Echocardiography Time Audit study
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Potential for inadvertent airway delivery of carbon dioxide with humidified high flow oxygen circuit
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
A survey of the sequelae of memorable anaesthetic drug errors from the anaesthetist ’s perspective
Drug errors amongst anaesthetists are common. Although there has been previous work on the system factors involved with drug error, there has been little research on the sequelae of a drug error from the anaesthetist ’s perspective. To clarify this issue, we surveyed anaesthetists regarding their most memorable drug error to identify associated factors and personal sequelae regarding their professional practice after the event. An online survey was sent anonymously to 989 Australian and New Zealand College of Anaesthetists (ANZCA) Fellows in March 2016 and the results were collected over the following two months. There w...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
A retrospective observational study of patients with dilated cardiomyopathy undergoing non-cardiac surgery
The perioperative risks and factors associated with adverse cardiac outcomes in patients with dilated cardiomyopathy undergoing non-cardiac surgery are unknown. Interrogation of the Nelson Hospital transthoracic echocardiogram database identified 127 patients with dilated cardiomyopathy who satisfied the study criteria and underwent non-cardiac surgery between June 1999 and July 2013. Demographic and clinical data along with postoperative death within 30 days or a major adverse cardiac event were retrieved and analysed. The mean age was 75.9 years. Seventy-one percent of the patients had severe impairment of left ventricul...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Administration of anaesthetic triggering agents to patients tested malignant hyperthermia normal and their relatives in New Zealand: an update
Testing for malignant hyperthermia in New Zealand involves two tests —in vitro contracture testing of excised lateral quadriceps muscle and DNA analysis. In vitro contracture testing is regarded as the gold standard in malignant hyperthermia diagnosis but several publications have questioned the reliability of a normal result. Analysis of 479 anaesthetic records in 280 patients or their descendants throughout New Zealand who had tested negative for malignant hyperthermia, demonstrated there was no evidence of malignant hyperthermia episodes in this group who had been administered anaesthetic triggering agents. A wide ran...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Outcomes of telemedicine intervention in a regional intensive care unit: a before and after study
Telemedicine consultations in remote intensive care units (ICUs) overseas were found to be effective in reducing mortality and hospital length of stay (LOS). In Australia, there were anecdotal reports of these clinical outcomes. This retrospective before and after study assessed the improvement in patient outcomes with the implementation of a telemedicine program in a regional high dependency unit. Daily virtual consultations were conducted between the rural facility and the intensivists at the regional centre. A total of 525 patients received intensive care support between 2010 and 2015. Hospital and High Dependency Unit ...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Incidence of elevated procalcitonin and presepsin levels after severe trauma: a pilot cohort study
In this study, 75 patients were included. PCT levels on days 0 and 1 were 0.1±0.4 and 1.8±6.3 ng/ml, respectively (P=0.02). PSEP levels on days 0 and 1 were 221 ±261 and 222±207 pg/ml, respectively (P=0.98). As per multivariate logistic regression analyses, packed red blood cell (PRBC) transfusion was the only independent risk factor for higher PCT levels on day 1 (P=0.04). Using PCT to diagnose sepsis in trauma patients on day 1 requires caution. PRBC transfusion was found to be a risk factor for increasing PCT levels. On the other hand, PSEP levels were not affected by trauma during the early phases. (Source: Anaesth...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Impact of thrombelastography in paediatric intensive care
We assessed the clinical impact of thrombelastography (TEG ®) results (TEG® 5000, Haemonetics Corporation, Braintree, MA, USA) by measuring their ability to cause changes in a theoretical treatment plan and contribute to the understanding of haemostasis. We prospectively included paediatric intensive care unit (PICU) patients who had standard tests of hae mostasis and TEG ordered and had an arterial catheter or extracorporeal access port in situ. Blood for standard tests and TEG was taken simultaneously. Independent of patient care, general patient information and results of standard laboratory tests were presented to fi...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Effect of sugammadex versus neostigmine/atropine combination on postoperative cognitive dysfunction after elective surgery
This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were>40 years. The Mini –Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge. The anaesthetic protocol was the same for all patients, except for the neuromuscular block revers...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
The effect of a surgery-specific cardiac output –guided haemodynamic algorithm on outcomes in patients undergoing pancreaticoduodenectomy in a high-volume centre: a retrospective comparative study
In this retrospective observational study performed in a high-volume hepatobiliary –pancreatic unit, we evaluated the effect of a surgery-specific goal-directed therapy (GDT) physiologic algorithm on complications and length of hospital stay. We compared patients who underwent pancreaticoduodenectomy with either a standardised Enhanced Recovery After Surgery program (usual care group), or a standardised Enhanced Recovery After Surgery program in combination with a surgery-specific cardiac output–guided algorithm (GDT group). We included 145 consecutive patients: 47 in the GDT group and 98 in the usual care group. Multi...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
In vitro evaluation of the effect of haemodilution with dextran 40 on coagulation profile as measured by thromboelastometry and multiple electrode aggregometry
We evaluated the effects of haemodilution with either dextran 40 or 0.9% normal saline on coagulation in vitro using rotational thromboelastometry (ROTEM ®, Pentapharm Co., Munich, Germany) and multiple electrode aggregometry (Multiplate® Platelet Function Analyser, Dynabyte, Munich, Germany). Venous blood samples obtained from 20 healthy volunteers were diluted in vitro with dextran 40 or normal saline by 5%, 10% and 15%. Fibrinogen concentration, ROTEM-EXTEM® (screening test for the extrinsic coagulation pathway), FIBTEM® (an EXTEM-based assay of the fibrin component of clot) parameters including coagulation time, cl...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Effect of nicotine replacement therapy on mortality, delirium, and duration of therapy in critically ill smokers: a systematic review and meta-analysis
Nicotine replacement therapy is widely used in critically ill smokers and its effect on delirium, mortality and duration of intensive care unit (ICU) admission is unknown. The aims of this review were to determine whether the management of nicotine withdrawal with nicotine replacement therapy reduces delirium, mortality or length of stay in critically ill smokers in ICU. The primary outcome was incidence of author-defined ICU delirium. Secondary outcomes were ICU or hospital mortality, ICU-free days at day 28, and ICU or hospital length of stay. We conducted a systematic review and meta-analysis of the data sources MEDLINE...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Australian and New Zealand Anaesthetic Allergy Group Perioperative Anaphylaxis Investigation Guidelines
These guidelines are a consensus document developed by a working party of the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) to provide an approach to the investigation of perioperative anaphylaxis. They focus primarily on the use of skin testing as it is the investigation with the greatest clinical utility for the identification of the likely causative agent and potentially safer alternatives. The practicalities and process of skin testing, its limitations, and the place of other tests are discussed. These guidelines also address the roles of graded challenge and in vitro testing. The implications of anaphy...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
What are we injecting with our drugs?
In preparation for a case, an anaesthetist opened a 20 ml glass vial of propofol and aspirated the propofol into a syringe via a blunt drawing-up needle. Increased resistance was felt with aspiration. On inspection, a shard of glass was found at the tip of the drawing-up needle. The shard was presumed to be from the propofol ampoule, and to have fallen into the solution upon snapping open its glass tip. This illustrative case raises the issue of contamination of drugs by particles introduced during the drawing-up process. It also highlights the possibility that during the drawing-up process, intravenous drugs may become co...
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
Can the timing of perioperative fluids affect hospital length of stay?
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 11, 2017 Category: Anesthesiology Source Type: research
