Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2021
Case ReportsAllergic contact dermatitis to a dye or alcohol in a chlorhexidine-based skin preparation: A case report.
This case report describes a patient who developed allergic contact dermatitis to a chlorhexidine skin preparation applied for a transversus abdominis plane block, but not to a different chlorhexidine solution applied to the surgical field. The patient had presented for an elective inguinal hernia repair. He had a known history of anaphylaxis to non-steroidal anti-inflammatory medication but was otherwise well. ⋯ The skin preparations differed in the dyes and alcohols that they contained. The dyes or alcohol in the preparation for the transversus abdominis plane block were therefore considered the likely cause of this patient's allergic reaction. Dyes and alcohols should be considered as a cause of skin allergy in the perioperative setting.
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Anaesth Intensive Care · Jan 2021
Perioperative anaphylaxis: A five-year review in a tertiary paediatric hospital.
Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. ⋯ Three patients (25.0%) had non-IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.
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Anaesth Intensive Care · Jan 2021
A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice.
We conducted a survey of Australian and New Zealand anaesthetists designed to quantify self-reported use of cricoid pressure (CP) in patients presumed to be at risk of gastric regurgitation, and to ascertain the underlying justifications used to support individual practice. We aimed to identify the perceived benefits and harms associated with the use of CP and to explore the potential impact of medicolegal concerns on clinical decision-making. We also sought to ascertain the views of Australian and New Zealand anaesthetists on whether recommendations relating to CP should be included in airway management guidelines. ⋯ When asked whether participants believed the use of CP reduces the risk of gastric regurgitation, 39.8% indicated yes, 23.8% believed no and 36.3% were unsure. Of the respondents who indicated that they routinely performed CP, 159/267 (60%) indicated that concerns over the potential medicolegal consequences of omitting CP in a patient who subsequently aspirates was one of the main reasons for using CP. The majority (224/337; 66%) of respondents believed that recommendations about the use of CP in airway management guidelines should include individual practitioner judgement, while only 55/337 (16%) respondents believed that routine CP should be advocated in contemporary emergency airway management guidelines.
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Anaesth Intensive Care · Jan 2021
Meta AnalysisSafety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis.
Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). ⋯ Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%-72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.