Anaesthesia and Intensive Care最新文献_第8页

Does gender still matter in the pursuit of a career in anaesthesia? 在追求麻醉学的职业生涯中，性别仍然重要吗?

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231212210

Claire H Stewart, Jane Carter, Natalie Purcell, Maryanne Balkin, Julia Birch, Greta C Pearce, Timothy Makar

{"title":"Does gender still matter in the pursuit of a career in anaesthesia?","authors":"Claire H Stewart, Jane Carter, Natalie Purcell, Maryanne Balkin, Julia Birch, Greta C Pearce, Timothy Makar","doi":"10.1177/0310057X231212210","DOIUrl":"10.1177/0310057X231212210","url":null,"abstract":"A survey sent to fellows of the Australian and New Zealand College of Anaesthetists (ANZCA) aimed to document issues affecting gender equity in the anaesthesia workplace. A response rate of 38% was achieved, with women representing a greater proportion of respondents (64.2%). On average women worked fewer hours than men and spent a larger percentage of time in public practice; however, satisfaction rates were similar between genders. There was a gender pay gap which could not be explained by the number of hours worked or years since achieving fellowship. The rates of bullying and harassment were high among all genders and have not changed in 20 years since the first gender equity survey by Strange Khursandi in 1998. Women perceived that they were more likely to be discriminated against particularly in the presence of other sources of discrimination, and highlighted the importance of the need for diversity and inclusion in anaesthetic workplaces. Furthermore, women reported higher rates of caregiving and unpaid domestic responsibilities, confirming that anaesthetists are not immune to the factors affecting broader society despite our professional status. The overall effect was summarised by half of female respondents reporting that they felt their gender was a barrier to a career in anaesthesia. While unable to be included in statistics due to low numbers, non-binary gendered anaesthetists responded and must be included in all future work. The inequities documented here are evidence that ANZCA's gender equity subcommittee must continue promoting and implementing policies in workplaces across Australia and New Zealand.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"113-126"},"PeriodicalIF":1.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440207","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}

引用次数: 0

Prevention of airway fires during tracheostomy is preferable. Comment on: Simulation training results in performance retention for the management of airway fires: A prospective observational study. 气管造口术期间最好预防气道火灾。评论：模拟训练在气道火灾管理中的成绩保持：一项前瞻性观察性研究。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-10-06 DOI: 10.1177/0310057X231196908

Kar-Soon Lim

引用次数: 0

Metabolic crisis in maple syrup urine disease: an unusual complication of a rare disease: a case report. 枫糖浆尿病的代谢危机:罕见疾病的罕见并发症:1例报告。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-23 DOI: 10.1177/0310057X231183981

Hemang P Doshi, Hemal H Vachharajani, Michael C Tchan, Mohamed A Nasreddine, Kate E Billmore

引用次数: 0

The introduction of blood gases into clinical practice. 将血气引入临床实践。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 DOI: 10.1177/0310057X231212299

Christine M Ball, Peter J Featherstone

引用次数: 0

Risk factors for mortality in severe COVID-19: Exploring the interplay of immunomodulatory therapy and coinfection. 重症 COVID-19 患者死亡的风险因素：探索免疫调节疗法与合并感染的相互作用。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-09-17 DOI: 10.1177/0310057X231183451

