Anaesthesia and Intensive Care最新文献

{"title":"Uterine atony prophylaxis with carbetocin versus oxytocin and the risk of major haemorrhage during caesarean section: A retrospective cohort study.","authors":"Nico Cs Terblanche,&nbsp;James E Sharman,&nbsp;Mark A Jones,&nbsp;Kye Gregory,&nbsp;David J Sturgess","doi":"10.1177/0310057X221140128","DOIUrl":"https://doi.org/10.1177/0310057X221140128","url":null,"abstract":"<p><p>Carbetocin and oxytocin are commonly recommended agents for active management of the third stage of labour. Evidence is inconclusive whether either one more effectively reduces the occurrence of important postpartum haemorrhage outcomes at caesarean section. We examined whether carbetocin is associated with a lower risk of severe postpartum haemorrhage (blood loss ≥ 1000 ml) in comparison with oxytocin for the third stage of labour in women undergoing caesarean section. This was a retrospective cohort study among women undergoing scheduled or intrapartum caesarean section between 1 January 2010 and 2 July 2015 who received carbetocin or oxytocin for the third stage of labour. The primary outcome was severe postpartum haemorrhage. Secondary outcomes included blood transfusion, interventions, third stage complications and estimated blood loss. Outcomes were examined overall and by timing of birth, scheduled versus intrapartum, using propensity score-matched analysis. Among 21,027 eligible participants, 10,564 women who received carbetocin and 3836 women who received oxytocin at caesarean section were included in the analysis. Carbetocin was associated with a lower risk of severe postpartum haemorrhage overall (2.1% versus 3.3%; odds ratio, 0.62; 95% confidence interval 0.48 to 0.79; <i>P </i><<i> </i>0.001). This reduction was apparent irrespective of timing of birth. Secondary outcomes also favoured carbetocin over oxytocin. In this retrospective cohort study, the risk of severe postpartum haemorrhage associated with carbetocin was lower than that associated with oxytocin in women undergoing caesarean section. Randomised clinical trials are needed to further investigate these findings.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 4","pages":"288-295"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797116","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 development of albumin solutions in the Second World War.","authors":"Peter J Featherstone, Christine M Ball","doi":"10.1177/0310057X231174704","DOIUrl":"10.1177/0310057X231174704","url":null,"abstract":"By the spring of 1940 it had become clear that the United States of America would eventually enter the Second World War, and there was a need to mobilise the nation’s scientific resources in anticipation of the conflict. Among the requests made to the National Research Council (which had been established during the First World War to encourage and coordinate ‘the employment of scientific methods in strengthening the national defense’) the US army and navy sought advice on the procurement of whole blood, as well as the production of stable blood derivatives, or substitutes, which could be used in the ‘emergency treatment of traumatic shock, burns and haemorrhage resulting from modern military operations.’ Chaired by Walter Cannon, Professor of Physiology at Harvard Medical School, the National Research Council Committee on Transfusions first met in Washington DC on 31 May 1940. Representatives of the American Red Cross were also in attendance. In addition to discussing issues relating to whole blood and plasma, hopes were expressed that a substitute for human plasma could be found. ‘In the interest of clear thinking’, it was agreed that protein biochemists should be engaged in this pursuit, and Cannon therefore approached Edwin Cohn and colleagues from the Department of Physical Chemistry, Harvard Medical School, to investigate whether a safe and effective plasma fraction could be isolated from bovine blood, which was readily available as a by-product of the meatpacking industry. During the summer of 1940, novel techniques for the separation of plasma into five major fractions were devised at Harvard. Later known as the Cohn process, this utilised ethanol–water mixtures at low temperature and controlled pH, protein and salt concentration, and could easily be scaled up for industrial production. It quickly became apparent that the albumin fraction had many desirable physiological properties for the Cover photo. Pressure bandaged after they suffered burns when their ship was hit by a kamikaze attack, men are fed aboard the USS Solace (AH-5). c. 1945. Courtesy of US National Archives and Record Administration.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 4","pages":"236-238"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/44/10.1177_0310057X231174704.PMC10331509.