Anaesthesia
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A case of atypical headache presenting following otherwise unremarkable epidural analgesia in labour is presented. Although there was no suggestion of accidental dural puncture during insertion of the epidural catheter, and despite the unusual features of the headache and complicated case history, an epidural blood patch was performed 13 weeks post-partum, with improvement of the patient's symptoms. A repeat epidural blood patch 2 weeks later completely resolved her headache.
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Accidental bronchial intubation was examined in the first 3947 cases reported to the Australian Incident Monitoring Study and was found to have accounted for 154 (3.7%) of the total incidents reported. Most incidents were detected in the operating theatre (93.5%) and during maintenance of anaesthesia (77.9%), by unexplained oxygen desaturation alone (63.6%). Capnography remained normal or unremarkable during 88.5% of the episodes. ⋯ Almost two-thirds (61.1%) of the incidents might have been avoided by the proposed markings on the tracheal tube. We conclude that when arterial desaturation occurs at any stage during anaesthesia the possibility of bronchial intubation must be considered. Asymmetrical ventilation may be difficult to detect clinically and in most cases there is no change in capnography.
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Music in theatre: not so harmonious. A survey of attitudes to music played in the operating theatre.
Music played to staff in the operating theatre is thought to improve surgeons' concentration but its effects on other theatre staff are unknown. We surveyed 200 anaesthetists to determine the prevalence of music playing in the operating theatre and anaesthetists' attitudes to it. ⋯ Around 26% of the sample felt that music reduced their vigilance and impaired their communication with other staff while 11.5% felt that music might distract their attention from alarms. Fifty-one per cent felt that music was distracting when a problem was encountered during the anaesthetic.
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The aim of this study was to determine the cause of death of those patients who died on general hospital wards after discharge from an intensive care unit. Of 1700 patients admitted over a 5-year period, 341 (20%) died in intensive care but a further 153 (9%) died on general wards. ⋯ The main causes of death were pneumonia, hypoxic or structural brain damage, cerebrovascular accident, malignancy, myocardial infarction, renal or multi-organ failure and sepsis. Some of these may have been preventable with further intensive care or improved care on the wards.