Annaleise R Howard-Jones, Stephen Huang, Sam R Orde, James M Branley

{"title":"Risk factors for mortality in severe COVID-19: Exploring the interplay of immunomodulatory therapy and coinfection.","authors":"Annaleise R Howard-Jones, Stephen Huang, Sam R Orde, James M Branley","doi":"10.1177/0310057X231183451","DOIUrl":"10.1177/0310057X231183451","url":null,"abstract":"Patients with severe clinical manifestations of coronavirus disease 2019 (COVID-19) present particular diagnostic and management challenges to critical care physicians, including identifying and responding to concurrent bacterial and fungal coinfections. This study evaluates risk factors for in-hospital mortality in patients admitted to the intensive care unit with severe COVID-19 during circulation of the B.1.617.2 (Delta) variant, including the impact of immunomodulators and bacterial and/or fungal coinfection. This retrospective cohort study enrolled patients with severe COVID-19. A Cox proportional hazard ratio analysis identified risk factors for in-hospital mortality. Outcomes were also compared between patients receiving and not receiving immunomodulatory therapy alongside standard care. Ninety patients admitted to the intensive care unit were enrolled. On multivariate analysis, the greatest risk factors for in-hospital mortality were invasive mechanical ventilation (hazard ratio (HR) = 15.27; 95% confidence interval (CI) 3.29-71.0; P < 0.001), elevated body mass index (HR = 1.07 per unit; 95% CI 1.02-1.13; P = 0.007) and older age (HR = 1.53 per decade; 95% CI 1.05-2.24; P = 0.028). Bacterial and/or fungal coinfection occurred at equal frequency in patients receiving and not receiving immunomodulatory therapy. However, in patients receiving immunomodulators, coinfection carried a significantly higher mortality risk (63.0%) compared with those without coinfection (15.4%; P = 0.038). Mortality from severe COVID-19 is significantly higher in older patients and those with elevated body mass index and requiring mechanical ventilation. Immunomodulatory therapy necessitates vigilance towards evolving coinfection in the intensive care setting.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"52-63"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10635758","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}

引用次数: 0

Airway management of lingual tonsillar hypertrophy: A narrative review. 舌扁桃体肥大的气道管理:叙述回顾。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231196910

Patrick Wong, Jamie W Sleigh

{"title":"Airway management of lingual tonsillar hypertrophy: A narrative review.","authors":"Patrick Wong, Jamie W Sleigh","doi":"10.1177/0310057X231196910","DOIUrl":"10.1177/0310057X231196910","url":null,"abstract":"Lingual tonsillar hypertrophy is rarely identified on routine airway assessment but may cause difficulties in airway management. We conducted a narrative review of case reports of lingual tonsillar hypertrophy to examine associated patient factors, success rates of airway management techniques and complications. We searched the literature for anaesthetic management of cases with lingual tonsillar hypertrophy. We found 89 patients in various case reports, from which we derived 92 cases to analyse. 64% of cases were assessed as having a normal airway. Difficult and impossible face mask ventilation occurred in 29.6% and 1.4% of cases, respectively. Difficult intubation and failed intubation occurred in 89.1% and 21.7% of cases, respectively. Multiple attempts (up to six) at intubation were performed, with no successful intubation after the third attempt with direct laryngoscopy. Some 16.5% of patients were woken up and 4.3% required emergency front of neck access. Complications included oesophageal intubation (10.9%), bleeding (9.8%) and severe hypoxia (3.2%). Our findings show that severe cases of lingual hypertrophy may cause an unanticipated difficult airway and serious complications, including hypoxic brain damage and death. A robust airway strategy is required which includes limiting the number of attempts at laryngoscopy, and early priming and performance of emergency front of neck access if required. In patients with known severe lingual tonsillar hypertrophy, awake intubation should be considered.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"16-27"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440206","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}

引用次数: 0

Response to "What is a case-control study? Comment on 'Oral midodrine does not expedite liberation from protracted vasopressor infusions: A case-control study'". 对“什么是病例对照研究?”对“口服米多卡因不能加速长期血管加压素输注的释放:一项病例对照研究”的评论。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231197692

Alexander Jt Wood, Rashmi Rauniyar, Angela Jacques, Robert N Palmer, Bradley Wibrow, Matthew H Anstey

引用次数: 0

Preliminary pharmacokinetics and patient experience of jet-injected dexmedetomidine in healthy adults. 健康成人喷射注射右美托咪定的初步药代动力学和患者体验。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-09-15 DOI: 10.1177/0310057X231178841

Nicola M Whittle, Jamie W Sleigh, James W McKeage, Jonathan Termaat, Logan J Voss, Brian J Anderson

