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Anaesthetist

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https://www.readbyqxmd.com/read/29779231/specialist-perioperative-allergy-clinic-services-in-the-uk-2018-results-from-the-royal-college-of-anaesthetists-sixth-national-audit-project-nap6-investigation-of-perioperative-anaphylaxis
#1
W Egner, T M Cook, T Garcez, S Marinho, H Kemp, D N Lucas, K Floss, S Farooque, H Torevell, M Thomas, K Ferguson, S Nasser, S Karanam, K-L Kong, N McGuire, M Bellamy, A Warner, J Hitchman, L Farmer, N J N Harper
BACKGROUND: The Royal College of Anaesthetists 6th National Audit Project examined Grade 3-5 perioperative anaphylaxis for one year in the UK. OBJECTIVE: To describe the causes and investigation of anaphylaxis in the NAP6 cohort, in relation to published guidance and previous baseline survey results. METHODS: We used a secure registry to gather details of Grade 3-5 perioperative anaphylaxis. Anonymous reports were aggregated for analysis and reviewed in detail...
May 19, 2018: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/29743063/optimising-perioperative-care-for-hip-and-knee-arthroplasty-in-south-africa-a-delphi-consensus-study
#2
U Plenge, M B Nortje, L C Marais, J D Jordaan, R Parker, N van der Westhuizen, J F van der Merwe, J Marais, W V September, G L Davies, T Pretorius, C Solomon, P Ryan, A M Torborg, Z Farina, R Smit, C Cairns, H Shanahan, S Sombili, A Mazibuko, H R Hobbs, O S Porrill, N E Timothy, R E Siebritz, C van der Westhuizen, A J Troskie, C A Blake, L A Gray, T W Munting, H K S Steinhaus, P Rowe, J G van der Walt, R Isaacs Noordien, A Theron, B M Biccard
BACKGROUND: A structured approach to perioperative patient management based on an enhanced recovery pathway protocol facilitates early recovery and reduces morbidity in high income countries. However, in low- and middle-income countries (LMICs), the feasibility of implementing enhanced recovery pathways and its influence on patient outcomes is scarcely investigated. To inform similar practice in LMICs for total hip and knee arthroplasty, it is necessary to identify potential factors for inclusion in such a programme, appropriate for LMICs...
May 9, 2018: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/29742967/restrictive-versus-liberal-fluid-therapy-for-major-abdominal-surgery
#3
Paul S Myles, Rinaldo Bellomo, Tomas Corcoran, Andrew Forbes, Philip Peyton, David Story, Chris Christophi, Kate Leslie, Shay McGuinness, Rachael Parke, Jonathan Serpell, Matthew T V Chan, Thomas Painter, Stuart McCluskey, Gary Minto, Sophie Wallace
Background Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion. Methods In a pragmatic, international trial, we randomly assigned 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery...
May 9, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29728260/anesthesia-in-a-pediatric-patient-with-rohadd-syndrome
#4
E Esparza Isasa, M A Palomero Rodríguez, I Acebedo Bambaren, C Medrano Viñas, D Gil Mayo, F Domínguez Pérez, D Pestaña Lagunas
Rapid-onset obesity with hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome is a rare entity that is characterised by its onset in healthy children at 2-4 years of age. It is a complex syndrome that includes, among other symptoms, rapid weight gain with hyperphagia, hypothalamic dysfunction, central hypoventilation, and autonomic dysregulation. The case is presented of a 10-year-old boy with a diagnosis of ROHHAD syndrome undergoing insertion of a port-a-cath under general anaesthesia, who developed complications during the anaesthetic procedure related to his illness...
May 1, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29727235/anaesthesia-what-a-surgeon-needs-to-know
#5
E M Valsamis, J Sadler, T Kennedy, C Thornhill, C Carey, D Ricketts
Surgeons and anaesthetists work closely together, sometimes in challenging circumstances. To help surgeons cooperate with anaesthetists to deliver high quality care for patients, a working knowledge of modern anaesthetic practice is useful. The specialty of anaesthetics is developing rapidly, and periodic updating of this knowledge is likely to be required. This article provides an update of anaesthetic practice for surgeons, covering the varied roles of anaesthetists, preoperative assessment, management on the day of surgery (induction, maintenance and reversal of anaesthetic), general anaesthesia, the role of regional blocks and sedation...
May 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29716493/an-international-survey-evaluating-factors-influencing-the-use-of-total-intravenous-anaesthesia
#6
Gtc Wong, S W Choi, D H Tran, H Kulkarni, M Irwin
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 platform to allow evaluation of the respondent's rating of the importance of a range of factors in their decision not to use TIVA for a particular case...
May 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29706412/handover-from-operating-theatre-to-the-intensive-care-unit-a-quality-improvement-study
#7
Andrea P Marshall, Georgia Tobiano, Niki Murphy, Greg Comadira, Nicola Willis, Therese Gardiner, Lucy Hervey, Wendy Simpson, Brigid M Gillespie
BACKGROUND: Transitioning a patient from the operating theatre (OT) to the intensive care unit (ICU) is a dynamic and complex process. Handover of the critically ill postoperative patient can contribute to procedural and communication errors. Standardised protocols are means for structuring and improving handover content. Both have been shown to be effective in reducing information omission and improve communication during this transition period. OBJECTIVES: The aim of this uncontrolled before and after study was to improve handover processes and communication about the care for critically ill patients transferred from OT to ICU...
