Anaesthesia and Intensive Care最新文献

{"title":"Returning to work following parental leave: the experiences of Australian anaesthetists.","authors":"Isabelle L Cooper, Anna F Pietzsch, Rosmarin Zacher, Lachlan Webb, Anita Pelecanos, Victoria A Eley","doi":"10.1177/0310057X241265726","DOIUrl":"https://doi.org/10.1177/0310057X241265726","url":null,"abstract":"<p><p>With increasing gender balance in specialist medical training and employment in Australia, there is a corresponding need to consider how parental leave and subsequent return to work is managed in the workplace. An electronic survey exploring the experiences of pregnancy and return to work following parental leave was distributed by the Australian and New Zealand College of Anaesthetists (ANZCA). The return-to-work component of the survey evaluated parental leave and return-to-work patterns, lactation practices and facilities, supports and resources utilised during the return-to-work process. We report on 391 return-to-work episodes from 219 respondents. One hundred and seventy-two (79%) were specialists at the time of survey completion. Six to 11 months was the most frequent duration of parental leave, and this duration was associated with higher satisfaction levels than shorter durations of leave (odds ratio 5.44, 95% confidence interval 3.18-9.31, <i>P</i> < 0.001). Breastfeeding continued in 246 (63%) return-to-work episodes, and absent or inadequate lactation facilities were reported in 239 (88%). In 227 (58%) return-to-work experiences, respondents received no formal support on returning to work. One hundred and thirty-five (62%) respondents did not utilise any existing return-to-work resources, and family and friends were the main source of support for 113 (52%) respondents. Return-to-work processes should be tailored to meet individual needs. Consistent with existing recommendations, satisfactory lactation facilities must be provided. We recommend that the period of one-to-one supervision be flexible and negotiated, to suit the unique return-to-work trajectory of each worker. Existing ANZCA resources could assist departments in supporting anaesthetists who return to work following parental leave.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X241265726"},"PeriodicalIF":1.1,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomised, open-label trial of nebulised unfractionated heparin in patients mechanically ventilated for COVID-19.","authors":"Roger J Smith, Angajendra N Ghosh, Simone Said, Frank Mp van Haren, John G Laffey, Gordon S Doig, John D Santamaria, Barry Dixon","doi":"10.1177/0310057X251322783","DOIUrl":"https://doi.org/10.1177/0310057X251322783","url":null,"abstract":"<p><p>Nebulised unfractionated heparin (UFH) might reduce time to ventilator separation in patients with COVID-19 by reducing virus infectivity, pulmonary coagulopathy, and inflammation, but clinical trial data are limited. Between 1 July 2020 and 23 March 2022, we conducted, at two hospitals in Victoria, Australia, a randomised, parallel-group, open-label, controlled trial of nebulised UFH. Eligible patients were aged 18 years or more, intubated, under intensive care unit management, had a P_aO₂ to F_IO₂ ratio of 300 or less, had acute opacities affecting at least one lung quadrant and attributed to COVID-19, and were polymerase chain reaction-positive for SARS-CoV-2 or had further testing planned. The target sample size was 270, however, the trial was stopped due to slow recruitment. There were 50 enrolments, all of whom were analysed. The median age was 55 (interquartile range (IQR) 46-64) years, 28 (56%) were males, and 46 (92%) had acute respiratory distress syndrome. Twenty-seven (54%) were randomised to nebulised heparin and 23 (46%) to standard care. Nebulised UFH was administered to the heparin group on 6 (IQR 4-10) days; median daily dose of 83 (IQR 75-88) kIU. The primary outcome, time to separation from invasive ventilation to day 28 adjusted for the competing risk of death, was not significantly different between groups but took numerically longer in the nebulised heparin group (12.0, standard deviation (SD) 10.4 days versus 7.4, SD 6.9 days; hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.31 to 1.01, <i>P</i> = 0.052). One patient died by day 28 in each group, fewer than expected. Time to separation from invasive ventilation among survivors to day 28 occurred more quickly than expected in the standard care group and was, without correction for multiple comparisons, significantly slower in the heparin group (11.3, SD 10.0 days, <i>n</i> = 26 versus 6.4, SD 5.2 days, <i>n</i> = 22; HR 0.52, 95% CI 0.30 to 0.92, <i>P</i> = 0.024). Nebulised heparin did not reduce time to ventilator separation in intubated adult patients with COVID-19. The study is limited by the small sample size and potential for sampling bias. Further study is required.