Anaesthesia and Intensive Care最新文献

{"title":"A simulated 'can't intubate, can't oxygenate' manikin crossover study investigating a modified front-of-neck access airway device.","authors":"Stuart Paterson, Zeik Devereaux-McLean, Georgia Mohler, Dheeraj Sharma, Malcolm B Anderson, Adam J Mahoney","doi":"10.1177/0310057X241266861","DOIUrl":"10.1177/0310057X241266861","url":null,"abstract":"<p><p>A 'can't intubate, can't oxygenate' (CICO) situation is an uncommon and time-critical emergency. Many institutions have adopted a 'scalpel-bougie-endotracheal tube (ETT)' technique based on evidence produced by the 4th National Audit Project of the Royal College of Anaesthetists and 2015 Difficult Airway Society guidelines. We made a modification to the traditional 'scalpel-bougie-ETT' technique, using a shortened bougie and replacing the ETT with a cuffed Melker airway in a preassembled device (called 'Secure Airway for Front-of-neck Emergencies' (SAFE airway device)), which we felt might reduce cognitive load on a single operator in an emergency CICO situation. We then performed a simulation crossover study using 20 volunteer anaesthetic doctors to compare this modification with the traditional technique. After a standardised pre-recorded video demonstration, participants performed simulated tube insertion using both the standard 'scalpel-bougie-ETT' technique and the SAFE airway device in randomised order. Participants were filmed for accurate timestamping. The primary outcome was time to successful tube insertion while secondary outcomes included number of attempts and ease of insertion. Overall time to cuff inflation was shorter, statistically and practically, with the SAFE airway device compared with the ETT (median 30 <i>vs</i>. 52 seconds, <i>P</i> < 0.001). Twenty-five percent of participants required multiple attempts using the ETT method versus 5% using the SAFE airway device, which was also rated as being easier to use. This study demonstrates that the SAFE airway device was fast, effective, easy to use and acceptable to airway practitioners in a simulated manikin environment. These findings indicate that further studies of the SAFE airway device are warranted.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"63-69"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142875603","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 effect of deep versus awake removal of the laryngeal mask airway on the incidence of emergence delirium in paediatric tonsillectomy: A randomised controlled trial.","authors":"Dhruv Kapoor, Eliza A Tweddle, Luke Baitch","doi":"10.1177/0310057X241275114","DOIUrl":"10.1177/0310057X241275114","url":null,"abstract":"<p><p>Emergence delirium, characterised by inconsolable crying, perceptual disturbances and thrashing, occurs in young children during the recovery phase from general anaesthesia. Our aim was to determine whether timing of laryngeal mask airway removal (deeply anaesthetised versus awake) influenced the incidence of emergence delirium in children after tonsillectomy. A single-centre, randomised controlled trial was conducted at Albury Wodonga Health, a regional hospital in Australia. Included patients were two to seven years old, American Society of Anesthesiologists physical status classification 1-2, undergoing elective tonsillectomy (with or without adenoidectomy or grommet insertion) under general anaesthesia. Patients were randomised to have their laryngeal mask removed whilst deeply anaesthetised (in the operating theatre) or after awakening (in the post-anaesthesia care unit (PACU)). Pediatric Anesthesia Emergence Delirium score was determined at 5 and 20 min after eye opening, and frequency of complications (cough, vomiting, excessive salivation, oxygen desaturation and laryngospasm) in the PACU were recorded. Sixty-two patients were randomised to deep laryngeal mask removal and 62 to awake. In the awake versus deep groups, 33 (53%) versus 40 (65%) participants had emergence delirium at 5 min (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.30 to 1.29, <i>P</i> = 0.20). At 20 min, 18 (29%) <i>vs</i>. 19 (31%) participants had emergence delirium (OR 0.93, 95% CI 0.43 to 2.00, <i>P</i> = 0.88). A greater incidence of most PACU complications was observed in the awake versus deep group; cough (24% <i>vs</i>. 8%), vomiting (8% <i>vs</i>. 0%), excessive salivation (23% <i>vs</i>. 8%) and oxygen desaturation (16% <i>vs</i>. 0%). We found no significant difference between the two techniques in terms of preventing emergence delirium. However, other PACU complications were more frequent with awake removal.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"55-62"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456186","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":"ChatGPT-4's capability in addressing multiple-choice questions within the primary examination of the Australian and New Zealand College of Anaesthetists.","authors":"Steven C Cai, Alpha Ms Tung","doi":"10.1177/0310057X241266625","DOIUrl":"10.1177/0310057X241266625","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"70-74"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279294","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":"Association of medical emergency team activation in the 24-hour postoperative period with length of stay and in-hospital mortality.","authors":"Tess I Donoghue, Matthew J Brain","doi":"10.1177/0310057X241272107","DOIUrl":"10.1177/0310057X241272107","url":null,"abstract":"<p><p>Medical emergency team (MET) activations were designed to improve patient safety and outcomes by providing timely and specialised care to patients experiencing clinical deterioration. The primary objective of this study was to describe the association between MET events in the early (24-h) postoperative period and in-hospital mortality as well as length of stay. A retrospective data linkage study was performed of prospectively collected data from patient administrative data and the MET database at Launceston General Hospital located in Tasmania, Australia. Over five years, 109,116 operating room cases fulfilled the inclusion criteria, of which 85,235 were the first operating room case in a unique admission episode after exclusions. A MET event within the first 24 h after surgery was associated with an increased median length of stay from 0.16 to 4.00 days with a median difference of 2.96 days (95% confidence interval (CI) 2.86 to 3.08) and more than doubled the hazard of mortality for each day a patient remained in hospital after completion of surgery (hazard ratio 2.3, 95% CI 1.9 to 2.8). Emergency surgical patients were at higher risk. Of recorded MET triggers, cardiac arrest was the most strongly associated event with in-hospital mortality. Notably, staff concern as a trigger for MET activation was associated with a hazard nearly as great as chest pain. Other MET triggers that reached statistical significance were bleeding, respiratory rate more than 36/min, peripheral oxygen saturations less than 84% and systolic blood pressure less than 80 mmHg. Despite being frequent, MET events should be regarded as a serious marker of an adverse patient journey that may warrant higher resource allocation.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"15-24"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930621","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 cost analysis of the anaesthetic management of patients with confirmed or suspected coronavirus disease 2019 (COVID-19) in a tertiary referral hospital in Queensland, Australia.","authors":"Anthony T Hodge, Angela R Tognolini, Elizabeth K Martin, Victoria A Eley","doi":"10.1177/0310057X241272108","DOIUrl":"10.1177/0310057X241272108","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic in Australia resulted in significant additional infection control precautions for consumers and the health workforce. Prior to widespread vaccine availability, substantial changes were made to the operating theatre management of patients presenting for surgery with suspected or diagnosed COVID-19. This study aimed to calculate the actual costs of operating theatre care for patients with confirmed or suspected COVID-19. Data were prospectively collected for all patients presenting for surgery with confirmed or suspected COVID-19 at the Royal Brisbane and Women's Hospital. Information collected included patient characteristics, surgical and anaesthesia details, equipment, theatre utilisation, staffing and cleaning. The associated variable costs and usual costs of care were calculated according to the Australian National Efficient Price. We compared estimated usual costs with those estimated for patients with confirmed or suspected COVID-19. Twenty-four patients with suspected COVID-19 infection underwent surgery between May 2020 and February 2021. Cost analysis revealed a mean (standard deviation (SD), range) increase in costs of providing perioperative care for COVID-19 suspect patients of A$2252 (A$2570, A$315.85-10,398); that is, a mean of 207.5% more than usual care costs. This was primarily due to the increased number of staff and time required to complete these cases with appropriate infection control.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"6-14"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930615","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":"Culprit allergen prevalence in polyreactive individuals reflects prescription trends: A tool for estimating comparative anaphylaxis risk using the example of neuromuscular blocking agents.","authors":"Paul Hm Sadleir, Catherine E Goddard, Russell C Clarke, Peri S Mickle, Peter R Platt","doi":"10.1177/0310057X241275115","DOIUrl":"10.1177/0310057X241275115","url":null,"abstract":"<p><p>Prescription-event monitoring (PEM) is the current gold standard for determining the risk of rare drug side-effects and comparing the risk between agents; however, spontaneous or prompted reporting schemes have low case-detection rates and exposure may be difficult to estimate. A novel method is described that allows a comparative adverse event rate between two drugs to be estimated-based on patterns of cross-reactivity-requiring only a sample of cases and no direct knowledge of drug exposure rates. Agreement was compared between the novel method and historical estimates of risk using PEM for comparative risk of rocuronium versus vecuronium anaphylaxis. The novel method was applied to a sample of patients investigated by the Western Australian Anaesthetic Drug Reaction Clinic over a 21-year period. Relative population exposure was estimated from the number of patients with either rocuronium or vecuronium anaphylaxis subsequently shown to be reactive on skin testing to both agents. This was used to correct the total number of cases of hypersensitivity triggered by each agent. Measures of spread were by bootstrap sampling. Historical estimates were gathered by literature review. Additional comparisons of agreement between estimates made by the novel method and PEM were made using cross-reactivity data and PEM rates reported in the literature. There was agreement between estimates of comparative anaphylaxis risk between the novel method and PEM. Two-hundred and twenty-eight cases of anaphylaxis were observed, 89% caused by rocuronium. Patients reactive to both agents were more likely to be female, and had a higher acute mast cell tryptase level. Patients with a history of rocuronium anaphylaxis were more likely to be reactive to one agent only (69% <i>vs</i>. 