Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2017
Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists Perioperative Anaphylaxis Management Guidelines.
Anaphylaxis is an uncommon but important cause of serious morbidity and even mortality in the perioperative period. The Australian and New Zealand College of Anaesthetists (ANZCA) with the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) have developed clinical management guidelines that include six crisis management cards. The content of the guidelines and cards is based on published literature and other international guidelines for the management of anaesthesia-related and non-anaesthesia-related anaphylaxis. ⋯ These guidelines are intended to apply to anaphylaxis occurring only during the perioperative period. They are not intended to apply to anaphylaxis outside the setting of dedicated monitoring and management by an anaesthetist. In this paper guidelines will be presented along with a brief background to their development.
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Anaesth Intensive Care · Mar 2017
Randomized Controlled TrialValidation of a difficult endotracheal intubation simulator designed for use in anaesthesia training.
There is a need for a validated endotracheal intubation trainer that has variable difficulty settings for the training and assessment of medical practitioners. In this study three anatomical modifications were retrofitted to a commercial manikin and then validated. These modifications included restricted movements of the mandible as well as changes to the upper incisors. ⋯ The time for the novice and intermediate groups improved significantly by the fourth attempt, novice 15 seconds (CI 5.4, 24.6, P=0.002) and intermediate 10 seconds (CI 1.0, 19.0, P=0.03). Other aspects of validity were also satisfied during this study. A high degree of validity was established for these modifications, which can be retrofitted to an existing manikin and then used for teaching or assessment.
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Anaesth Intensive Care · Mar 2017
Review Case ReportsDelivery of anoxic gas mixtures in anaesthesia: case report and review of the struggle towards safer standards of care.
In 1983 a patient at The Alfred Hospital, Melbourne died during general anaesthesia for emergency surgery, in the weeks following maintenance to the operating theatre gas supply. In the ensuing investigation, it was revealed that he had been given 100% nitrous oxide throughout the anaesthetic due to the inadvertent crossing of the nitrous oxide and oxygen pipelines during the repair work. In this article we review the published literature on the delivery of hypoxic and anoxic gas mixtures, and the associated morbidity and mortality. ⋯ We consider the risks to patient safety when technological advances outpaced the implementation of essential safety standards. We investigate the events that pushed the development of safer standards of anaesthetic practice and patient monitoring, which have contributed to modern day theatre practice. Finally, we consider the risks that still exist in the hospital environment, and the need for on-going vigilance.
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Anaesth Intensive Care · Mar 2017
Patient and procedural factors associated with an increased risk of harm or death in the first 4,000 incidents reported to webAIRS.
This report describes an analysis of patient and procedural factors associated with a higher proportion of harm or death versus no harm in the first 4,000 incidents reported to webAIRS. The report is supplementary to a previous cross-sectional report on the first 4,000 incidents reported to webAIRS. The aim of this analysis was to identify potential patient or procedural factors that are more common in incidents resulting in harm or death than in incidents with more benign outcomes. ⋯ In addition, the proportion of incidents associated with death was higher for incidents in which the patient's age was >80 years, the American Society of Anesthesiologists physical status was 4 or 5, incidents involving non-elective procedures, and incidents occurring after hours (1800 to 0800 hours). When faced with incidents with these potential risk factors, anaesthetists should consider earlier interventions and request assistance at an earlier stage. Educational strategies on incident prevention and management should place even further emphasis on scenarios involving these factors.
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Anaesth Intensive Care · Mar 2017
Survey of research capability at Australian and New Zealand College of Anaesthetists accredited training sites.
The Australian and New Zealand College of Anaesthetists (ANZCA) has more than 200 accredited training sites in Australia, New Zealand, Hong Kong, Malaysia and Singapore, many of which participate in ANZCA Clinical Trials Network (CTN)-endorsed clinical trials. We undertook a survey of accredited sites to determine research capability, activity and potential. With ethics committee approval an electronic survey was distributed to accredited sites in July 2015. ⋯ Fifty-eight (28%) of the 207 accredited sites were identified as participating in recent ANZCA CTN-endorsed clinical trials. Research capability and activity were higher in these sites. This survey has identified a strong base upon which to expand clinical trial activity, and regions, sectors, investigators and research coordinators who may benefit from additional support.