Checklists, cognitive aids, and the future of patient safety
On Wednesday, October 30, 1935, an evaluation flight of the Boeing Model 299 was undertaken at Wright Field, northeast of Dayton, OH, USA. The Model 299 was the most technologically sophisticated aircraft of its time and was nicknamed the Flying Fortress because of the extent of its armaments. Major Ployer P. Hill was the pilot, and it was his first flight in the new aircraft. The aircraft appeared to ascend normally, but suddenly stalled, turned on one wing, and crashed, killing two of the aircraft ’s five crew, including Major Hill. The investigation into the crash discovered that Major Hill had omitted a crucial step ...
Source: British Journal of Anaesthesia - June 26, 2017 Category: Anesthesiology Source Type: research
Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery
Conclusions: In this large observational study we identified a significant dose-dependent association between low preoperative BP values and increased postoperative mortality in the elderly. In the whole population, elevated diastolic, not systolic, BP was associated with increased mortality. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 15, 2017 Category: Anesthesiology Source Type: research
Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome
AbstractPrevious meta-analyses suggest that perioperative goal-directed therapy (GDT) is useful to decrease postoperative morbidity. Most GDT studies analysed were done with pulmonary artery catheters, oesophageal Doppler and calibrated pulse contour methods. Uncalibrated pulse contour (uPC) techniques are an appealing alternative but their accuracy has been questioned. The effects of GDT on fluid management (volumes and volume variability) remain unclear. We performed a meta-analysis of randomized controlled trials investigating the effects of GDT with uPC methods on postoperative outcome. The primary endpoint was postope...
Source: British Journal of Anaesthesia - June 11, 2017 Category: Anesthesiology Source Type: research
Digital innovations and emerging technologies for enhanced recovery programmes
AbstractEnhanced recovery programmes (ERPs) are increasingly used to improve post-surgical recovery. However, compliance to various components of ERPs —a key determinant of success—remains sub-optimal. Emerging technologies have the potential to help patients and caregivers to improve compliance with ERPs.Preoperative physical condition, a major determinant of postoperative outcome, could be optimized with the use of text messages (SMS) or dig ital applications (Apps) designed to facilitate smoking cessation, modify physical activity, and better manage hypertension and diabetes. Several non-invasive haemodynamic monito...
Source: British Journal of Anaesthesia - June 9, 2017 Category: Anesthesiology Source Type: research
Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis
AbstractNeuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. We performed a systematic review and meta-analysis of studies comparing the influence of deepvs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes. Trials were identified from Medline, Embase, and Central databases from inc...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
In This Issue
(Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Effects of arterial load variations on dynamic arterial elastance: an experimental study
Conclusions. Acute modifications of arterial load induced significant changes on Eadyn; vasodilatation increased Eadyn, whereas vasoconstriction decreased it. The Eadyn was associated with both arterial load and cardiac factors, suggesting that Eadyn should be more properly considered as a ventriculo-arterial coupling index. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Characterization of peripheral and central sensitization after dorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: a prospective pilot study
Conclusions. The study demonstrates that patients with unilateral radicular low back pain who receive dorsal root ganglion interventions show changes in pressure pain thresholds and conditioned pain modulation that are consistent with a ‘normalization’ of peripheral and central sensitization. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial
Conclusions: Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay.Clinical trial registration. The study was registered in the German Clinical Trials Register (DRKS 00006961).https://drks-neu.uniklinik-freiburg.de/drks_web/ (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control
Editor —Tracheal extubation after general anesthesia is a critical event of an anaesthetic, probably more important than induction and intubation of the airway; minor complications can result in significant morbidity and even mortality.12 Both the Fourth National Audit Project and the ASA closed claims analysis reported complications from extubation.34 The Difficult Airway Society developed a systematic approach to anticipated easy extubations and to those deemed difficult. Asleep extubation (commonly referred to as deep extubation), as opposed to awake extubation, is in a different arm of the Difficult Airway Society al...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Hydrogen peroxide: more harm than good?
Editor —Hydrogen peroxide remains a frequently used agent in operating theatres despite its marginal benefits and potential for serious complications. We are writing to remind anaesthetists of the risks of hydrogen peroxide use and pose the question: does hydrogen peroxide cause more harm than good? (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Raw EEG characteristics, bispectral index, and suppression ratio variations during generalized seizure in electroconvulsive therapy
Editor —We wish to report our findings of an observational prospective study of raw EEG characteristics, bispectral index (BIS) and suppression ratio (SR) variations during a generalized tonic–clonic seizure induced by electroconvulsive therapy (ECT). After obtaining the approval of the Ethics Committe e for biomedical research, 20 patients were included for a total of 39 sessions. The BIS sensor (BIS Quatro, Medtronic-minneapolis USA) was connected to the BIS-VISTA® (Medtronic-minneapolis USA) monitor (smoothing rate, 10 s). The BIS and SR values were retained for analysis if their corresponding signal quality ind...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Maintaining oxygenation with high-flow nasal cannula during emergent awake surgical tracheostomy
Editor —Patients presenting with acute upper airway obstruction are at significant risk of morbidity and continue to be managed poorly.1 Although several approaches can be taken, surgical tracheostomy placement under local anaesthesia is recommended because it ensures patients are kept awake, maintaining airway patency.2 This poses several challenges for the anaesthetist, including limited access to the surgical field and risk of complete airway obstruction in a patient with potentially limited reserve. (Source: British Journal of Anaesthesia)
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
Prediction of postoperative mortality in elderly patients with hip fracture: are specific and geriatric scores better than general scores?
Editor —Elderly patients with hip fracture are at high risk of mortality. An accurate prediction of postoperative mortality is important for communicating information, in guiding decision-making, and management. Among preoperative scores, the ASA physical status score does not consider the surgery, makes no adjustment for age, and is subjective.1 The PreOperative Score to predict PostOperative Mortality (POSPOM) is more accurate but has not been validated specifically in elderly patients.2 Many geriatric scores focusing on multimorbidity, such as the Cumulative Illness Rating Scale (CIRS)3 and Charlson comorbidity index,...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
25-Hydroxyvitamin D deficiency among anaesthesiologists and anaesthesiology residents in Chile
Editor —Approximately one billion people worldwide have 25-hydroxyvitamin D (25OHD) deficiency.1 –3 The Endocrine Society considers plasma levels equal or lower than 20 ng mL−1 as a deficiency and levels higher than 30 ng mL−1 as optimal levels.4 Low sunlight exposure is the determining factor for 25OHD deficiency. Such factor relies on the season and the latitude of residence, among others.56 Indoor work is associated with a low sunlight exposure. Therefore, anaesthesiologists may be at risk of developing deficient levels of 25OHD. The prevalence of 25OHD deficiency in this population remains unknown. (Sourc...
Source: British Journal of Anaesthesia - June 2, 2017 Category: Anesthesiology Source Type: research
