Anaesthesia and Intensive Care最新文献

{"title":"A photographic assessment of contamination of operating theatre sharps and pharmaceutical waste bins in 21 Australian and New Zealand hospitals.","authors":"Daniel Brooks Reid, Richard Seglenieks, Rajesh Pachchigar, Timothy Wong, Jess Davies","doi":"10.1177/0310057X261433580","DOIUrl":"https://doi.org/10.1177/0310057X261433580","url":null,"abstract":"<p><p>The segregation and proper disposal of hospital waste are growing issues. This study aims to identify and visually quantify the amount of non-sharps items found in sharps waste bins across Australian and New Zealand operating theatre complexes. In this multi-site collaborative audit of 21 hospitals, a 'bird's-eye' photograph was taken and visible non-sharps items were counted, categorised and collated from every sharps waste bin within participating operating theatre complexes. Each bin was assessed a minimum of two times with a minimum two-week interval between assessments. Sixteen thousand, three hundred and sixty-nine non-sharps contaminants were identified in 896 sharps waste bins assessed across 21 sites. The bins assessed were 78% sharps waste bins (698 bins) and 32% (198) were pharmaceutical and sharps bins. The most common misplaced items were unbroken glass vials (31.9%), syringes without needles (28.9%) and packaging (12.1%). Incorrect placement of non-sharps items into sharps waste bins was frequent and common across all participating Australian and New Zealand operating theatres. Care must be taken to ensure pharmaceutical waste enters incinerated waste streams. Redirecting appropriate items into general waste or recycling streams could significantly reduce their financial and environmental cost.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"310057X261433580"},"PeriodicalIF":1.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728096","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 effects of remifentanil and dexmedetomidine on the gastro-oesophageal pressure gradient: A crossover randomised controlled volunteer trial.","authors":"Islam M Elhalawani, Adam M Deane, Guy L Ludbrook, Richard W Watts, Richard Champion, Richard H Holloway, Ryan Df Adams, Caroline E Cousins, Marianne J Chapman","doi":"10.1177/0310057X251379094","DOIUrl":"10.1177/0310057X251379094","url":null,"abstract":"<p><p>Remifentanil and dexmedetomidine are sedative agents used both in anaesthetic and critical care practice. Their effects on the gastro-oesophageal pressure gradient and hence on the potential risk for regurgitation have not been quantified. The aim of this study was to measure and compare the effects of both agents on the gastro-oesophageal pressure gradient. The study used a randomised, double blinded crossover study design, and 16 healthy volunteers were sedated on two separate occasions. Baseline lower oesophageal sphincter pressure (26 and 28 mmHg for dexmedetomidine and remifentanil, respectively) and gastro-oesophageal pressure gradient (20 mmHg for both dexmedetomidine and reminfentanil) were recorded. Then, each volunteer received increasing doses of target-controlled infusions of dexmedetomidine (1, 2, 4, 6 ng/ml) or remifentanil (1, 2, 3, 4 ng/ml). Each dose level was maintained for 20 minutes, and both lower oesophageal sphincter pressure and gastro-oesophageal pressure gradient were continuously recorded. Measurements were averaged. Out of 16 subjects recruited, data were analysable from 11 (aged 18-54 years, body mass index 17.7-27.9 kg/m², five men and six women). The dose regimens of both agents provided similar profiles of progressive sedation over time, with sedation scores reaching a minimum of -2 on the 'observer's assessment of alertness and sedation score' with both medications. With dexmedetomidine, the bispectral index gradually decreased in line with sedation scores (<i>P</i><0.05), but remifentanil produced little change in the bispectral index from baseline. Both agents decreased gastro-oesophageal pressure gradient (<i>P</i><0.001) similarly, (<i>P</i>=0.199), in line with the decreases in sedation scores. In conclusion, when remifentanil or dexmedetomidine are administered to provide sedation they induce similar decreases in gastro-oesophageal pressure gradient. This may put patients at comparable risk of gastro-oesophageal reflux.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"133-139"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755152","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":"Does the extended use of anaesthetic breathing circuits increase microbial contamination? A systematic review and meta-analysis.","authors":"Daniel C Y Cheng, Aolei Yu, Andrew Lindberg, Jo Tallon, Benjamin L Olesnicky","doi":"10.1177/0310057X251377312","DOIUrl":"10.1177/0310057X251377312","url":null,"abstract":"<p><p>Hospitals, and in particular operating theatres, contribute significantly to the carbon footprint of modern healthcare. Operating theatres account for a large part of hospital waste, which can be offset by using more reusable or recyclable equipment. However, environmentally sustainable decisions within healthcare need to be evaluated to ensure they can be introduced without a negative impact on patient safety or outcomes. We performed a systematic review and meta-analysis to evaluate the difference in the rates of microbiological contamination of anaesthetic breathing circuits between single day or extended (more than one day) use in the provision of general anaesthesia in adult patients, where a microbial filter was used and changed for each patient regardless of the duration of breathing circuit usage. The results demonstrate no significant increase in the rate of contamination between single day and extended use breathing circuits (odds ratio (OR): 0.84; 95% confidence interval (CI): 0.44 to 1.60) or single day and seven-day breathing circuits (OR: 1.30, 95% CI: 0.34 to 4.97). This supports the use of extended use breathing circuits for up to seven days for both the demonstrated environmental and financial benefits, with no evidence of compromise to patient safety.