Anaesthesia and intensive care
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Anaesth Intensive Care · Jan 2025
The effect of type of anaesthetic on delirium after surgery for acute hip fracture: An instrumental variable analysis to assess causation.
Delirium is the most common in-hospital complication affecting older adults with acute hip fractures. Current evidence demonstrates inconsistent associations between anaesthetic type for acute hip fracture surgery and postoperative delirium. Using the Australian and New Zealand Hip Fracture Registry database, we conducted a retrospective cohort study of patients aged 50 years and over who underwent acute hip fracture surgery between 2015 and 2020. ⋯ After adjusting for known confounders, general anaesthesia patients were at slightly increased odds of developing delirium (OR 1.14, 95% CI 1.04 to 1.25, P = 0.0052). However, the instrumental variable analysis found no statistically significant difference between groups (OR 1.03, 95% CI 0.99 to 1.07, P = 0.141). Therefore, while a weak association was found between general anaesthesia exposure and postoperative delirium, an instrumental variable analysis to compensate for unmeasured confounding showed no causal association between general anaesthesia and postoperative delirium.
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Anaesth Intensive Care · Jan 2025
A feasibility study of measuring maternal anaemia and postoperative outcomes after caesarean section.
SummaryIron-deficiency anaemia (IDA) is a global health problem. The impact of IDA on outcomes in obstetric patients who undergo caesarean section (CS) is unknown. We assessed the feasibility of conducting a large study to investigate perioperative anaemia and outcomes after CS. ⋯ The prevalence of participants discharged with IDA was unquantifiable. Postoperative IDA in obstetric patients is likely to be a serious problem that is currently unrecognised. Our data suggest that a definitive study to determine associations between maternal anaemia and perioperative outcomes after CS surgery is feasible.
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Anaesth Intensive Care · Jan 2025
Culprit allergen prevalence in polyreactive individuals reflects prescription trends: A tool for estimating comparative anaphylaxis risk using the example of neuromuscular blocking agents.
Prescription-event monitoring (PEM) is the current gold standard for determining the risk of rare drug side-effects and comparing the risk between agents; however, spontaneous or prompted reporting schemes have low case-detection rates and exposure may be difficult to estimate. A novel method is described that allows a comparative adverse event rate between two drugs to be estimated-based on patterns of cross-reactivity-requiring only a sample of cases and no direct knowledge of drug exposure rates. Agreement was compared between the novel method and historical estimates of risk using PEM for comparative risk of rocuronium versus vecuronium anaphylaxis. ⋯ The median risk from historical estimates was 4.7 times, while the previous PEM estimate in Western Australian was 3.0 times. Using a subgroup of patients susceptible to the same side-effect of two drugs, the relative exposure rate and corrected comparative risk of an adverse effect can be estimated for a population. Using this technique, which requires assessment only of cases to estimate relative exposure rates, we have estimated that the risk of anaphylaxis from rocuronium to be 2.2 times that of vecuronium in Western Australia.
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Anaesth Intensive Care · Jan 2025
Factors associated with poor intraoperative perfusion and postoperative complications in otolaryngological autologous tissue transfers: A single-centre retrospective observational study.
The purpose of this study was to identify haemodynamic factors that are associated with tissue hypoperfusion in flap/graft surgical patients that might be modified to reduce perioperative morbidity. We conducted a single-centre, retrospective, observational study of 1355 patients undergoing head and neck flap reconstructions. Logistic regression and chi-square analyses were employed to identify factors which signal perioperative complications. ⋯ Elevated max PPV was significantly associated with elevated lactate and AKI in univariate regression, but only AKI in the multivariate analysis (P = 0.003). Case duration was the only variable associated with take-back surgery in the multivariate regression (P = 0.007); it was also associated with lactic acidosis (P = 0.003). Neither IV fluid administration nor the use of vasopressors appeared to be associated with study outcomes in the multivariate analysis.
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Anaesth Intensive Care · Jan 2025
A cost analysis of the anaesthetic management of patients with confirmed or suspected coronavirus disease 2019 (COVID-19) in a tertiary referral hospital in Queensland, Australia.
The coronavirus disease 2019 (COVID-19) pandemic in Australia resulted in significant additional infection control precautions for consumers and the health workforce. Prior to widespread vaccine availability, substantial changes were made to the operating theatre management of patients presenting for surgery with suspected or diagnosed COVID-19. This study aimed to calculate the actual costs of operating theatre care for patients with confirmed or suspected COVID-19. ⋯ Twenty-four patients with suspected COVID-19 infection underwent surgery between May 2020 and February 2021. Cost analysis revealed a mean (standard deviation (SD), range) increase in costs of providing perioperative care for COVID-19 suspect patients of A$2252 (A$2570, A$315.85-10,398); that is, a mean of 207.5% more than usual care costs. This was primarily due to the increased number of staff and time required to complete these cases with appropriate infection control.