Australian and New Zealand College of Anaesthetists Annual Scientific Meeting, 7 to 11 May, 2018, Sydney Convention and Exhibition Centre, Sydney, New South Wales
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Potential consequences of high-dose infusion of ketamine for refractory status epilepticus: case reports and systematic literature review
We present two cases of RSE that responded rapidly to ketamine infusion, both with fatal outcomes secondary to metabolic acidosis and cardiovascular collapse. We performed a systematic review of the application and consequences of ketamine use in RSE. PubMed, Ovid, MEDLINE and PMC were searched for articles describing ketamine treatment for RSE according to a predetermined search strategy and inclusion criteria. The systematic review revealed wide discrepancies in ketamine dosing (infusion maintenance dose range 0.0075 –10.5 mg/kg/hour), but good outcomes in medically managed RSE (75% of studies reported moderate or comp...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
A survey of the impact of patient adverse events and near misses on anaesthetists in Australia and New Zealand
We conducted a cross-sectional online survey of members of the Australian and New Zealand College of Anaesthetists to investigate their experiences of adverse patient safety events and near misses, including their use of incident reporting systems and the organisational support available. There were 247 respondents. Of the 243 anaesthetists whose patients had an adverse event or near miss, 199 reported this had affected them personally or professionally; 177 reported stress, 153 anxiety, 109 sleep disturbance, and 127 lower professional confidence. Of 188 who had reported an adverse event using their local incident reporti...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Introduction of a mandatory pre-block safety checklist into a regional anaesthesia block room service: a quality improvement project
Wrong-side block is an uncommon yet potentially preventable complication of regional anaesthesia. One strategy for reducing the incidence of wrong-side block is to introduce an additional check into the pre-block workflow in the form of a block ‘time out’ or ‘stop before you block’. In the aftermath of a wrong-side block incident at our institution, the mandatory use of a pre-block safety checklist was successfully introduced into the workflow of the block room. Compliance with the checklist rose from 31% in the six-month pre-inter vention phase to over 90% in the six-month post-intervention phase. This was achieve...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
An audit of perioperative blood transfusions in a regional hospital to rationalise a maximum surgical blood ordering schedule
Appropriate preoperative blood typing and cross-matching is an important quality improvement target to minimise costs and rationalise the use of blood bank resources. This can be facilitated using a maximum surgical blood ordering schedule (MSBOS) for specific operations. It is recommended that individual hospitals develop a site-specific MSBOS based on institutional data, but this is challenging in non-tertiary centres without electronic databases. Our aim was to audit our perioperative blood transfusions to develop a site-specific MSBOS. A retrospective audit of blood transfusions in surgical patients in our regional ref...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Attitudes and self-reported end-of-life care of Australian and New Zealand intensive care doctors in the context of organ donation after circulatory death
The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals ’ attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors’ attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD d onors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses co...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Inhalational versus propofol-based total intravenous anaesthesia: practice patterns and perspectives among Australasian anaesthetists
Increasing evidence suggests that total intravenous anaesthesia (TIVA) may be the preferred anaesthetic for cancer resection surgery. To assist the preparation of a randomised controlled trial (RCT) examining Volatile (versus TIVA) Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) we developed an 18-question electronic survey to investigate practice patterns and perspectives (emphasising indications, barriers, and impact on cancer outcomes) of TIVA versus inhalational general anaesthesia in Australasia. The survey was emailed to 1,000 (of 5,300 active Fellows) randomly selected Australian and New Zealand C...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
A randomised controlled trial comparing fibreoptic-guided tracheal intubation through two supraglottic devices: Ambu ® AuraGain™ laryngeal mask and LMA® Fastrach™
The Ambu ®AuraGain™ laryngeal mask (LM) (Ambu A/S, Ballerup, Denmark) is one of the few readily available second-generation supraglottic airway devices (SADs) that offer a conduit for fibreoptic-guided endotracheal intubation. We aimed to compare fibreoptic intubation through this device with the LMA® (l aryngeal mask airway) Fastrach™ (Teleflex Medical, Co. Westmeath, Ireland), which has been a recommended dedicated rescue device for the management of the unanticipated difficult airway. This randomised controlled trial compared a previously described fibreoptic score in 116 patients with no known airway pathology, w...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Does a catheter over needle system reduce infusate leak in continuous peripheral nerve blockade: a randomised controlled trial
Continuous peripheral nerve blockade is a common technique in the analgesic management for many procedures. Leakage of local anaesthetic from around the nerve catheter insertion site can increase the chance of catheter dislodgement, risks infective complications, and could divert anaesthetic away from the nerve causing the block to fail. We conducted a randomised controlled trial to assess whether the type of nerve catheter influenced local anaesthetic leak rate. One hundred and ten patients scheduled for elective unilateral total knee arthroplasty were randomised to receive a perineural catheter with either a catheter ove...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Fasting or starving? Measurement of blood ketone levels in 100 fasted elective and emergency adult surgical patients at an Australian tertiary hospital
Prolonged fasting leads to a shift from carbohydrate to fat as the primary energy source, resulting in the production of ketones such as beta-hydroxybutyrate. Hyperketonaemia and ketoacidosis have been observed in young children fasting for surgery. The aim of this study was to investigate ketonaemia in adults fasted for surgery. One hundred non-diabetic adults presenting for elective or emergency surgery were assessed for the presence of hyperketonaemia (beta-hydroxybutyrate levels more than 1 mmol/l), and the relationship between beta-hydroxybutyrate, blood glucose and fasting duration was investigated. Three of 100 pati...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Nutritional prehabilitation: physiological basis and clinical evidence
In this narrative review, we describe the physiological basis for nutritional prehabilitation and evaluate the clinical evidence for its current roles in the perioperative period. Surgical stress and fasting induce insulin resistance as a result of altered mitochondrial function. Insulin resistance in the perioperative period leads to increased morbidity in a dose-dependent fashion, while preoperative carbohydrate loading attenuates insulin resistance, minimises protein loss and improves postoperative muscle function. Carbohydrate loading is an established practice in many countries and a key component of enhanced recovery...
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Anaesthesia and awareness: searching for the truth about consciousness in Oblivion
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
The silence of our friends
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
How do we eliminate, or reduce the incidence of, wrong-side anaesthetic blocks?
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
Mechanised cardiac massage
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - September 7, 2018 Category: Anesthesiology Source Type: research
