The effectiveness of regional anaesthesia before and after the introduction of a dedicated regional anaesthesia service incorporating a block room
Dedicated regional anaesthesia services incorporating block rooms and/or block teams may facilitate theatre efficiency and improve training in regional anaesthesia. Currently, it is unknown if a dedicated regional anaesthesia service improves the effectiveness of regional anaesthesia. In November 2013, the Royal Brisbane and Women ’s Hospital established a dedicated regional anaesthesia service comprising a block team and a block room. Pre-intervention (conventional model of care) registry data was retrospectively compared with post-intervention (dedicated regional anaesthesia service) audit data, with regard to pain and...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Evidence of malignant hyperthermia in patients administered triggering agents before malignant hyperthermia susceptibility identified: missed opportunities prior to diagnosis
Malignant hyperthermia (MH) is a hypermetabolic disorder of skeletal muscle triggered almost exclusively by potent inhalational agents and suxamethonium. Signs of an MH reaction are non-specific and may be confused with the presentation of other problems such as sepsis and overheating of a patient. A high index of suspicion is needed to be aware of an early presentation of MH. Nine patients are presented who showed abnormal signs with an earlier anaesthetic where the possible diagnosis of an MH reaction was missed. These patients either presented later with an MH reaction, confirmed by DNA analysis and in some cases in vit...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study
This study was undertaken to determine the prevalence of persistent post-surgical opioid use and patient-related factors associated with post-surgical opioid use. One thousand and thirteen opioid-na ïve patients awaiting elective surgery in a tertiary private hospital in Sydney were enrolled. Preoperatively, patients completed a questionnaire comprising potential predictors of persistent post-surgical opioid use. Patients underwent surgery with routine perioperative care, and were followed up at 90 to 120 days after surgery to determine opioid use. Factors associated with opioid use were assessed with logistic regression....
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Assessment of the reliability of intubation and ease of use of the Cook Staged Extubation Set —an observational study
The Staged Extubation Set has recently been introduced by Cook Medical for the management of difficult airway patients who potentially require reintubation; however, its reliability for intubation and ease of use is not reported in the literature. The set contains a wire and reintubation catheter with a central lumen for the wire and oxygenation if required. Reintubation is by a two-stage Seldinger-like technique. After induction of general anaesthesia, 23 low-risk elective surgical patients had the Staged Extubation Wire from the Cook set inserted into their trachea under direct laryngoscopy. The intubation was subsequent...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Predictive value of quick Sepsis-Related Organ Failure Scores following sepsis-related Medical Emergency Team calls: a retrospective cohort study
We conducted a cohort study of adult ward patients who had a Medical Emergency Team (MET) call triggered by confirmed or suspected sepsis in an Australian tertiary centre to assess the predictive utility of systemic inflammatory response syndrome (SIRS) and quick Sepsis-Related Organ Failure Assessment (qSOFA) scores for 28-day mortality over a 12-month period. Sepsis was the causative aetiology in 970 MET calls for 646 patients with a mean age of 68 years and median Charlson Comorbidity score (CCS) of 3.0. Four hundred and seven (63%) patients had microbiological identification of a causative organism with 35 (9%) demonst...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Postoperative troponin measurement as a screening tool for adverse cardiac events in adult patients undergoing moderate or major non-cardiac surgery
We examined the medical records of all patients ≥45 years of age undergoing moderate or major non-cardiac surgery in our tertiary referral hospital over a six-month period. We determined how many patients had a troponin (TnT) measurement recorded in the first three days postoperatively, how many of these were abnormal, and the occurrence of MAC E within 30 days. Two thousand and two hundred patients underwent 2,577 operations that met the study criteria. A postoperative TnT was measured after 4.5% of operations. Thirty-eight percent of patients with a recorded TnT measurement, and 44% of those with an abnormal measuremen...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Perioperative assessment of older surgical patients using a frailty index —feasibility and association with adverse post-operative outcomes
This study aimed to examine the feasibility of using a frailty index (FI) based on comprehensive geriatric assessment (CGA), to assess the level of frailty in older surgical patients preoperatively and to evaluate the association of FI-CGA with poorer postoperative outcomes. Two hundred and forty-six patients aged ≥70 years undergoing intermediate- to high-risk surgery in a tertiary hospital were recruited. Frailty was assessed using a 57-item FI-CGA form, with fit, intermediate frail, and frail patients defined as FI ≤0.25,>0.25 to 0.4, and>0.4, respectively. Adverse outcomes were ascertained at 30 days and 12 months ...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Effect of hypocaloric normoprotein or trophic feeding versus target full enteral feeding on patient outcomes in critically ill adults: a systematic review
Uncertainty surrounds the optimal approach to feeding the critically ill, with increasing interest in the concept of intentional underfeeding to reduce metabolic stress while maintaining gut integrity. Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this systematic review evaluates clinical outcomes reported in studies comparing hypocaloric normonitrogenous or trophic feeding (collectively ‘intentional underfeeding’) targeted full energy feeding administered via enteral nutrition to adult critically ill patients. Electronic databases including PubMed, CINA...
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Understanding the lives of anaesthesia trainees
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Can we reduce the prevalence of persistent opioid use after surgery by predicting the future?
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Intravenous crystalloids in the late 19th and early 20th century
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - November 15, 2017 Category: Anesthesiology Source Type: research
Abstracts from ANZCA
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Veno-arterial extracorporeal membrane oxygenation for severe cardiogenic shock secondary to phaeochromocytoma crisis
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Fungal coronary embolus while on extracorporeal membrane oxygenation
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
A brief safety assessment of active self-warming blankets; too hot to handle?
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
