Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2024
Case ReportsIntraoperative 'pressure field' haemodynamic monitoring in a patient with severe aortic regurgitation having laparoscopic robot-assisted colorectal surgery.
Laparoscopic robot-assisted colorectal surgery can pose significant haemodynamic challenges for patients with severe aortic regurgitation. The increased afterload caused by pneumoperitoneum and aortic compression, along with concurrent factors like hypercarbia, Trendelenburg positioning and ventilatory impairment, can worsen aortic regurgitation, leading to myocardial ischaemia and heart failure. ⋯ Minimally invasive haemodynamic monitoring enabling real-time visualisation of a patient's 'pressure field' has been suggested as a potential adjunct or alternative to TOE, with the added advantage of providing continuous quantitative information about both stroke volume and the afterload to ventricular ejection in a single visualisation. We describe an example of successful concurrent use of pressure field haemodynamic monitoring and TOE in a patient with severe aortic regurgitation having a prolonged laparoscopic robot-assisted pelvic exenteration.
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Anaesth Intensive Care · Nov 2024
A comprehensive audit of difficult airway trolleys in selected Victorian hospitals.
This study aimed to assess the availability, design, and contents of difficult airway trolleys in hospitals in Victoria, Australia. A survey audit was conducted with a 92.3% reply rate, and the responses from 22 major Victorian hospitals were analysed. The results showed that difficult airway trolleys were available in 100% of operating theatres, emergency departments and intensive care units, and the rate of standardisation was high. ⋯ The carriage of non-essential items was reduced compared with earlier audits. However, there was heterogeneity in the brands of supraglottic airway devices, videolaryngoscopes and cognitive aids used. The study highlights the need for ongoing improvement to the organization and content of difficult airway trolleys, and for further discussion regarding the safety of equipment variation across institutions.
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Anaesth Intensive Care · Nov 2024
Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review.
Of the total carbon footprint of Australia, 7% is attributed to healthcare. In the UK, inhalational agents make up 5% of the healthcare carbon footprint. This systematic review aims to determine which methods of education about the environmental impact of inhalational anaesthetic agents can be utilised to promote behaviour change, reducing the anaesthetic-related carbon footprint. ⋯ The most common teaching techniques utilised in education curricula were didactic lectures (85%), visual prompts (54%), emails (46%), and conversation forums (31%). All but one study reported a positive relationship between teaching sessions and behavioural change resulting in lower inhalational anaesthetic use by participants and their organisations, reducing healthcare-associated emissions. This systematic review has demonstrated that single education sessions as well as multi-focused, multimodal education curricula on the topic of greener anaesthesia can be beneficial in promoting behavioural change.
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Anaesth Intensive Care · Nov 2024
Historical Article'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.
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Anaesth Intensive Care · Nov 2024
Historical ArticleTwo 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.