Anaesthesia
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Critical incident reporting was introduced into the intensive care unit (ICU) as part of the development of a quality assurance programme within our department. Over a 3-year period 281 critical incidents were reported. Factors relating to causation, detection and prevention of critical incidents were sought. ⋯ Critical incident reporting was effective in revealing latent errors in our "system' and clarifying the role of human error in the generation of incidents. It has proven to be a useful technique to highlight problems previously undetected in our quality assurance programme. Improvements in quality of care following implementation of preventative strategies await further assessment.
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Clinical Trial
Haemodynamic effects of intravenous nimodipine following aneurysmal subarachnoid haemorrhage: implications for monitoring.
Nimodipine is widely used in patients with aneurysmal subarachnoid haemorrhage for the prevention and treatment of delayed ischaemic neurological deficits. Intravenous nimodipine has significant vasodilatory properties and may compromise the achievement of haemodynamic targets in patients who receive hypertensive hypervolaemic haemodilution therapy. ⋯ Formal haemodynamic assessment in these patients showed widely varying haemodynamic variables, with differences in the need for inotropic and vasopressor therapy. We conclude that optimal haemodynamic management in this subgroup of patients will require the use of pulmonary artery catheterisation.
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The Sonomatic Confirmation of Tracheal Intubation (SCOTI, Penlon, UK) device was evaluated in the laboratory with cut and uncut tracheal tubes and in 50 adult patients who underwent tracheal and oesophageal intubation with uncut tracheal tubes. We could not configure the SCOTI reliably with cut tracheal tubes. In the clinical study using uncut tubes the SCOTI identified all oesophageal intubations, but was only able to identify 84% (95% CI: 73.8-94.2%) of tracheal intubations. We recommend caution in using this device and further independent evaluation to determine its reliability.
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Case Reports Clinical Trial Controlled Clinical Trial
Pain relief with oral cannabinoids in familial Mediterranean fever.
Cannabinoids have analgesic and, possibly, anti-inflammatory properties but their clinical use has been restricted by legislation. This is the first United Kingdom report of the controlled use of a standardised pharmaceutical preparation of cannabinoids in capsular form. The therapy was assessed in a patient with familial Mediterranean fever, who presented with chronic relapsing pain and inflammation of gastrointestinal origin. ⋯ Although no anti-inflammatory effects of tetrahydrocannabinol were detected during the trial, a highly significant reduction (p < 0.001) in additional analgesic requirements was achieved. Future study designs can now incorporate prescribable forms of cannabinoids but the choice of previous cannabis users only as patients has clinical limitations. Cannabis naive patients would tolerate controlled investigations but may generate medicolegal problems.