{"title":"Reduction of iatrogenic withdrawal syndrome in high-risk critically ill patients with acute respiratory distress syndrome.","authors":"Ruchi P Jain, Katarzyna Gosek, Madeline Johnston","doi":"10.1177/0310057X241233604","DOIUrl":"10.1177/0310057X241233604","url":null,"abstract":"<p><p>Limited data suggest a subset of patients with acute respiratory distress syndrome receive high-dose and prolonged opioid and sedative infusions. With prolonged use, patients may be at risk for developing iatrogenic withdrawal syndrome after discontinuation or tapering of these agents. Iatrogenic withdrawal syndrome is well described in paediatric patients; however, limited guidance exists in adult intensive care unit patients regarding risk factors and ideal management strategies. This article discusses several weaning strategies for high-risk patients to minimise withdrawal symptoms and safely reduce or discontinue opioid and sedative infusions. Ideal weaning strategies are lacking, but several options exist. These include a gradual reduction of the agent, changing the route of delivery by switching to an enteral or parenteral longer-acting agent from the same class, and substitution to an alternative agent to help mitigate potential withdrawal symptoms. This should be accomplished through a multidisciplinary approach by involving experts from relevant specialties while closely observing for withdrawal symptoms.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"272-281"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126618","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":"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":"220-230"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","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":"Comment on 'Time to re-evaluate the routine use of sterile gowns in neuraxial anaesthesia'.","authors":"Lars P Wang","doi":"10.1177/0310057X251325883","DOIUrl":"10.1177/0310057X251325883","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"285-286"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","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}
Sophie A Meyerson, Ben Olesnicky, Gene Lee, Andrea S Santoro, Ravinay Bhindi
{"title":"The impact of the introduction of monitored anaesthesia care in the cardiac catheterisation laboratory on Clinical Review, Rapid Response, and Blue Code rates, and mortality.","authors":"Sophie A Meyerson, Ben Olesnicky, Gene Lee, Andrea S Santoro, Ravinay Bhindi","doi":"10.1177/0310057X241304423","DOIUrl":"10.1177/0310057X241304423","url":null,"abstract":"<p><p>Most procedures in cardiac catheterisation laboratories (CCLs) have traditionally been performed under conscious sedation under the supervision of the treating proceduralist. With growing demand for more complex procedures to be performed, in emergencies and in patients with limited cardiorespiratory reserve, a reconsideration of the level of supervision provided is required. We conducted a retrospective cohort study of all patients who had CCL procedures and required an overnight stay at Royal North Shore Hospital during a 12-month period prior to introducing monitored anaesthesia care (MAC), compared with a 12-month period following introduction of MAC on selected weekdays. Primary outcomes were the difference in rates of Code Blue calls (triggering the cardiac arrest team), Clinical Reviews and Rapid Responses (defined as per the NSW Health 'Between the Flags' Deteriorating Patient Safety Net System) in the 24 h post-procedure between patients who did and did not have MAC. The secondary outcome was a difference in mortality (within 24 h of a procedure and in-hospital) between patients who did and did not have MAC. One thousand nine hundred and eight patients were analysed (926 pre-intervention, 982 post-intervention). We found no statistically significant difference in any of the primary or secondary outcomes between the pre-intervention and post-intervention patients overall. However, we found a statistically significant lower rate of Code Blue calls in patients who had MAC (<i>n</i> = 3, 0.6%) compared with no MAC (<i>n</i> = 31, 2.3%). We also found a significantly lower 24-h mortality in patients who had MAC (<i>n</i> = 1, 0.2%) compared with no MAC (<i>n</i> = 22, 1.6%), but no difference in overall in-hospital mortality.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"265-271"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397801","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":"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":"253-264"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","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":"Documentation of informed consent for anaesthesia: A single-site retrospective audit at a rural Australian hospital.","authors":"Yannick J De Silva, Luke Anderson","doi":"10.1177/0310057X241281364","DOIUrl":"10.1177/0310057X241281364","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"282-284"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930634","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}
Emily R Balmaks, Richard Seglenieks, Tanita Botha, Forbes McGain
{"title":"A survey of nitrous oxide usage and knowledge of its environmental effects across healthcare worker groups.","authors":"Emily R Balmaks, Richard Seglenieks, Tanita Botha, Forbes McGain","doi":"10.1177/0310057X251330318","DOIUrl":"https://doi.org/10.1177/0310057X251330318","url":null,"abstract":"<p><p>Nitrous oxide (N<sub>2</sub>O) is a greenhouse gas that is a significant contributor to the carbon dioxide-equivalent emissions of health services. We aimed to obtain information about N<sub>2</sub>O usage and knowledge of its environmental effects among clinical staff at an Australian metropolitan public health network. We distributed an anonymised survey to doctors, nurses and midwives working in anaesthesia, birthing, adult and paediatric emergency medicine, and paediatrics. We analysed 403 of 1320 (31%) responses; 117 of 198 (59%) from anaesthesia, 102 of 368 (27%) from birthing, 137 of 643 (21%) from adult and paediatric emergency medicine and 40 of 111 (36%) from paediatrics. Descriptive statistics were used, and statistical analyses performed on questions regarding environmental knowledge. Of those who currently used N<sub>2</sub>O, the majority indicated there were alternative therapies (184/239, 77%), which they would (137/239, 57%) or could (90/239, 38%) be willing to use. Approximately half (219/385, 57%) of respondents correctly identified N<sub>2</sub>O as a greenhouse gas, but only 70/382 (18%) identified its global warming potential as hundreds of times that of carbon dioxide. Almost half (180/383, 47%) answered that N<sub>2</sub>O is ozone depleting. For anaesthetists, 96% (45/47) knew that N<sub>2</sub>O was a greenhouse gas, compared with 41% (32/79) of midwives. This survey demonstrated that frequency of use and reason for use of N<sub>2</sub>O varies between clinical groups, and that a significant proportion of staff that use N<sub>2</sub>O do not know its harmful environmental characteristics. Our results provide data to inform future research on interventions to minimise clinical use of N<sub>2</sub>O, and suggest that educational programs should form part of these efforts.