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M Crowther, K van der Spuy, F Roodt, M B Nejthardt, J G Davids, J Roos, E Cloete, T Pretorius, G L Davies, J G van der Walt, C van der Westhuizen, M Flint, J L C Swanevelder, B M Biccard
Hypertension is not consistently associated with postoperative cardiovascular morbidity and is therefore not considered a major peri-operative risk factor. However, hypertension may predispose to peri-operative haemodynamic changes known to be associated with peri-operative morbidity and mortality, such as intra-operative hypotension and tachycardia. The objective of this study was to determine whether pre-operative hypertension was independently associated with haemodynamic changes known to be associated with adverse peri-operative outcomes...
March 12, 2018: Anaesthesia
A Pym, E Ben-Menachem
Postoperative nausea and vomiting (PONV) is a common and distressing problem for patients and increases the burden of care in post-anaesthesia care units (PACU). As such it has been a recent focus for quality improvement. Evidence-based guidelines have demonstrated the benefit of PONV risk stratification and prophylaxis, but may be underutilised in clinical practice. This prospective pre-/post-intervention study was conducted at an adult tertiary hospital in non-cardiac adult surgical patients at higher-risk of PONV...
March 2018: Anaesthesia and Intensive Care
Awy Chua, M J Chua, Pca Kam
Significant surgical advances have been made recently in corneal transplantation. Penetrating keratoplasty was the dominant method from 1905, until selective lamellar keratoplasty emerged as the preferred technique over the last 20 years. Advanced techniques such as corneal limbal stem cell transplant and keratoprosthesis are also available. The major surgical complications of corneal transplantation are extrusion of ocular content and expulsive choroidal haemorrhage. It is essential for an ophthalmic anaesthetist to have a good understanding of these new surgical procedures so as to provide optimal surgical conditions...
March 2018: Anaesthesia and Intensive Care
Clare Dyer
No abstract text is available yet for this article.
March 5, 2018: BMJ: British Medical Journal
Jeni Stevens, Virginia Schmied, Elaine Burns, Hannah G Dahlen
PROBLEM: Providing skin-to-skin contact in the operating theatre and recovery is challenging. BACKGROUND: Barriers are reported in the provision of uninterrupted skin-to-skin contact following a caesarean section. AIM: To explore how health professionals' practice impacts the facilitation of skin-to-skin contact within the first 2h following a caesarean section. METHODS: Video ethnographic research was conducted utilising video recordings, observations, field notes, focus groups and interviews...
February 26, 2018: Women and Birth: Journal of the Australian College of Midwives
Martin R Tramèr
No abstract text is available yet for this article.
April 2018: European Journal of Anaesthesiology
Linzi Maybin
No abstract text is available yet for this article.
February 23, 2018: British Dental Journal
T Kumaravadivel Dharmalingam, Constance Liew Sat Lin, Rajesh Kumar Muniandy
Rubinstein-Taybi syndrome (RTS) is a rare autosomal dominant disorder that occurs due to a microdeletion of chromosome 16p13. The craniofacial abnormalities in these patients may pose a challenge for anaesthetist performing tracheal intubation. However, there are no known reported cases of drug interaction with non-depolarising muscle relaxant in patients with RTS. This young patient with RTS presented with an unexpected prolonged atracurium effect during the course of anaesthesia. After ruling out other possible causes, we have come to a conclusion that RTS itself could have played a role in the prolonged effect of atracurium...
February 22, 2018: BMJ Case Reports
Yogesh Dabholkar, Haritosh Velankar, Sneha Suryanarayan, Twinkle Y Dabholkar, Akanksha A Saberwal, Bhavika Verma
The WHO has designed a safe surgery checklist to enhance communication and awareness of patient safety during surgery and to minimise complications. WHO recommends that the check-list be evaluated and customised by end users as a tool to promote safe surgery. The aim of present study was to evaluate the impact of WHO safety checklist on patient safety awareness in otorhinolaryngology and to customise it for the speciality. A prospective structured questionnaire based study was done in ENT operating room for duration of 1 month each for cases, before and after implementation of safe surgery checklist...
March 2018: Indian Journal of Otolaryngology and Head and Neck Surgery
Gareth S Turnbull, Mounir Hakimi, George J McLauchlan
INTRODUCTION: With rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective orthopaedic surgery. The aim of this study was to investigate the impact on trauma theatre productivity of different surgeons and anaesthetists working together in a Major Trauma Centre. The influence of consultant presence and weekend operating on productivity was also considered...
February 12, 2018: Injury
A Ramgolam, G L Hall, G Zhang, M Hegarty, B S von Ungern-Sternberg
BACKGROUND: Laryngeal mask airways (LMA) are widely used during tonsillectomies. Contrasting evidence exists regarding the timing of the removal and the risk of perioperative respiratory adverse events. We assessed whether the likelihood of perioperative respiratory adverse events is influenced by the timing of LMA removal in children with at least one risk factor for these events. METHODS: Participants (n=290, 0-16 yr) were randomised to have their LMA removed either deep (in theatre by anaesthetist at end-tidal sevoflurane >1 minimum alveolar concentration) or awake (in theatre by anaesthetist or in postanaesthesia care unit by anaesthetist or trained nurse)...