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":"54 2","pages":"125-132"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147376016","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":"Challenges with labour epidural placement in a parturient with a lumbar arachnoid cyst: a case report.","authors":"Joseph Burton, Luke Baitch","doi":"10.1177/0310057X251377800","DOIUrl":"10.1177/0310057X251377800","url":null,"abstract":"<p><p>This case report describes the management of a patient with a lumbar arachnoid cyst requesting epidural labour analgesia. The patient was otherwise healthy but had suffered from multiple dural punctures during attempted epidural placement in a previous pregnancy. Magnetic resonance imaging following the dural punctures revealed the cyst, which was at the level of the L3-4 interspace, effacing the posterior epidural space at that level. Multidisciplinary management in this subsequent pregnancy, involving radiology and anaesthesia specialists, allowed ultrasound-guided identification of a higher epidural space, and successful and uneventful epidural placement during labour. Multiple dural punctures with attempted epidural placement should prompt anaesthetists to consider spinal magnetic resonance imaging to identify anatomical abnormalities that may be present, which may have implications for future management.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"163-167"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342931","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":"The impact of surgical site infections on the development of theatre attire during the 1960s and 1970s.","authors":"Peter J Featherstone, Christine M Ball","doi":"10.1177/0310057X261416283","DOIUrl":"10.1177/0310057X261416283","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"98-100"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200113","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":"Reducing waste from single-use procedure packs in hospitals: A scoping review.","authors":"Alexandra R Seville, Katy Jl Bell, Kristen M Pickles, Scott McAlister, Philomena Colagiuri, Luise Kazda","doi":"10.1177/0310057X251374693","DOIUrl":"10.1177/0310057X251374693","url":null,"abstract":"<p><p>Single-use items in pre-packaged procedure packs are disposed of after opening, regardless of whether they were used. We aimed to synthesise published evidence on evaluations of hospital-relevant interventions or comparisons targeting waste from procedure packs. We included intervention and aetiological observational studies, excluding purely descriptive studies, secondary studies and conference abstracts. We searched MEDLINE, Embase, CINAHL and Scopus from inception to 7 May 2024 and undertook forward and backward citation searches of included records. Of 1074 records retrieved, 14 studies met inclusion criteria. Eight were before-after quality improvement studies, five were comparative life cycle assessments and one was an audit. Studies reported on reductions in items in the pack (<i>n</i> = 8), change from single-use to reusable items (<i>n</i> = 3) and comparisons between different packs (<i>n</i> = 2) or individually packed items and packs (<i>n</i> = 1). Twelve studies reported on financial and waste impacts, six on environmental impacts and three on staff/patient impacts. Studies reported financial savings up to US$49.43 for reduced item packs and up to £7.22 for reusable packs versus single-use packs. Pack size and weight can often be much reduced, leading to less resource use and up to 2042g reduction in waste/pack and up to 860g less CO₂ equivalent (CO₂e) emissions. Switching instruments in packs from single-use to reusable reduced emissions by up to 90% where local energy was not predominantly from fossil fuels. No negative impacts on staff or patient outcomes were reported. Initiatives to reduce waste from single-use procedure packs may result in significant financial, resource use and CO₂e emissions savings.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"113-124"},"PeriodicalIF":1.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12967391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193975","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":"Residual neuromuscular blockade following electroconvulsive therapy.","authors":"Siaavash Maghami, Dale Currigan","doi":"10.1177/0310057X251378510","DOIUrl":"10.1177/0310057X251378510","url":null,"abstract":"<p><p>Post-procedural residual neuromuscular paralysis is an uncommon but serious complication in the general surgical population. Whilst the incidence of post-procedural residual neuromuscular paralysis in the general surgical population has been widely reported, there are no published data on the definition or incidence of this complication in patients undergoing electroconvulsive therapy (ECT). In our single-centre, prospective observational audit we studied the incidence of residual neuromuscular blockade following ECT between January and April 2021. Out of 25 procedures carried out over this time period, 23 were included for analysis. A total of 14 patients (61%) left the ECT suite with potentially clinically significant residual neuromuscular blockade. The median suxamethonium dose was 0.83mg/kg (interquartile range 0.68-0.91). Despite the known complications resulting from post-procedural residual neuromuscular blockade, neuromuscular monitoring is not mandated in guidelines published by the Australian and New Zealand College of Anaesthetists or the American Society of Anesthesiologists. Our preliminary findings suggest that further research into the scope and significance of residual neuromuscular blockade following ECT is warranted.