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9802470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic cannula cricothyroidotomy and percutaneous oxygen insufflation with the Rapid-O2®: A simple and effective tool for enhancing safety in difficult airway management.","authors":"Sivan Wexler,&nbsp;Stavros N Prineas","doi":"10.1177/0310057X221148212","DOIUrl":"https://doi.org/10.1177/0310057X221148212","url":null,"abstract":"<p><p>Prophylactic cannula cricothyroidotomy is a recognised technique for actual or potential difficult airway management, where it confers a number of technical and non-technical benefits. Oxygenation with this technique is traditionally achieved by way of pressure-regulated, high flow jet ventilation and requires specialised equipment and considerable expertise for safe use, neither of which are always readily available. As an alternative, we describe the management of two patients with progressive upper airway obstruction in whom prophylactic cannula cricothyroidotomy and oxygen insufflation were performed using equipment which we consider is safer, widely available and already familiar to most anaesthetists throughout Australia.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 4","pages":"296-303"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9789694","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":"Pass rates of four P2/N95 respirators or filtering facepiece respirators in Australian healthcare providers: A prospective observational study.","authors":"Caitlin Sr Low,&nbsp;Sean Z Ngui,&nbsp;Matthew J Casey,&nbsp;Chloe Vuong,&nbsp;Afsana Afroz,&nbsp;Shomik Sengupta,&nbsp;Laurence Weinberg","doi":"10.1177/0310057X231154017","DOIUrl":"https://doi.org/10.1177/0310057X231154017","url":null,"abstract":"<p><p>P2/N95 respirators or filtering facepiece respirators may not have the same pass rate on quantitative fit testing. The aim of this study was to investigate the pass rate of four commonly used filtering facepiece respirators in Australian healthcare providers. The secondary objectives included assessing the ease of donning, doffing and comfort of wearing these four filtering facepiece respirators for more than 30 minutes. A multivariable analysis was also conducted to assess if certain variables (e.g. age, sex, body mass index, ethnicity, facial width and length) were associated with passing or failing fit testing. We conducted a prospective observational study of 150 hospital staff who presented for fit testing in a metropolitan hospital in Victoria, Australia. The order of the four filtering facepiece respirators being tested was randomised. A Cochran's Q test was used to test the global null hypothesis that all four filtering facepiece respirators being tested have the same pass rate. A difference in pass rate was found between the four filtering facepiece respirators that were tested (<i>P</i> < 0.001). The 3M™ Aura 1870+ (3M Australia Pty Ltd, North Ryde, NSW) had the highest pass rate (83%) followed by the 3M™ 1860 (3M Australia Pty Ltd, North Ryde, NSW) (61%), BSN ProShield™ N95 (BSN Medical, Mulgrave, Victoria) (55%) and the BYD DE2322 N95 (BYD Care, Los Angeles, CA, USA) (44%). There was also a difference in the ease of donning, doffing and comfort. Therefore, healthcare facilities that perform fit testing should take these factors into consideration when designing an effective respiratory protection programme.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 4","pages":"268-273"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796224","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":"Dynamic three-dimensional printing: The future of bronchoscopic simulation training?","authors":"Rao Fu,&nbsp;Nicole G Hone,&nbsp;James R Broadbent,&nbsp;Bernard J Guy,&nbsp;Jeremy S Young","doi":"10.1177/0310057X231154015","DOIUrl":"https://doi.org/10.1177/0310057X231154015","url":null,"abstract":"<p><p>High-fidelity models are required for technical mastery of bronchoscopic procedures in the fields of anaesthesia, intensive care, surgery and respiratory medicine. Our group has created a three-dimensional (3D) airway model prototype to emulate physiological and pathological movement. Developed from the concepts of our previously described 3D printed paediatric trachea for airway management training, this model produces movements created by injection of air or saline through a side Luer Lock port. The anaesthesia and intensive care applications of the model could include bronchoscopic navigation through narrow pathologies and simulated bleeding tumours. It also has the potential to be used to practice placement of a double-lumen tube and broncho-alveolar lavage among other procedures. For surgical training, the model has high tissue realism and allows for rigid bronchoscopy. The novel and high-fidelity 3D printed airway model with dynamic pathologies represents capability to provide both generic and patient-specific advancement for all modes of anatomical representation. The prototype illustrates the potential of combining the fields of industrial design with clinical anaesthesia.