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251322783"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In reply.","authors":"Bradley H Tuohey, Cliff L Shelton, Stefan Dieleman, Forbes McGain","doi":"10.1177/0310057X251325888","DOIUrl":"https://doi.org/10.1177/0310057X251325888","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251325888"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The validity of self-reported smoking status on day of surgery in a mixed elective surgery population.","authors":"Sara B Urquhart, Gemma I Webb, Samuel Leong, Ashley R Webb","doi":"10.1177/0310057X251315764","DOIUrl":"https://doi.org/10.1177/0310057X251315764","url":null,"abstract":"<p><p>Rates of misrepresenting smoking status on day of surgery varies with the clinical context. In perioperative smoking cessation trials, participants in the intervention group might be more likely to provide untruthful data about quitting when they have received substantial quit support but continued to smoke. The objective of this study was to determine misrepresentation rates of smoking status on day of surgery in mixed elective surgical populations, comparing groups offered or not offered additional cessation support. We undertook a post hoc analysis of data from three published randomised trials at a Melbourne public hospital that incorporated interventions during the wait-list period aimed at increasing smoking cessation. Participants were smokers (<i>n</i> = 1413) who were randomised to minimal cessation help at wait-listing (control group) or significant assistance, for example, mailed nicotine replacement (intervention group). Quit by day of surgery claims were verified by exhaled carbon monoxide (true cessation <8 parts per million). Verified cessation (>24 h) before surgery occurred in 161/1413 (11.4%) while 44/1413 (3.1%) misrepresented quitting. Continued smoking was in 1208/1413 (85.5%). Misrepresentations were higher in the intervention/offer of help groups (4.1%) than control groups (1.7%) (odds ratio (OR) 2.46, 95% confidence interval (CI) 1.17 to 5.63, <i>P</i> = 0.012). Offering cessation help increased quitting odds by 77%, (OR 1.77, 95% CI 1.24 to 2.52, <i>P</i> = 0.002). In contrast to other studies, we found group allocation in cessation trial settings had a significant effect on misrepresentation risk. The implication of this is that biochemical verification of quit status is essential in trial contexts for accurate data collection and to prevent misclassification bias.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251315764"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural catheters and sterile precautions.","authors":"Lars P Wang","doi":"10.1177/0310057X251325883","DOIUrl":"https://doi.org/10.1177/0310057X251325883","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251325883"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case series of incidents reported to webAIRS relating to glucagon-like peptide 1 agonist use.","authors":"Clayton Yx Lam, D-Yin Lin, Yasmin Endlich","doi":"10.1177/0310057X241311597","DOIUrl":"https://doi.org/10.1177/0310057X241311597","url":null,"abstract":"<p><p>The increasing prescription of glucagon-like peptide 1 (GLP-1) agonists presents a peri-operative challenge for anaesthetists. These drugs delay gastric emptying, potentially increasing pulmonary aspiration risk. Despite recent recommendations from the Australian and New Zealand College of Anaesthetists, Australian Society of Anaesthetists, and American Society of Anesthesiologists, there remain no formalised guidelines regarding preoperative optimisation for patients taking GLP-1 agonists. Given the current lack of evidence, we present a case series of incidents involving patients treated with GLP-1 agonists reported to webAIRS, a web-based anaesthetic incident reporting system in Australia and New Zealand. Among 11,700 reports from July 2009 to April 2024, 13 incidents related to GLP-1 agonist use were identified, including seven cases concerning aspiration. Patient factors potentially contributing to increased aspiration risks in these incidents included a higher body mass index, type 2 diabetes mellitus, gastro-oesophageal reflux disease, emergency case, and time from GLP-1 agonist cessation. Most incidents involved a rapid sequence induction for general anaesthesia with no cases utilising gastric ultrasound, preoperative nasogastric tube insertion, or intravenous erythromycin use. This case series highlights the potential concerns relating to GLP-1 treatment in the perioperative setting. Interdisciplinary collaboration and communication between anaesthetists, surgeons, general practitioners and endocrinologists are required to further investigate and establish preoperative guidelines for safe GLP-1 agonist use. Specifically, consideration in determining actual gastric contents of each patient despite generic fasting guidelines is needed. Early preoperative risk stratification should also improve patient safety and outcomes.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X241311597"},"PeriodicalIF":1.