Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2024
Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020.
This multicentre, retrospective medical record audit evaluated opioid analgesia prescribing within a Victorian metropolitan public hospital network. The study included all surgical patients discharged between January 2012 and December 2020 with one or more discharge prescriptions from three metropolitan hospitals (n = 117,989). The main outcome measures were mean oral morphine equivalent daily dose (OMEDD), mean number of opioid types and proportion of patients prescribed one or more slow-release opioids on discharge. ⋯ Subanalysis was undertaken to evaluate key changes in the opioid prescribing landscape in the health network. The removal of default opioid pack sizes in the electronic medication management system (December 2014) and the release of the Faculty of Pain Medicine-Australian and New Zealand College of Anaesthetists' statement regarding the use of opioid analgesics in patients with chronic non-cancer pain (March 2018) were associated with significant reductions in mean OMEDD prescribed on discharge (136 mg vs 122 mg and 120 mg vs 85.4 mg, respectively, P < 0.001). In conclusion, the quantity of opioids prescribed on discharge in this patient group peaked in 2013 and has been decreasing since.
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Anaesth Intensive Care · Apr 2024
Basophil activation test in the diagnostic workup of perioperative anaphylaxis due to neuromuscular blocking agents: A case series and implications for practice.
In Australia, neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Current investigation of suspected anaphylaxis includes tryptase levels, serum immunoglobulin E (IgE) levels, and skin testing, including intradermal testing and skin prick testing. The gold standard for the diagnosis of a hypersensitivity reaction is a challenge test, but this poses a risk to patient safety. ⋯ This acts as a surrogate marker for mast cell and basophil activation, thereby identifying IgE-mediated allergy. It is most commonly used to supplement equivocal findings from initial in vitro testing to assist in confirming the diagnosis of a hypersensitivity reaction and identify the causative agent. We present a case series in which five patients with suspected anaphylaxis underwent a BAT, demonstrating its role and limitations in allergy testing within Australia.
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Anaesth Intensive Care · Apr 2024
Trainee anaesthetist self-assessment using an entrustment scale in workplace-based assessment.
The role of self-assessment in workplace-based assessment remains contested. However, anaesthesia trainees need to learn to judge the quality of their own work. Entrustment scales have facilitated a shared understanding of performance standards among supervisors by aligning assessment ratings with everyday clinical supervisory decisions. ⋯ Possible explanations of divergent ratings included one party being unaware of a vital aspect of the performance and different interpretations of the prospective nature of the scale. The substantial concordance between trainee and supervisor ratings supports the contention that the entrustment scale helped produce a shared understanding of the desired performance standard. Discussion between trainees and supervisors on the reasoning underlying their respective judgements would provide further opportunities to enhance this shared understanding.
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Anaesth Intensive Care · Apr 2024
Two sides to every story: Reappraising the early history of liver transplantation at Addenbrooke's Hospital, Cambridge.
Over the course of the past six decades, liver transplantation has evolved to become the treatment of choice for chronic end-stage liver disease and some cases of acute hepatic failure. Currently, more than 34,000 liver transplants are conducted worldwide per annum, and overall one year survival rates exceed 90%. However, the early years of human liver transplantation were beset by failure. ⋯ This article outlines the results of research aimed at critically appraising this postscript. In doing so a number of unexpected discoveries were made. These highlight some important lessons for medical historians and demonstrate that if you look hard enough, there really are two sides to every story.
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Anaesth Intensive Care · Apr 2024
'On the inhalation of the vapour of Æther, with cases': The first paper on anaesthesia read before a medical society in Australia.
On 7 September 1847, in Melbourne in the Port Phillip District of the Colony of New South Wales, David John Thomas (1813-1871) presented a paper, 'On the inhalation of the vapour of Æther, with cases', at an ordinary monthly meeting of the Port Phillip Medical Association. This is the earliest known presentation of a paper on etherisation in Australia. ⋯ The handwritten manuscript is now preserved in the Medical History Museum, University of Melbourne, Melbourne, Victoria. A transcript of the complete manuscript is now recorded with relevant historical notes.