Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2016
Survey of anaesthetists' practice of sedation for gastrointestinal endoscopy.
We conducted a survey of Australian specialist anaesthetists about their practice of sedation for elective and emergency gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. A 24-item survey was emailed to 1,000 anaesthetists in August 2015. Responses were received from 409 anaesthetists (response rate=41%) with responses from 395 anaesthetists analysed. ⋯ Propofol was routinely administered by 99% of respondents for gastroscopy and 100% of respondents for ERCP and colonoscopy. A maximum depth of sedation in which patients were unresponsive to painful stimulation was targeted by the majority of respondents for all procedures except for elective gastroscopy. These results may be used to facilitate comparison of practice in Australia and overseas, and give an indication of compliance by Australian anaesthetists with the relevant Australian and New Zealand College of Anaesthetists guideline.
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Anaesth Intensive Care · Jul 2016
Feasibility and acceptability of remotely monitored pedometer-guided physical activity.
Nearly 70% of the Australian adult population are either sedentary, or have low levels of physical activity. There has been interest in addressing this problem by the 'mHealth', or mobile Health, arena, which is concerned with the confluence of mobile technology and health promotion. The newer generation of activity pedometers has the ability to automatically upload information, to enable aggregation and meta-data analysis of individual patient data. ⋯ Percentage of days reaching the target activity level of >10,000 steps/day varied markedly between participants from 4.5% to 95.7%. This study demonstrates the feasibility and acceptability of a remotely monitored pedometer-guided physical activity intervention. This technology may be useful to encourage increased exercise as a form of 'prehabilitation' of adequately screened at-risk surgical or obstetric patients.
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Anaesth Intensive Care · Jul 2016
A site check prior to regional anaesthesia to prevent wrong-sided blocks.
This paper describes the implementation of the 'Stop Before You Block' (SB4YB) initiative in an Australian teaching hospital. This process, which began in the UK in 2010, is a pre-procedure pause to confirm the correct side of a regional anaesthetic block. A change in practice was implemented with the formal roll out of a SB4YB educational program. ⋯ We propose that Stop Before You Block or a block time-out should be performed prior to all unilateral nerve blocks. Success of this initiative requires education, and both cultural and systems changes to occur. We propose that a formal block time-out should become part of the surgical safety checklist and this activity should be endorsed and promoted by anaesthetic professional bodies.
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Anaesth Intensive Care · Jul 2016
Historical ArticleAnaesthesia on the Western Front-perspectives a century later.
This year, 2016, marks the centenary of some of the worst battles of World War I. It is timely to reflect on the experiences of those who lived through those events, and the significant effects on the development of anaesthesia that occurred as a result. ⋯ The challenges of the Western Front, with its massive numbers of injured, saw progress in the understanding and management of trauma and shock, and significant improvement in the provision of anaesthesia and the training of anaesthesia providers. The result was increased anaesthetic safety for the civilian population after the war and further development of anaesthesia and resuscitation as a specialised area of medicine.
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Anaesth Intensive Care · Jul 2016
Biography Historical ArticleThe introduction of expired air resuscitation into Surf Life Saving Australia.
Surf Life Saving Australia, which began in the early 1900s, initially adopted the indirect resuscitation methods used by the Royal Life Saving Society. As new indirect methods became available, both organisations adapted their resuscitation techniques and followed international developments closely. In the 1950s, accumulating evidence suggested that direct methods of resuscitation, such as mouth-to-mouth ventilation, might be more efficacious. ⋯ Following the convention, Queensland Surf Life Saving conducted training sessions in cooperation with anaesthetists Roger Bennett and Tess Brophy (later Cramond), at St Andrew's Hospital in Brisbane. Two volunteers were anaesthetised and paralysed on two separate weekends to allow over one hundred people to gain experience in expired-air and bag-mask ventilation. One of the volunteers in these training exercises kindly provided much of the material that led to this paper, providing a first hand account of the experiments and an invaluable insight into the cooperation between anaesthetists and volunteer rescue associations.