April 26, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29700894/consensus-statement-on-clear-fluids-fasting-for-elective-pediatirc-general-anesthesia
#8
Mark Thomas, Christa Morrison, Richard Newton, Ehrenfried Schindler
Pediatric anesthetic guidelines for the management of preoperative fasting of clear fluids are currently 2 hours. The traditional 2 hours clear fluid fasting time was recommended to decrease the risk of pulmonary aspiration and is not in keeping with current literature. It appears that a liberalized clear fluid fasting regime does not affect the incidence of pulmonary aspiration and in those who do aspirate, the sequelae are not usually severe or long-lasting. With a 2-hour clear fasting policy, the literature suggests that this translates into 6-7 hours actual duration of fasting with several studies up to 15 hours...
April 27, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29700892/prevention-of-perioperative-venous-thromboembolism-in-pediatric-patients-guidelines-from-the-association-of-paediatric-anaesthetists-of-great-britain-and-ireland-apagbi
#9
Judith Morgan, Matthew Checketts, Amaia Arana, Elizabeth Chalmers, Jamie Maclean, Mark Powis, Neil Morton
The Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) Guidelines Working Group on Thromboprophylaxis in Children has reviewed the literature and where possible provided advice on the care of children in the perioperative period. Areas reviewed include the incidence of perioperative venous thromboembolism (VTE), risk factors, evidence for mechanical and chemical prophylaxis, and complications. Safe practice of regional anesthesia with anticoagulant prophylaxis is detailed. In summary, there are few areas of strong evidence...
April 27, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29661387/pre-hospital-advanced-airway-management-by-anaesthetist-and-nurse-anaesthetist-critical-care-teams-a-prospective-observational-study-of-2028-pre-hospital-tracheal-intubations
#10
M Gellerfors, E Fevang, A Bäckman, A Krüger, S Mikkelsen, J Nurmi, L Rognås, E Sandström, G Skallsjö, C Svensén, D Gryth, H M Lossius
BACKGROUND: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. METHODS: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29661386/association-between-intraoperative-opioid-administration-and-30-day-readmission-a-pre-specified-analysis-of-registry-data-from-a-healthcare-network-in-new-england
#11
D R Long, A L Lihn, S Friedrich, F T Scheffenbichler, K C Safavi, S M Burns, J C Schneider, S D Grabitz, T T Houle, M Eikermann
BACKGROUND: The use of intraoperative opioids may influence the rate of postoperative complications. This study evaluated the association between intraoperative opioid dose and the risk of 30-day hospital readmission. METHODS: We conducted a pre-specified analysis of existing registry data for 153 902 surgical cases performed under general anaesthesia at Massachusetts General Hospital and two affiliated medical centres. We examined the association between total intraoperative opioid dose (categorised in quintiles) and 30-day hospital readmission, controlling for several patient-, anaesthetist-, and case-specific factors...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29661380/relationship-between-severe-obesity-and-depth-to-the-cricothyroid-membrane-in-third-trimester-non-labouring-parturients-a-prospective-observational-study
#12
K Gadd, K Wills, R Harle, N Terblanche
BACKGROUND: Severely obese parturients have increased 'cannot intubate, cannot oxygenate' risk during Caesarean section under general anaesthesia. Front-of-neck access (FONA) at the cricothyroid membrane (CTM) is definitive management; however, attempted FONA can fail. Point-of-care ultrasonography may provide useful information about CTM depth to aid FONA in obesity. This study determined the difference in CTM depth between severely obese and non-obese parturients, utilising ultrasonography...
May 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29660772/human-factors-enablers-and-barriers-for-successful-airway-management-an-in-depth-interview-study
#13
R Schnittker, S Marshall, T Horberry, K L Young
Human factors are the individual, team, environmental and organisational aspects of the anaesthetic environment that affect performance and decision-making of anaesthesia teams. This study aimed to identify which human factors were enablers and/or barriers to anaesthesia teams during airway management challenges. Sixteen interviews were conducted with experienced anaesthetists and anaesthetic nurses using an in-depth interview technique (the Critical Decision Method) to identify human factors enablers and/or barriers during successful management of a significant airway challenge...
April 16, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29656528/the-role-of-scalpel-bougie-cricothyroidotomy-in-managing-emergency-front-of-neck-airway-access-a-review-and-technical-update-for-ent-surgeons
#14
N D McNiven, J P Pracy, B A McGrath, A K Robson
In October 2016 an editorial was published jointly in Clinical Otolaryngology and the British Journal of Anaesthesia concerning the appropriate management of the difficult airway in a situation of 'Can't Intubate Can't Oxygenate' (CICO).1 It highlighted the importance of joint working between surgeons and anaesthetists and also made a case for the wider use of the scalpel-bougie cricothyroidotomy technique in securing a Front of Neck Airway (FONA), especially in an emergency. This article is protected by copyright...