33%, <i>P</i> < 0.01). It was estimated that rocuronium was prescribed 3.9 times more frequently than vecuronium. When the observed proportion of cases was corrected for exposure rate, the risk of rocuronium anaphylaxis was 2.2 times that of vecuronium (95% confidence interval 1.7 to 2.8). The median risk from historical estimates was 4.7 times, while the previous PEM estimate in Western Australian was 3.0 times. Using a subgroup of patients susceptible to the same side-effect of two drugs, the relative exposure rate and corrected comparative risk of an adverse effect can be estimated for a population. Using this technique, which requires assessment only of cases to estimate relative exposure rates, we have estimated that the risk of anaphylaxis from rocuronium to be 2.2 times that of vecuronium in Western Australia.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"45-54"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930630","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 history of heparin.","authors":"Christine M Ball, Peter J Featherstone","doi":"10.1177/0310057X241301977","DOIUrl":"10.1177/0310057X241301977","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"3-5"},"PeriodicalIF":1.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863100","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":"Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review.","authors":"Brieana C Nolan, Michael J Hoskins, Bríd Phillips, Kiah L Evans","doi":"10.1177/0310057X241263113","DOIUrl":"10.1177/0310057X241263113","url":null,"abstract":"<p><p>Of the total carbon footprint of Australia, 7% is attributed to healthcare. In the UK, inhalational agents make up 5% of the healthcare carbon footprint. This systematic review aims to determine which methods of education about the environmental impact of inhalational anaesthetic agents can be utilised to promote behaviour change, reducing the anaesthetic-related carbon footprint. This systematic review sourced records from CINAHL, EMBASE, ERIC, JBI and MEDLINE from 1970 to March 2022. The search identified 589 records, 13 of which met eligibility criteria after the screening process, in which 10 of these records were conference abstracts. Education curricula focused on inhalational agent choice (69%), lowering the fresh gas flow during maintenance anaesthesia (69%), encouraging alternatives such as total intravenous anaesthesia (23%) and/or switching off the gas on transfer (8%). The most common teaching techniques utilised in education curricula were didactic lectures (85%), visual prompts (54%), emails (46%), and conversation forums (31%). All but one study reported a positive relationship between teaching sessions and behavioural change resulting in lower inhalational anaesthetic use by participants and their organisations, reducing healthcare-associated emissions. This systematic review has demonstrated that single education sessions as well as multi-focused, multimodal education curricula on the topic of greener anaesthesia can be beneficial in promoting behavioural change.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"356-368"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103610","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":"Anaesthesia healthcare workers' interactions with COVID-19-positive and -suspect patients: A multi-site observational study from Queensland, Australia.","authors":"Adrian Chin, Christine Woods, Anita M Pelecanos, Angela Tognolini, Gunjan Chawla, Sheridan Bell, Ivan L Rapchuk, Jimmy Wang, Victoria A Eley","doi":"10.1177/0310057X241265723","DOIUrl":"10.1177/0310057X241265723","url":null,"abstract":"<p><p>Occupationally acquired COVID-19 is a hazard for healthcare workers (HCWs). In four hospitals of the Metro North Hospitals and Health Service in Queensland, Australia, we invited HCWs to report the nature of any anaesthesia interactions with COVID-19-positive and COVID-19-suspect patients. This was to assist workforce planning in future pandemics. Data collection consisted of three phases; 1) participating HCWs recorded details of episodes of care (EOCs) with COVID-19-positive or COVID-19-suspect patients; 2) these HCWs were invited to complete a follow-up survey about their own health status regarding COVID-19 infections; 3) electronic health records were used to assess patient demographics, infectious status and outcomes. Between 21 March 2020 and 17 May 2022, 63 anaesthesia HCWs reported 90 EOCs with 67 unique patients. The median (interquartile range (IQR)) age of the HCWs was 40.5 years (34-46); 55% (34/62) were male, 62% (39/63) were consultants and 21% (13/63) were registrars. The median (IQR) age of patients was 39 (28-63) years. Personal protective equipment (PPE) was deemed to be appropriate by the HCWs in (86/88) 98% of the EOCs. Twenty-four HCWs (38%) responded to a follow-up survey. Of 12 HCWs who subsequently tested positive to COVID-19, only four had cared for a COVID-19-positive patient in the two weeks prior to their diagnosis. Most responding HCWs perceived they contracted COVID-19 in the community, experiencing mild illness. We found relatively low COVID-19 case numbers, high PPE use and low transmission of COVID-19 within the hospital setting.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"377-385"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456181","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":"Dr Gilbert Reynolds Troup: A founder of the Australian Society of Anaesthetists.","authors":"Michael G Cooper","doi":"10.1177/0310057X241267928","DOIUrl":"https://doi.org/10.1177/0310057X241267928","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"52 1_suppl","pages":"3-5"},"PeriodicalIF":1.1,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543153","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}