Three-Dimensional Printing: An Aid to Epidural Access for Neuromodulation.

Objective: The case report details to use of three-dimensional (3D) printing as an aid to neuromodulation.

Methods: A patient is described in whom previous attempts at spinal neuromodulation had failed due to lack of epidural or intrathecal access, and the use of a 3D printed model allowed for improved planning and ultimately, success.

Results: Successful spinal cord stimulation was achieved with the plan developed by access to a 3D model of the patient's spine.

A Phase 1c Trial Comparing the Efficacy and Safety of a New Aqueous Formulation of Alphaxalone with Propofol.

Background: Phaxan™ (PHAX, Chemic Labs, Canton, MA) is an aqueous solution of 10 mg/mL alphaxalone and 13% 7-sulfobutylether β-cyclodextrin (betadex). In preclinical studies, PHAX is a fast onset-offset IV anesthetic like propofol, but causes less cardiovascular depression. This first-in-man study was designed to find the anesthetic dose of PHAX and to compare it with an equivalent dose of propofol for safety, efficacy, and quality of recovery from anesthesia and sedation.

Pulmonary hypertension and pregnancy: the experience of a tertiary institution over 15 years.

Background: Pulmonary hypertension (PH) in pregnancy is associated with a high maternal mortality and morbidity and has been found to be as high as 30-56%.

Aim: To review the management of such patients in a tertiary center over a 15 year period, as the current literature consists of a few case reports, a few small case series and 2 meta-analyses.

Materials And Methods: A review of all patients admitted to our institution for management of PH in pregnancy between 1994 and February 2009 was undertaken.

Validity of anaesthetic complication coding data as a clinical indicator.

Clinical indicators using routinely collected International Statistical Classification of Diseases, Australian Modification (ICD-10-AM) data offer promise as tools for improvement of quality. The ICD-10-AM is the coding system used by Australian administrators to summarise information from the clinical record to describe a patient's hospital encounter. The use of anaesthesia complications as coded by this system has been proposed by two jurisdictions as a monitor of the quality of anaesthetic services.

Preparedness for internship: a survey of new interns in a large Victorian health service.

Objective: To gain better understanding of the work-preparedness of new interns and identify areas where further training and education should be provided.

Design: Surveys of new interns assessing self-reported confidence and preparedness for tasks commonly undertaken without direct supervision. The first survey was undertaken before the cohort had started work, the second once they had completed their second intern rotation.

Development of a multi-source feedback tool for consultant anaesthetist performance.

The process of development, and implementation, of a multi-source feedback tool for consultant anaesthetists is described. Rater groups included the anaesthetist-in-charge, anaesthetic assistants, anaesthetic trainees and, for some, the nurse-in-charge of the floor. Multiple items were developed to rate consultant behaviour, especially non-technical aspects of behaviour, and used across some or all of the rater groups.

Analgesic effect of subanesthetic intravenous ketamine in refractory neuropathic pain: a case report.

A 59-year-old male patient with progressive neuropathic pain secondary to chronic idiopathic axonal polyneuropathy responded poorly to conventional therapies including gabapentin, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors and opioids. Following continuous intravenous administration of low dose ketamine, an N-methyl-D-aspartic acid receptor antagonist, 20 mg/h for 5 days, almost complete pain relief was obtained without significant side effects. The analgesic effect lasted 10-12 weeks and the ketamine infusion was repeated, with this pattern being maintained for 3.

Does patient position influence Doppler signal quality from the USCOM ultrasonic cardiac output monitor?

Background: The USCOM1A continuous wave cardiac output monitor (USCOM Pty Ltd., Sydney, NSW, Australia) is a novel Doppler-based device used to measure cardiac output noninvasively. The proper alignment of the transducer, and hence the ultrasound beam to the aortic or pulmonary outflow tracts, is essential to acquire accurate measurements and often much time is spent on transducer and/or patient positioning.

Preadmission processes may improve length of stay for colorectal surgery.

Background: The preadmission process (PAP) is known to reduce length of stay prior to surgery, but there are few data on its effects on postoperative stay. The aim of the present study was to test the hypothesis that a PAP may reduce postoperative length of stay as well as the preoperative length of stay.

Methods: An audit of admission and discharge times for patients having major colorectal surgery was undertaken to determine the impact of the preadmission process at Dandenong Hospital.