March 2018: British Journal of Anaesthesia
C Gariel, B Cogniat, F-P Desgranges, D Chassard, L Bouvet
BACKGROUND: Medication errors are not uncommon in hospitalized patients. Paediatric patients may have increased risk for medication errors related to complexity of weight-based dosing calculations or problems with drug preparation and dilution. This study aimed to determine the incidence of medication errors in paediatric anaesthesia in a university paediatric hospital, and to identify their characteristics and potential predictive factors. METHODS: This prospective incident monitoring study was conducted between November 2015 and January 2016 in an exclusively paediatric surgical centre...
March 2018: British Journal of Anaesthesia
Aoife C Kiernan, Peadar S Waters, Sean Tierney, Paul Neary, Maria Donnelly, Dara O Kavanagh, Bridget Egan
INTRODUCTION: Emergency laparotomy (EL) is a commonly performed operation with increased morbidity and mortality. Currently, there is a lack of published outcomes following emergency laparotomy within an Irish population. The aim of this study was to assess our outcomes and compare these to predefined outcomes from NELA. METHODS: A review of a prospectively maintained database of all patients who underwent an emergency laparotomy between January 1st 2015 and October 31st 2016 was performed...
February 15, 2018: Irish Journal of Medical Science
D S Almghairbi, L Sharp, R Griffiths, R Evley, S Gupta, I K Moppett
Drug errors in the anaesthetic domain remain a serious cause of iatrogenic harm. To help reduce this issue, we explored the potential safety impact of using a simple colour-coded tray for anaesthetic drug preparation and storage. Over a six-month period, three different trained researchers observed 30 cases at three NHS Trusts. Ten observations involved standard drug trays in 'normal' practice, and 20 observations, involved 'Rainbow trays' before and after their introduction. We conducted 20 semi-structured interviews immediately after completing the Rainbow tray observation with the anaesthetists involved...
March 2018: Anaesthesia
S Mota, C Filipe, A L Almeida
INTRODUCTION AND OBJECTIVES: Thrombotic thrombocytopenic purpura and atypical haemolytic uremic syndrome (aHUS) are acute, rare, life-threatening thrombotic microangiopathies that require swift management. We report a case of acute microangiopathic haemolytic anaemia (MAHA) presenting in perioperative setting. CLINICAL CASE: After hepatic pericystectomy for hydatid cyst, a 46-year-old female developed MAHA, thrombocytopenia and acute renal failure in the immediate postoperative period...
February 6, 2018: Revista Española de Anestesiología y Reanimación
Khurram Ayub, Ruth A Corrigan, Jyoti Misra, Svetlana Galitzine
Introduction: Persons with paraplegia present complex challenges to anaesthetists. Complications experienced by these patients can require major orthoplastic surgery such as excision of infected bone and soft tissue due to pressure sores and soft tissue reconstruction. Anaesthetic strategies deemed both safe and acceptable to this population are essential. Case presentation: We report a case series of five procedures in four patients with complete chronic spinal cord injury (CSCI) who underwent operations in lateral position under standby anaesthesia and audio-visual distraction (AVD) with minimal sedation...
2018: Spinal Cord Series and Cases
T Reeves, S Bates, T Sharp, K Richardson, S Bali, J Plumb, H Anderson, J Prentis, M Swart, D Z H Levett
Background: Cardiopulmonary exercise testing (CPET) is an exercise stress test with concomitant expired gas analysis that provides an objective, non-invasive measure of functional capacity under stress. CPET-derived variables predict postoperative morbidity and mortality after major abdominal and thoracic surgery. Two previous surveys have reported increasing utilisation of CPET preoperatively in England. We aimed to evaluate current CPET practice in the UK, to identify who performs CPET, how it is performed, how the data generated are used and the funding models...
2018: Perioperative Medicine
A Hewitt-Smith, F Bulamba, S Ttendo, K Pappenheim, I A Walker, A F Smith
The Association of Anaesthetists of Great Britain and Ireland and the then Uganda Society of Anaesthesia established the Uganda Fellowship Scheme in 2006, to provide scholarships to encourage doctors to train in anaesthesia in Uganda. We conducted an evaluation of this programme using online questionnaires and face-to-face semi-structured interviews with trainees who received scholarships, as well as with senior surgeons and anaesthetists. Focus group discussions were held to assess changes in attitudes towards anaesthesia over the last 10 years...
February 7, 2018: Anaesthesia
A Higgs, B A McGrath, C Goddard, J Rangasami, G Suntharalingam, R Gale, T M Cook
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not...
February 2018: British Journal of Anaesthesia
B F Geerts, D P Veelo
No abstract text is available yet for this article.
February 2018: British Journal of Anaesthesia
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