Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2024
Variations of nitrous oxide procurement per public hospital bed between Australian states and territories: A cross-sectional analysis.
We aimed to identify variations in nitrous oxide (N2O) procurement between Australian states and territories per public hospital bed by undertaking a cross-sectional analysis of N2O procurement data for all Australian public hospitals from 1 January 2017 to 30 June 2022. Data were obtained from state and territory departments of health. All Australian public hospitals across six states and two territories were included. ⋯ CO2e emissions from N2O purchase varied more than threefold per public hospital bed between different states/territories (0.47-1.48 CO2e tonnes per hospital bed). There were significant variations in N2O procurement between Australian states and territories when adjusted for public hospital bed numbers. Further analysis of this variation to determine cause and to guide mitigation interventions is therefore warranted.
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Anaesth Intensive Care · Sep 2024
ReviewRoutine cognitive screening for older people undergoing major elective surgery: Benefits, risks and costs.
Cognitive impairment and older age are major risk factors for postoperative delirium. Professional societies have advocated preoperative screening to identify at-risk individuals for implementation of interventions, which have moderate effectiveness in preventing delirium. However, it remains unclear from the guidelines whether screening should be completed routinely for all older individuals or targeted, and also which specific screening tool is preferred. ⋯ We also performed a cost-benefit analysis of routine screening (versus no screening). Furthermore, we summarised the sensitivities and specificities of commonly used screening tools and reviewed evolving screening tools that may have an increasing role in future practice. We concluded that routine screening is useful and appears to be cost-effective for reducing postoperative delirium, with a cost-benefit ratio of 2.89 (adjusted ratio of 2.34), and has additional advantages over other approaches such as targeted screening or routine intervention.