April 15, 2018: Clinical Otolaryngology
https://www.readbyqxmd.com/read/29629686/an-investigation-of-barriers-to-the-use-of-the-world-health-organization-surgical-safety-checklist-in-theatres
#15
S Verwey, P D Gopalan
BACKGROUND: The World Health Organization (WHO) has implemented the Surgical Safety Checklist (SSCL) as part of the Safe Surgery Saves Lives campaign. This is aimed at improving surgical safety worldwide. Despite many perceived benefits of the SSCL, compliance and acceptance in many areas remain poor. OBJECTIVES: To investigate perceptions of theatre staff regarding the checklist and to identify reasons and barriers for poor compliance and implementation. METHODS: Questionnaires were handed out to theatre teams across all surgical disciplines at two large hospitals in Durban, South Africa, over a 2-week period...
March 28, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/29627071/ultrasound-versus-anatomical-landmarks-immediate-complications-in-the-central-venous-catheterization-in-children-under-18-years-of-age
#16
D Rivera-Tocancipá, E Díaz-Sánchez, C A Montalvo-Arce
INTRODUCTION: The insertion of a central venous line in children and adolescents is technically more difficult, due to the smaller size of the structures. This can lead to an increase in immediate complications, which can be reduced when using ultrasound. In our institution, the percentage of these complications and the use of ultrasound are unknown. OBJECTIVE: To describe the frequency of immediate complications of central venous catheterisation guided by the ultrasound in a general university hospital, compared to the anatomical landmarks technique in children less than 18years of age...
April 4, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/29620988/a-simple-guide-to-regional-anaesthesia
#17
E M Valsamis, S Wade, C Thornhill, C Carey, D Ricketts
Regional anaesthesia is widely used in modern anaesthetic practice for perioperative and postoperative analgesia. In the operating theatre, regional anaesthesia is used both on its own and in combination with other techniques (general anaesthesia and sedation). Regional anaesthesia is now a core skill set in anaesthetic training. This article provides a basic outline of regional anaesthesia for surgeons and other non-anaesthetic staff working with anaesthetists, reviewing preparation, consent, basic and specialist equipment, central neuraxial blocks (spinal, epidural and caudal), trunk blocks, upper limb blocks (interscalene, supraclavicular, infraclavicular and axillary) and lower limb blocks (femoral, fascia iliaca, sciatic, popliteal and ankle)...
April 2, 2018: British Journal of Hospital Medicine
https://www.readbyqxmd.com/read/29611788/c-mac-%C3%A2-videolaryngoscopy-the-anaesthetic-assistant-s-view
#18
Lydia Jones, Kathleen Mulcahy, Jeremy Fox, Tim M Cook, Fiona E Kelly
Although videolaryngoscopy plays a major role in the 2015 Difficult Airway Society guidelines, the impact on anaesthetic assistant working practices and training has not previously been reported. We surveyed anaesthetic assistants in our hospital to document their experience with using the C-MAC© videolaryngoscope (48 practitioners, 100% response rate). Improvements in the following were reported: patient safety 100%; ability to see whether laryngoscopy is difficult 98%; ability to anticipate the 'next step' 98%; team-working and human factors 96%; ability to call a senior anaesthetist more quickly 94%; assessment or adjustment of cricoid force application 92%, understanding of laryngeal anatomy 92%; training in intubation 98%; training in cricoid force application 87%...
April 2018: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29582421/the-enhanced-recovery-after-surgery-eras-greenie-board-a-navy-inspired-quality-improvement-tool
#19
A J Smirk, J J Nicholson, Y L Console, N J Hunt, A Herschtal, M N H H Nguyen, B Riedel
The United States Navy uses a visual feedback system for pilots, named 'the Greenie Board', to improve flight manoeuvres on aircraft carriers. Given that increased compliance with enhanced recovery after surgery protocols reduces postoperative complications, we decided to apply a similar feedback system to our institutional enhanced recovery programme. We undertook a prospective 12-month audit of 194 patients assigned to our enhanced recovery programme and evaluated adherence to the anaesthesia-related components of our protocol, before and after implementing a Greenie Board...
March 26, 2018: Anaesthesia
https://www.readbyqxmd.com/read/29576126/investigation-into-the-visual-perceptive-ability-of-anaesthetists-during-ultrasound-guided-interscalene-and-femoral-blocks-conducted-on-soft-embalmed-cadavers-a-randomised-single-blind-study
#20
A Mustafa, J Seeley, S Munirama, M Columb, M McKendrick, A Schwab, G Corner, R Eisma, G Mcleod
BACKGROUND: Errors may occur during regional anaesthesia whilst searching for nerves, needle tips, and test doses. Poor visual search impacts on decision making, clinical intervention, and patient safety. METHODS: We conducted a randomised single-blind study in a single university hospital. Twenty trainees and two consultants examined the paired B-mode and fused B-mode and elastography video recordings of 24 interscalene and 24 femoral blocks conducted on two soft embalmed cadavers...
April 2018: British Journal of Anaesthesia
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