiac surgery compared to pulmonary arterial thermodilution.
Many devices are available to assess cardiac output (CO) in critically ill patients and in the operating room. Classical CO monitoring via a pulmonary artery catheter involves continuous cardiac output (CCO) measurement. The second generation of Flotrac/Vigileo monitors propose an analysis of peripheral arterial pulse waves to calculate CO (APCO) without calibration. ⋯ Large inter-individual variability does exist. During cardiac surgery and after leaving the operating room, Vigileo is not clinically equivalent to continuous thermodilution by pulmonary artery catheter Nevertheless, the connection between CCO and ICO relates the difference between APCO and CCO more to the different algorithms used. Further efforts should be concentrated on assessing the ability of this device to track changes in cardiac output.
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Anaesth Intensive Care · Mar 2010
Case ReportsTotal spinal following labour epidural analgesia managed with non-invasive ventilation.
A 30-year-old woman developed total spinal anaesthesia during establishment of labour analgesia via an epidural catheter The subsequent respiratory failure was successfully managed with non-invasive ventilation. This report describes the use of non-invasive ventilation in the parturient and the process of managing the parturient safely in an appropriately monitored environment. This case displays the potential benefit of this technique in the setting of a total spinal block in preventing the need for intubation and ventilation (and subsequent emergency caesarean section) and providing adequate ventilatory function until the block subsided adequately.
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Anaesth Intensive Care · Mar 2010
Pilot study of the air-Q intubating laryngeal airway in clinical use.
The air-Q Intubating Laryngeal Airway (ILA) is a newly introduced extraglottic airway device. In this pilot study, we evaluated its use as a routine airway device during positive pressure ventilation. Ease of endotracheal intubation through the device was also assessed. ⋯ One patient was diagnosed with bilateral lingual nerve injury but made a complete recovery in four weeks. The air-Q ILA is an adequate extraglottic airway device in terms of insertion and ventilation. However the proposed advantage of ease of endotracheal intubation requires further investigation.
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Anaesth Intensive Care · Mar 2010
Patients' understanding of technical terms used during the pre-anaesthetic consultation.
Communication between patients and anaesthetists is being recognised as an increasingly important aspect of clinical care. Patients need to understand the nature and consequences of any proposed procedure prior to giving informed consent. In this regard, anaesthetists have a responsibility to provide adequate information about anaesthesia and related procedures in a form that patients are likely to understand. ⋯ We have identified many technical terms that may not be understood by patients presenting for anaesthesia care. An awareness of commonly misunderstood words may facilitate better transfer of information during pre-anaesthesia consultations. Our study findings should remind doctors that patients frequently fail to understand or take in what we tell them.
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Anaesth Intensive Care · Mar 2010
Randomized Controlled TrialA randomised controlled trial of hyperbaric bupivacaine with opioids, injected as either a mixture or sequentially, for spinal anaesthesia for caesarean section.
It is common practice to mix opioids with hyperbaric bupivacaine in a single syringe before intrathecal injection of the mixture. Mixing these drugs may alter the density of the hyperbaric solution, affecting the spread of local anaesthetic and opioid. Forty-eight women having elective caesarean section under spinal anaesthesia were recruited to this double-blind, randomised trial. ⋯ There was no difference between groups in the incidence of hypotension, need for vasopressor or side-effects. Morphine consumption was significantly higher in group M (13.3 +/- 11.2 vs. 6.2 +/- 7.2 mg, P = 0.015). Mixing of fentanyl and morphine with hyperbaric bupivacaine results in a higher level of sensory block than sequential administration of bupivacaine then opioid and may be associated with higher postoperative opioid requirement.