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 4","pages":"274-280"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9853789","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":"Incidence of postoperative delirium in surgical patients: An observational retrospective cohort study.","authors":"Peter Y Xiang,&nbsp;Luke Boyle,&nbsp;Timothy G Short,&nbsp;Carolyn Deng,&nbsp;Douglas Campbell","doi":"10.1177/0310057X231156459","DOIUrl":"https://doi.org/10.1177/0310057X231156459","url":null,"abstract":"<p><p>SummaryPerioperative neurocognitive disorders including postoperative delirium (POD) are common complications of anaesthesia and surgery, associated with morbidity, mortality and a large economic cost. Currently, limited data are available on the incidence of POD in the New Zealand population. The objective of this study was to utilise New Zealand national level datasets to identify the incidence of POD. Our primary outcome was defined as a diagnosis of delirium via ICD 9/10 coding within seven days of surgery. We also analysed demographic, anaesthetic and surgical characteristics. All adult patients undergoing any surgical intervention under sedation, regional, general or neuraxial anaesthesia were included, and patients who received surgical intervention under local anaesthetic infiltration alone were excluded. We reviewed ten years of patient admissions from 2007 to 2016. Our sample size was 2,249,910 patients. The incidence of POD was 1.9%, much lower than previously observed, potentially indicating significant under-reporting of POD in this national level database. With acknowledgement of the limitations of potential undercoding and under-reporting, we found that the incidence of POD was higher with increasing age, male sex, general anaesthesia, Māori ethnicity, increasing comorbidity, surgical severity and emergency surgery. A diagnosis of POD was associated with increased mortality and hospital length of stay. Our results highlight potential risk factors of POD and disparities in health outcomes in New Zealand. Additionally, these findings suggest systemic under-reporting of POD in national level datasets.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 4","pages":"260-267"},"PeriodicalIF":1.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10218999","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":"Long-term capacity planning for obstetric surgical suites using quantile linear regression.","authors":"Franklin Dexter,&nbsp;Richard H Epstein,&nbsp;Kokila N Thenuwara","doi":"10.1177/0310057X221127713","DOIUrl":"https://doi.org/10.1177/0310057X221127713","url":null,"abstract":"<p><p>Obstetric surgical suites differ from most inpatient surgical suites, serving one specialty, and often small. We evaluated long-term capacity planning for these operating rooms. The retrospective cohort study included all caesarean births in three operating rooms over 28 years, 1994 through 2021, plus all other obstetric procedures over the latter 19 years. We calculated the obstetric anaesthesia activity index, 0.5 × neuraxial labour analgesia placement + 1.0 × caesarean births. Annual caesarean births from one year to the next had a Pearson linear correlation coefficient of 0.993. Therefore, linear regression can be used for long-term capacity planning. However, the difference between 0.9 and 0.1 quantiles in weekly caseloads was greater than tenfold larger than the annual rate of growth in births per week. Therefore, clinicians likely would be unable to distinguish, by experience, between growth versus being busy due to variability, suggesting value of the modelling. Over 19 years, the fraction of the obstetric workload from caesarean births was unchanging, Pearson correlation coefficient of 0.04. Therefore, use of the obstetric anaesthesia activity index to judge changes in workload was appropriate. The annual total for the index increased linearly, Pearson correlation coefficient of 0.98, supporting validity of the finding that long-term capacity can be planned with linear regression. The difference between 0.9 and 0.1 quantiles in weekly totals of the index exceeded annual rate of growth, supporting validity of the finding that variability week to week is very large relative to growth. These results help decision-makers ensure that operating rooms and staff meet referring hospitals' needs.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 3","pages":"178-184"},"PeriodicalIF":1.5,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9536953","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":"'Tea trolley' difficult airway teaching 2022: A new spin on an old idea.","authors":"Chad W Oughton,&nbsp;Andrew W Downey,&nbsp;Julia A Dubowitz","doi":"10.1177/0310057X221148213","DOIUrl":"https://doi.org/10.1177/0310057X221148213","url":null,"abstract":"Awake tracheal intubation (ATI) remains an important skill for the management of complex or threatened airways. However, anaesthetists indicate that we are less confident with this technique than any other airway management skill. 