A 3-day-old child presented with a gross swelling on the right side of the neck extending beyond the midline and inability to swallow. It was diagnosed to be cystic hygroma and decision was made to excise the swelling as an emergency operation to enable the child to swallow and thrive better. During the gaseous induction, difficulty was encountered in maintaining the airway and subsequently to intubate the patient. Intraoperatively the surgeon was not able to excise the tumour completely. Postoperatively it was decided to ventilate the child electively because of the intubation difficulties encountered and not so firm floor of the mouth because of surgical excision. The stay in the neonatal ICU was marked with infection and facial nerve palsy.
In a 6-month study period, 170 pharmacist interventions in an intensive care unit (ICU) were analysed. Of the interventions, 68.8% were solicited and 31.2% were initiated by the pharmacists. The majority of the interventions were initiated by specialists (69.4%) followed by the medical officers (15.9%) and nurses (9.4%). Most of the interventions occurred during the grand rounds (75.9%), followed by ward visits (12.9%) and communication through the satellite pharmacy (10.5%). The most frequent type of intervention made was for indication or therapeutic efficacy followed by general product information, drug regimen, laboratory assessment, disease state, pharmaceutical availability and adverse drug reaction or side effect. It was also found that 83.7% of pharmacists' suggestions were accepted, 6.4% were accepted with changes, and 9.9% were not accepted. The majority of the interventions were made by direct verbal communications followed by telephone and written communications. In conclusion the study indicates that pharmacist therapeutic recommendations form an important integral element of patient care in an ICU.