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251330318"},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324283","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}
Timothy P Webber, Benjamin J Young, Marianne J Chapman, Mark E Finnis
{"title":"Complications of induced hypertension for delayed cerebral ischaemia secondary to aneurysmal subarachnoid haemorrhage.","authors":"Timothy P Webber, Benjamin J Young, Marianne J Chapman, Mark E Finnis","doi":"10.1177/0310057X251330315","DOIUrl":"https://doi.org/10.1177/0310057X251330315","url":null,"abstract":"<p><p>The study objective was to determine the incidence of complications from induced hypertension used to treat delayed cerebral ischaemia (DCI) complicating aneurysmal subarachnoid haemorrhage (aSAH). Induced hypertension (IH) was defined as the use of vasopressors to achieve a supraphysiological systolic blood pressure target. A single-centre retrospective, observational cohort study was undertaken at the Royal Adelaide Hospital intensive care unit. Data are presented as predominantly median (interquartile range (IQR)). All patients admitted with a diagnosis of aSAH between 1 April 2020 and 1 April 2022 were included and analysed according to whether they did or did not receive vasopressors for IH. A total of 109 patients were included, of which 29 (27%) received vasopressors for IH (median age 58 (IQR 52-65) years, 65% female) and 80 did not receive IH (median age 55 (IQR 49-71) years, 62% female). Clinical DCI or radiological evidence of vasospasm were present in all patients given IH and in 16% of non-IH patients. Patients in the IH group had more ischaemic electrocardiogram (ECG) changes (17.2% <i>vs</i> 2.5%, <i>P</i> = 0.01), urine output (4807 (IQR 3186-5720) ml/day <i>vs</i> 2125 (IQR 1650-2760) ml/day, <i>P</i> < 0.001), fluid administration (4895 (IQR 3555-5999) ml/day <i>vs</i> 2704 (IQR 2300-3403) ml/day, <i>P</i> < 0.001) and intravenous potassium replacement (13 (IQR 5-24) mmol/day <i>vs</i> 5 (IQR 0-13) mmol/day, <i>P</i> = 0.001) than those in the non-IH group. IH was also associated with a greater incidence of hyponatraemia (58% <i>vs</i> 34%, <i>P</i> = 0.02). IH was not associated with arrhythmias or rebleeding. Mortality rates were 17% <i>vs</i> 20% (<i>P</i> > 0.9) in the IH and non-IH groups respectively. In conclusion, IH for the treatment of DCI following aSAH was associated with an increased rate of ischaemic ECG changes, increased urine output and hyponatraemia. However, in the IH group there was no increased rate of rebleeding, and 48% of the IH patients had an improvement in their neurological function following commencement of treatment.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251330315"},"PeriodicalIF":1.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315667","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":"Comparative strategies for overcoming pseudohypoxaemia: Guided by a case of leukocyte larceny in COVID-19 severe acute respiratory distress syndrome with chronic myelogenous leukaemia.","authors":"Daniel Grahf","doi":"10.1177/0310057X251334658","DOIUrl":"https://doi.org/10.1177/0310057X251334658","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251334658"},"PeriodicalIF":1.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301018","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":"Sleep, dreams and unconsciousness: Understanding anaesthesia through ancient Greek mythology.","authors":"Luke A Solomi","doi":"10.1177/0310057X251330656","DOIUrl":"https://doi.org/10.1177/0310057X251330656","url":null,"abstract":"<p><p>Sleep, dreams, unconsciousness and death are concepts regularly contended with by anaesthetists and their patients. The closely related genealogy of the entities personifying these concepts in ancient Greek mythology highlights a visceral uncertainty about the spectrum of human unconsciousness. Hypnos and Thanatos-Sleep and Death, respectively-commonly feature together in art and literature as twin brothers. Sleep was the more powerful of the two and was feared even by members of the Pantheon immune to death such as Zeus himself, drawing a parallel with the modern knowledge that all living organisms demonstrate susceptibility to anaesthesia. The power to induce sleep was regarded as a divine ability and was thus the domain of the gods. However, some mortals possessed these talents, usually through application of herbs or potions, highlighting an understanding that a state of unconsciousness could be induced by elements from the environment in the hands of a skilled or gifted operator. Through multiple different tales, the ancient Greeks also imply a distinction between physiological and drug-induced sleep, the latter of which is frequently associated with wrath and amnesia. Despite this distinction, sleep is commonly used interchangeably with general anaesthesia in discussions with patients. Though presumably intentioned to provide reassurance, using inaccurate terminology may impact on patients' ability to make an informed decision about receiving an anaesthetic. Perhaps there is a role for artistic and allegorical methods of communication to reflect this distinction to patients as we guide them through an odyssey of their own into a state of controlled unconsciousness.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X251330656"},"PeriodicalIF":1.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301028","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}