1 These days, it also appears that ATI is less commonly performed. 2 Australian and New Zealand College of Anaesthetists’ training currently requires trainees to be present or perform five awake bronchoscopies or intubations. 3 Experts believe more hands-on time is required for proficiency. Marsland et al. described that the development of basic bronchoscopic psychomotor skills on a bench-top trainer required multiple episodes of training, each lasting 20–30 minutes and totalling two to four hours. 4 Moreover, handling of a bronchoscope is only one aspect of awake bronchoscopic intubation. Safe and well-tolerated passage of an endotracheal tube also requires experience with topicalisation, ergonomics, troubleshooting technical issues and sedation (if provided). To our knowledge, there are no data guiding how many awake intubations are required to gain competence across all these skills. While five episodes with ideal conditions are achievable during training years, they are unlikely to convert a novice to a confident practitioner, let alone an expert. A review","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 3","pages":"229-231"},"PeriodicalIF":1.5,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9577075","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":"Prediction of hypofibrinogenaemia based on the starting fibrinogen and extent of haemodilution during cardiac surgery.","authors":"Neville M Gibbs,&nbsp;James F Preuss,&nbsp;Shannon A Matzelle,&nbsp;Alex Hansen,&nbsp;William M Weightman","doi":"10.1177/0310057X221138113","DOIUrl":"https://doi.org/10.1177/0310057X221138113","url":null,"abstract":"It is now recognised that correction of hypofibrinogenaemia is a priority in the management of coagulopathic bleeding, once drug-related causes have been reversed as far as possible. 1,2 Correction of low fibrinogen levels has also been shown to improve clot strength in the presence of thrombocytopenia. 2,3 For this reason, an additional alert to the likelihood of hypofibrinogenaemia may help clinicians to improve coagulation management, by prompting them to measure the fibrinogen level, and replace fibrinogen in a timely manner if nec-essary. We reasoned that such an alert could be obtained by considering the preoperative fibrinogen level and the extent of haemodilution pertaining at any particular stage of a procedure. This reasoning is based on the fact that fibrinogen is a large molecule, which under normal circumstances is confined to the intravascular space in the same way as haemoglobin. 4,5 Moreover, normal levels are not restored immediately, but instead occur over several hours. 6,7 Therefore, any reduction in the haemoglobin level caused by blood loss and its replacement with non-sanguineous fluid should be accompanied by a similar or greater proportional reduction in the fibrinogen level, assuming no blood products have been administered. We","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 3","pages":"219-222"},"PeriodicalIF":1.5,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9628911","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":"Patient compliance with preoperative instructions prior to an elective procedure: A quality improvement audit.","authors":"Mark Azer,&nbsp;Neha Chandrasekar,&nbsp;Jacqueline Jacqueline,&nbsp;Victor Lai,&nbsp;Jennifer J Yang,&nbsp;Tally Zhuo,&nbsp;Marie-Louise Dreux","doi":"10.1177/0310057X221141104","DOIUrl":"https://doi.org/10.1177/0310057X221141104","url":null,"abstract":"Prior to undergoing an elective procedure, patients are given instructions regarding which medications to with-hold or continue, are told to fast from a certain time, and complete an informed consent process for their procedure. Failure to understand and comply with this information can have significant patient safety, health economic and medicolegal implications. We aimed to determine the prevalence of incomplete compliance with medication and fasting instructions and incomplete knowledge of the procedure for which they had consented in our hospital. A quality improvement audit was performed on patients undergoing an elective procedure at a major tertiary hospital in Sydney over a two-week period in July 2020 and over another two-week period in July 2021. The project met New South Wales Health guidelines for a quality improvement activity not requiring ethics review, 1 which was confirmed by the South Eastern Sydney Local Health District Human Research Ethics Committee.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"51 3","pages":"226-228"},"PeriodicalIF":1.5,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9576048","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}