In reply to Castro-Alves and Kendall
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Is there more to the story of burnout in anaesthesiology trainees?
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
An international survey evaluating factors influencing the use of total intravenous anaesthesia
The purpose of this study was to evaluate factors influencing the use of propofol-based total intravenous anaesthesia (TIVA)since despite TIVA being a well-established technique, it is used far less frequently than volatile anaesthesia. Questions were formulated after reviewing the literature for perceived disadvantages of TIVA and meeting with a focus group consisting of both senior and junior anaesthestists from our department. Once the survey had been formulated, specialist anaesthetists from professional colleges and societies from several countries were invited to complete the survey on an electronic web-based platfor...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Extended duration regional analgesia for total knee arthroplasty: a randomised controlled trial comparing five days to three days of continuous adductor canal ropivacaine infusion
There is a growing body of evidence in favour of continuous adductor canal block (CACB) for total knee arthroplasty. However, there are no studies describing the optimal duration of the infusion. At our institution the usual practice was to stop the infusion on day three. Our hypothesis was that extending the infusion to five days would improve analgesia and quality of recovery. A prospective, non-blinded, randomised trial was undertaken. Patients received a continuous infusion of 0.2% ropivacaine via an adductor canal catheter for either three or five days. Primary outcome was pain while walking during the 24-hour period ...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Clinical practice variation in acute severe burn injury
The New South Wales (NSW) Statewide Burn Injury Service Database was reviewed to identify variations in clinical practice with respect to care of severely burn-injured patients in intensive care. We compared differences in practice relating to duration of endotracheal intubation and surgical grafting. In this retrospective observational study, we reviewed all intensive care unit (ICU) admissions to the two NSW adult burns centres, ICU A and ICU B, between January 2008 and December 2015. Data were analysed for association between duration of intubation and outcome. There were 855 admissions to adult ICU, with a significant ...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Strategies to reduce inappropriate laboratory blood test orders in intensive care are effective and safe: a before-and-after quality improvement study
Unnecessary pathology tests performed in intensive care units (ICU) might lead to increased costs of care and potential patient harm due to unnecessary phlebotomy. We hypothesised that a multimodal intervention program could result in a safe and effective reduction in the pathology tests ordered in our ICU. We conducted a single-centre pre- and post-study using multimodal interventions to address commonly ordered routine tests. The study was performed during the same six month period (August to February) over three years: 2012 to 2013 (pre-intervention), 2013 to 2014 (intervention) and 2014 to 2015 (post-intervention). Int...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Governance of rapid response teams in Australia and New Zealand
The objectives of this study were to describe current governance arrangements for RRTs within ANZ and contrast those against expected implementation, using the Australian Commission for Safety and Quality in Health Care N ational Standard 9 (S9) as a benchmark. Assessment focused on S9 subclauses 9.1.1 (governance and oversight), 9.1.2 (RRT implementation), 9.2.3 (data collection and dissemination), 9.2.4 (quality improvement), 9.5.2 (call reviews), 9.6.1 and 9.6.2 (basic and advanced life support [ALS] skill set). W e identified public and private hospitals across ANZ from government-maintained registers. Those reasonably...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
A two centre observational study of simultaneous pulse oximetry and arterial oxygen saturation recordings in intensive care unit patients
The influence of variables that might affect the accuracy of pulse oximetry (SpO2) recordings in critically ill patients is not well established. We sought to describe the relationship between paired SpO2/SaO2 (oxygen saturation via arterial blood gas analysis) in adult intensive care unit (ICU) patients and to describe the diagnostic performance of SpO2 in detecting low SaO2 and PaO2. A paired SpO2/SaO2 measurement was obtained from 404 adults in ICU. Measurements were used to calculate bias, precision, and limits of agreement. Associations between bias and variables including vasopressor and inotrope use, capillary refil...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Non-invasive estimation of cardiac index in healthy volunteers
The primary objective was to non-invasively measure the cardiac index (CI) and associated haemodynamic parameters of healthy volunteers and their changes with age. This was a single centre, prospective, observational study of healthy volunteers aged between 20 and 59 years, using the ClearSight ™ (Edwards Life Sciences, Irvine, CA, USA) device. We recorded 514 observations in 97 participants. The mean CI was 3.5 l/min/m2 (95% confidence interval [95% CI] 3.4 to 3.7 l/min/m2). The mean stroke volume index (SVI) was 47 ml/m2 (95% CI 45 to 49 ml/m2) and the mean systemic vascular resistance index was 2,242 dyne.s/cm5/m2 (95...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Validation of a revised Mandarin Chinese language version of the Postoperative Quality of Recovery Scale
The aim of the study was to validate a revised Mandarin version of the Postoperative Quality of Recovery Scale (PostopQRS) and to apply the revised version in a Chinese population. In a prospective design, bilingual volunteers completed the scale at baseline, day one, day seven, and day 14 in both languages, with the order of language and parallel forms randomised. In addition, lung cancer patients undergoing open or video-assisted thoracoscopic surgery (VATS) completed the Mandarin version prior to surgery, day one, day three, day seven, day 14, one month, and three months postoperatively. Sixty-eight volunteers participa...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
The effects of haemodilution with succinylated gelatin solution on coagulation in vitro as assessed by thromboelastometry and impedance (multiple electrode) aggregometry
We investigated the in vitro viscoelastic changes of progressive haemodilution with succinylated gelatin (SG) solution compared with normal saline (NS) using rotational thromboelastometry (ROTEM ®). Whole blood (WB) samples obtained from 20 healthy volunteers were diluted in vitro with SG solution or NS by 10%, 20% and 40%. Fibrinogen concentration and ROTEM (EXTEM, FIBTEM) variables including coagulation time (CT), clot formation time (CFT), α-angle, and maximum clot firmness (MCF) were measured in the undiluted sample and at each degree of haemodilution. Haemodilution with SG decreased FIBTEM MCF by 34.8% at 20% diluti...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Effect on neonatal outcome of pharmacological interventions for attenuation of the maternal haemodynamic response to tracheal intubation: a systematic review
The primary aim of this systematic review was to assess the effect on neonatal outcome of pharmacological interventions used for attenuation of the haemodynamic response to tracheal intubation in patients undergoing caesarean section under general anaesthesia. A systematic search of randomised controlled trials from 1990 to 2015 was conducted. The primary outcome measure was the Apgar score at five minutes and secondary outcomes were umbilical arterial blood gas parameters and neurological adaptive capacity scores. Twenty-seven randomised controlled trials (1,689 patients) were included in the qualitative synthesis. Only f...
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Thinking beyond routine daily pathology testing in the intensive care unit
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
The early history of cardiac massage
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - May 2, 2018 Category: Anesthesiology Source Type: research
Stoelting ’s Anesthesia and Co-existing Disease
(Source: Anaesthesia and Intensive Care)
Source: Anaesthesia and Intensive Care - March 9, 2018 Category: Anesthesiology Source Type: research
