Anaesthesia and intensive care
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Anaesth Intensive Care · Dec 2006
Case ReportsValue of transoesophageal echocardiography for diagnosis of intraoperative tumour embolization.
Malignant neoplasms such as renal cell carcinoma may invade the inferior vena cava leading to a risk of pulmonary tumour embolization during surgical excision. Although massive pulmonary tumour embolism occurs relatively rarely, it can have catastrophic consequences. ⋯ The use of transoesophageal echocardiography allowed the immediate diagnosis and appropriate management of the underlying cause of acute haemodynamic instability. The role of transoesophageal echocardiography in the diagnosis of pulmonary embolism is discussed.
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Anaesth Intensive Care · Dec 2006
Increasing the use of an existing medical emergency team in a teaching hospital.
Cultural barriers in hospital ward staff may limit the use of a Medical Emergency Team (MET) service. In December 2000 the role of the existing Code Blue team in our hospital was expanded to incorporate review of patients fulfilling commonly employed MET criteria. Between January 2001 and June 2003, the average call rate was only 9.8 calls/ 1000 admissions. ⋯ In the 12 months before the intervention (October 2003 to September 2004) there were 817 emergency response calls and 51,963 admissions (15.7 calls/1000 admissions). In the 12 months after the intervention there were 1349 emergency response calls (Code Blue plus MET calls) and 54,593 admissions (24.7 calls/1000 admissions [OR 1.59; 95% CI=1.45-1.73; P<0.0001]). Our findings suggest that increasing the use of an existing service to review patients fulfilling MET criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization.
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The continuing medical education (CME) needs of anaesthetists within Australia, New Zealand, Hong Kong, Malaysia and Singapore have been largely unknown. The aim of this study was to undertake a comprehensive survey of the attitude to CME, learning preferences, attitudes and abilities relating to self-paced material, literature and information searching, preferred content and preferred approach to CME of anaesthetists within these countries. A survey tool was developed and refined for ease of use by pilot-testing. ⋯ Anaesthetists within this region appear to be motivated by the need to make better decisions based on independent standards of practice. While Australia is a world leader in flexible education, it is still emerging as a discipline. Flexible education may be used to facilitate anaesthetists' participation in CME activities and in implementation of new knowledge in their workplace.
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Anaesth Intensive Care · Dec 2006
The relationship between calculated effect-site sevoflurane levels and awakening from anaesthesia.
We have previously described a system that displays real-time estimates of effect-site sevoflurane concentrations. Estimates of effect-site levels should be similar to minimum alveolar concentration (MAC) values, which are determined after allowing time for equilibrium. This study aimed to determine estimated effect-site sevoflurane concentrations at awakening from routine anaesthesia and to compare this with published estimates of MAC-awake. ⋯ This value is within the range of values determined for MAC-awake of sevoflurane. There was no correlation with any of the demographic or anaesthetic factors, but patients undergoing major surgery woke at a significantly lower mean sevoflurane level. These results support the use of effect-site sevoflurane concentration to guide administration of anaesthesia.
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Anaesth Intensive Care · Dec 2006
Locally developed guidelines reduce immediate complications from percutaneous dilatational tracheostomy using the Ciaglia Blue Rhino technique: a report on 200 procedures.
Ciaglia Blue Rhino percutaneous dilatational tracheostomy is used as an aid to ventilatory weaning. It carries an immediate complication rate previously reported in 100 consecutive patients by Fikkers et al at 6% for "major" complications and 30% for "minor" complications. Mortality has been associated with the procedure. ⋯ There was an immediate major complication rate of 3% and minor complication rate of 18%. No deaths occurred within 24 hours of the procedure. We conclude that applying our consensus guidelines produced an immediate complication rate for Ciaglia Blue Rhino percutaneous dilatational tracheostomy below published audits.