{"title":"Preliminary pharmacokinetics and patient experience of jet-injected dexmedetomidine in healthy adults.","authors":"Nicola M Whittle, Jamie W Sleigh, James W McKeage, Jonathan Termaat, Logan J Voss, Brian J Anderson","doi":"10.1177/0310057X231178841","DOIUrl":"10.1177/0310057X231178841","url":null,"abstract":"Jet injection is a drug delivery system without a needle. A compressed liquid drug formulation pierces the skin, depositing the drug into the subcutaneous or intramuscular tissues. We investigated the pharmacokinetics and patient experience of dexmedetomidine administered using jet injection in six healthy adult study participants. This needleless jet injection device was used to administer dexmedetomidine 0.5 μg/kg to the subcutaneous tissues overlying the deltoid muscle. Serum concentrations of dexmedetomidine were assayed at approximately 5 minutes, 15 minutes, 30 minutes, 1 hour and 4 hours after administration. Pharmacokinetic interrogation of concentration time profiles estimated an absorption half time for jet-injected dexmedetomidine of 21 minutes (coefficient of variation 69.4%) with a relative bioavailability assumed unity. In our samples the measured median peak (range) concentration was 0.164 μg/l (0.011-0.325 μg/l), observed in the sample taken at a median (range) of 13.5 minutes (11-30 minutes). The Richmond agitation sedation scale was used to assess the sedative effect, and scored 0 (alert and calm) or -1 (drowsy) in all participants. Five of the six participants stated they would prefer jet injection to needle injection in the future and one had no preference. The findings suggest that the use of a larger dose (>2 μg/kg) would be required to achieve the clinically relevant target concentration of 1 μg/l necessary to achieve deeper sedation (Richmond agitation sedation scale ≤3).","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"37-44"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10298222","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}

引用次数: 0

Assessing the impact of COVID-19 on Australian public interest in critical care. 评估COVID-19对澳大利亚重症监护公众利益的影响。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231198258

Rachel H T Yeong, Christopher B Hodge, Premkumar Gunasekaran

引用次数: 0

Inflammation risk before cardiac surgery and the treatment effect of intraoperative dexamethasone. 心脏手术前炎症风险及术中地塞米松治疗效果分析。

IF 1.5 4区医学

Anaesthesia and Intensive Care Pub Date : 2024-01-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231195098

Andrew J Toner, Tomas B Corcoran, Philip S Vlaskovsky, Arno P Nierich, Chris R Bain, Jan M Dieleman

{"title":"Inflammation risk before cardiac surgery and the treatment effect of intraoperative dexamethasone.","authors":"Andrew J Toner, Tomas B Corcoran, Philip S Vlaskovsky, Arno P Nierich, Chris R Bain, Jan M Dieleman","doi":"10.1177/0310057X231195098","DOIUrl":"10.1177/0310057X231195098","url":null,"abstract":"Patients who exhibit high systemic inflammation after cardiac surgery may benefit most from pre-emptive anti-inflammatory treatments. In this secondary analysis (n = 813) of the randomised, double-blind Intraoperative High-Dose Dexamethasone for Cardiac Surgery trial, we set out to develop an inflammation risk prediction model and assess whether patients at higher risk benefit from a single intraoperative dose of dexamethasone (1 mg/kg). Inflammation risk before surgery was quantified from a linear regression model developed in the placebo arm, relating preoperatively available covariates to peak postoperative C-reactive protein. The primary endpoint was the interaction between inflammation risk and the peak postoperative C-reactive protein reduction associated with dexamethasone treatment. The impact of dexamethasone on the main clinical outcome (a composite of death, myocardial infarction, stroke, renal failure, or respiratory failure within 30 days) was also explored in relation to inflammation risk. Preoperatively available covariates explained a minority of peak postoperative C-reactive protein variation and were not suitable for clinical application (R2 = 0.058, P = 0.012); C-reactive protein before surgery (excluded above 10 mg/L) was the most predictive covariate (P < 0.001). The anti-inflammatory effect of dexamethasone increased as the inflammation risk increased (-0.689 mg/L per unit predicted peak C-reactive protein, P = 0.002 for interaction). No treatment-effect heterogeneity was detected for the main clinical outcome (P = 0.167 for interaction). Overall, risk predictions from a model of inflammation after cardiac surgery were associated with the degree of peak postoperative C-reactive protein reduction derived from dexamethasone treatment. Future work should explore the impact of this phenomenon on clinical outcomes in larger surgical populations.","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"28-36"},"PeriodicalIF":1.5,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138433032","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}

引用次数: 0