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Safety-II principles in anaesthetic airway management - a qualitative analysis of difficult and failed intubations reported to webAIRS.","authors":"Yasmin Endlich, Ellen L Davies, Janet Kelly","doi":"10.1177/0310057X251318351","DOIUrl":"https://doi.org/10.1177/0310057X251318351","url":null,"abstract":"<p><p>Anaesthetic airway incidents persist as a significant concern in patient safety and, despite extensive investigations, continue to cause patient harm. Traditional safety investigations predominantly adhere to Safety-I principles, focusing on identifying and rectifying errors, often yielding limited new findings. In this analysis conducted within the webAIRS database, the focus shifted towards Safety-II principles. The aim of this study was to identify factors contributing to airway management safety by examining incidents that did not result in adverse patient outcomes. Incidents categorised as 'difficult intubation' or 'failed intubation' without causing harm to the patient and reported to webAIRS between 2016 and 2022, were included in the analysis.An inductive qualitative content analysis of narrative data from 129 such incidents revealed that the majority of reported events depicted scenarios deviating from controlled and planned circumstances. During the analysis four themes were identified: patient factors, system factors, individual anaesthetist factors and airway management strategy. Within the first three themes, multiple factors were linked to airway management strategies. The findings of this qualitative analysis show that 'Work as done' often differs from 'Work as imagined'.This qualitative analysis highlighted the dynamic nature of human management, as individuals respond to unplanned or unexpected events, showcasing adaptability and positive contributions to incident performance. Expanding the understanding of patient safety to also include Safety-II principles, provides a deeper and wider understanding of airway management safety.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251318351"},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"James Young Simpson's <i>Notice of a New Anaesthetic Agent</i>: The first pamphlet on chloroform.","authors":"Rajesh P Haridas","doi":"10.1177/0310057X241285167","DOIUrl":"https://doi.org/10.1177/0310057X241285167","url":null,"abstract":"<p><p>James Young Simpson's <i>Notice of a New Anaesthetic Agent</i> is a rare pamphlet of which three copies have hitherto been documented. Two of the three known copies were inscribed by Simpson with the words 'proof copy'. A fourth copy of the pamphlet, also inscribed with the words 'proof copy', has been identified. Although regarded by Simpson as a proof copy, there is previously unreported evidence that the pamphlet was advertised by the publisher on 12 November 1847, published on 13 November 1847, and sold on that day by booksellers in Edinburgh. Thus, the <i>Notice</i> pamphlet was the first published report of the use of chloroform as an anaesthetic agent. The pamphlet was issued 2 or 3 days before the well-known revised edition bearing the title <i>Account of a New Anaesthetic Agent</i>, and one week before the publication of Simpson's papers on chloroform in <i>The Lancet</i> and the <i>Medical Times</i>.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X241285167"},"PeriodicalIF":1.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two episodes of delayed emergence in a healthy young man.","authors":"James R Nielsen, Anil Keshava","doi":"10.1177/0310057X241275126","DOIUrl":"10.1177/0310057X241275126","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"136-138"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A feasibility study of measuring maternal anaemia and postoperative outcomes after caesarean section.","authors":"Mark O'Donnell, Alicia T Dennis","doi":"10.1177/0310057X241275127","DOIUrl":"10.1177/0310057X241275127","url":null,"abstract":"<p><p>SummaryIron-deficiency anaemia (IDA) is a global health problem. The impact of IDA on outcomes in obstetric patients who undergo caesarean section (CS) is unknown. We assessed the feasibility of conducting a large study to investigate perioperative anaemia and outcomes after CS. With ethics approval and trial registration, 60 obstetric patients (30 planned CS, 30 emergency CS) were included. Feasibility categories were willingness to participate in a study, to undergo additional blood tests (haemoglobin, ferritin), to have weight measured and to undertake quality of recovery (QoR) questionnaires. Of eligible people approached, 100% agreed to participate and 100% would participate in a future study. Ninety percent (95% confidence interval (CI) 82.4% to 97.6%) and 83% (95% CI 73.9% to 92.7%) agreed to additional tests in hospital and after discharge, respectively. Ninety-eight per cent (95% CI 95.1% to 100%) consented to being weighed, and 100% completed QoR questionnaires. Preoperatively, 8.5% (95% CI 1.4% to 15.6%) of participants were anaemic. Postoperative haemoglobin was measured in only 22 (36.7%, 95% CI 24.5% to 48.9%) participants, and 40.9% (95% CI 20.4% to 61.5%) were anaemic, suggesting at least a quadrupling of the proportion of anaemic patients from pre- to postoperatively. Ferritin was not measured postoperatively in any participant. The prevalence of participants discharged with IDA was unquantifiable. Postoperative IDA in obstetric patients is likely to be a serious problem that is currently unrecognised. Our data suggest that a definitive study to determine associations between maternal anaemia and perioperative outcomes after CS surgery is feasible.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"92-102"},"PeriodicalIF":1.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}