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"157-162"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342549","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":"Follow-up to 'Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020'.","authors":"Jeremy D Szmerling, Paul Wembridge, Annie Williams, Gordon J Mar","doi":"10.1177/0310057X251377303","DOIUrl":"10.1177/0310057X251377303","url":null,"abstract":"","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"186-188"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755068","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":"Randomised controlled trials for the prevention of venous thromboembolism in critically ill patients: A systematic review of sample size methodologies.","authors":"Talia M Bitonti, Kevin M Durr, Shannon M Fernando, Bram Rochwerg, Marc Carrier, Deborah M Siegal, Alexandre Tran","doi":"10.1177/0310057X251397167","DOIUrl":"10.1177/0310057X251397167","url":null,"abstract":"<p><p>Venous thromboembolism (VTE), encompassing deep vein thrombosis and pulmonary embolism, contributes significantly to morbidity and mortality in critically ill patients. This increased incidence is influenced by factors such as indwelling central venous catheters, continuous sedation, and vasoactive infusions, in addition to traditional VTE risk factors such as immobility. Optimal VTE prophylaxis remains uncertain owing to significant variability with regard to differences across existing randomized controlled trials (RCTs) in terms of patient populations, types and dosing of prophylactic interventions, and definitions of VTE outcomes. RCTs conducted on critically ill patients are often limited by over-optimistic estimates of baseline event rates and potential treatment benefit. We conducted a systematic review to evaluate the described sample size methodologies and justification amongst VTE-prevention RCTs for critically ill patients. We searched MEDLINE and Embase from inception until 9 September 2024, and included 12 RCTs enrolling 9154 patients. Sample sizes ranged from 36 to 3746 participants. Only six studies met their recruitment targets, while four did not report a sample size calculation. Among the seven studies that reported an estimated control event rate, only one met that estimate. No studies achieved their planned absolute risk reduction, and only one met its relative risk reduction target. Prognostic enrichment strategies were employed in 41.6% of trials, while predictive enrichment was rarely used. These findings suggest that intensive care unit VTE prophylaxis trials frequently overestimate baseline risk and treatment effect size, contributing to underpowered studies and potential premature abandonment of promising interventions. Future trials should incorporate enrichment strategies and justify assumptions based on clinical relevance and patient-centred outcomes.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"104-112"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780094","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":"Critical hyponatraemia secondary to severe bilateral renal artery stenosis requiring intensive care - an unusual aetiopathogenesis for a common problem.","authors":"Nicolas Sieben, Stephen Luke, Sananta Dash","doi":"10.1177/0310057X251377310","DOIUrl":"10.1177/0310057X251377310","url":null,"abstract":"<p><p>A woman in her early sixties presented to the emergency department with an altered level of consciousness and severe hypertension (blood pressure 197/111 mmHg) on a background of Grave's disease, osteoporosis and hypertension. She was intubated following prolonged seizure activity attributed to critical hyponatraemia (serum sodium 108 mmol/L). Abnormal renal function (estimated glomerular filtration rate 51 ml/min per 1.73m²) was also identified on admission. She was transferred to the intensive care unit for further investigation and management of hypertension and hyponatraemia, where she made an excellent recovery and a unifying diagnosis of bilateral renal artery stenosis was made. Renal artery stenosis has been previously described with chronic and unilateral presentations not requiring intensive care support. This case report describes the pathophysiology of this previously unreported presentation of severe symptomatic hyponatraemia and hypertension due to bilateral renal artery stenosis and the challenges faced in intensive care to determine the diagnosis.</p>","PeriodicalId":7746,"journal":{"name":"Anaesthesia and Intensive Care","volume":" ","pages":"178-184"},"PeriodicalIF":1.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342850","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}