Anaesthesia and intensive care
-
Anaesth Intensive Care · Nov 2020
Clinical TrialBlind intubation through an i-gel® in the prone position: A prospective cohort study.
Accidental extubation in the prone position is a medical emergency in which quick and low resource demanding airway management is required. Regaining oxygenation is the primary goal, but sometimes intubation may be required to regain oxygenation. Blind intubation through an i-gel® (Intersurgical Ltd, Wokingham, Berkshire, UK) may be a quick and low resource demanding method. ⋯ Overall, the success rate was 36%. Blind intubation using an i-gel as an intubation conduit in the prone position is not recommended. Netherlands Trial Register number NL6387 (NTR7659).
-
Anaesth Intensive Care · Nov 2020
ReviewDifficult and failed intubation in the first 4000 incidents reported on webAIRS.
A review of the first 4000 reports to the webAIRS anaesthesia incident reporting database was performed to analyse cases reported as difficult or failed intubation. Patient, task, caregiver and system factors were evaluated. Among the 4000 reports, there were 170 incidents of difficult or failed intubation. ⋯ However, 12% suffered moderate harm, 3.5% severe harm and there were three deaths (although only one related to the airway incident). Despite advances and significant developments in airway management strategies, difficult and failed intubation still occurs. Although not all incidents are predictable, nor are all preventable, the information provided by this analysis might assist with future planning, preparation and management of difficult intubation.
-
Anaesth Intensive Care · Nov 2020
Postoperative use of slow-release opioids: The impact of the Australian and New Zealand College of Anaesthetists/Faculty of Pain Medicine position statement on clinical practice.
Dose titration with immediate-release opioids is currently recommended for acute pain. The Australian and New Zealand College of Anaesthetists and the Faculty of Pain Medicine released a statement in March 2018 supporting their use in the treatment of opioid-naïve patients; however, the impact of this statement on clinical practice is currently unknown. This retrospective cohort study was conducted to compare opioid prescribing patterns before and after the release of the recommendations. ⋯ After adjusting for confounders, the odds of slow-release opioids being prescribed postoperatively and at discharge reduced by 86% and 88%, respectively (postoperative period: odds ratio 0.14, P < 0.05; discharge: odds ratio 0.12, P < 0.05). In addition, orthopaedic patients were more likely to receive slow-release opioids, consistent with existing literature. As the use of slow-release opioids has been associated with increased harm and protracted opioid use compared to immediate-release opioids, it is hoped that wider dissemination of these recommendations and a change in prescribing practice can be a step towards overcoming the opioid crisis.
-
Anaesth Intensive Care · Nov 2020
The gap between attitudes and processes related to 'family-friendly' practices in anaesthesia training in New Zealand: A survey of anaesthesia supervisors of training and departmental directors.
Gender inequity persists within the anaesthetic workforce, despite approaching numerical parity in Australia and New Zealand. There is evidence, from anaesthesia and the wider health workforce, that domestic gender norms regarding parental responsibilities contribute to this. The creation of 'family-friendly' workplaces may be useful in driving change, a concept reflected in the gender equity action plan developed by the Australian and New Zealand College of Anaesthetists. ⋯ Several barriers contributing to this discrepancy were identified, including workforce logistics, governance, departmental structures and attitudes. Uncertainty in responses regarding aspects of working hours, parental leave and the use of domestic sick leave reflect gaps in understanding, with scope for further enquiry and education. To redress gender bias seriously through the development of family-friendly policies and practices requires supportive governance and logistics, along with some cultural change.