Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2018
Randomized Controlled Trial Comparative StudyA randomised controlled trial comparing fibreoptic-guided tracheal intubation through two supraglottic devices: Ambu® AuraGain™ laryngeal mask and LMA® Fastrach™.
The Ambu®AuraGain™ laryngeal mask (LM) (Ambu A/S, Ballerup, Denmark) is one of the few readily available second-generation supraglottic airway devices (SADs) that offer a conduit for fibreoptic-guided endotracheal intubation. We aimed to compare fibreoptic intubation through this device with the LMA® (laryngeal mask airway) Fastrach™ (Teleflex Medical, Co. Westmeath, Ireland), which has been a recommended dedicated rescue device for the management of the unanticipated difficult airway. ⋯ The AuraGain LM was also quicker to insert compared to the Fastrach LMA. Similar rates of minor complications, such as sore throat and dysphonia occurred in both groups. Our study indicates that when used in patients with complete muscle relaxation and no known airway pathology, the AuraGain LM achieves better laryngeal alignment and quicker, easier and more successful fibreoptic-guided ETT intubation than the Fastrach LMA.
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Anaesth Intensive Care · Sep 2018
ReviewNutritional prehabilitation: physiological basis and clinical evidence.
In this narrative review, we describe the physiological basis for nutritional prehabilitation and evaluate the clinical evidence for its current roles in the perioperative period. Surgical stress and fasting induce insulin resistance as a result of altered mitochondrial function. Insulin resistance in the perioperative period leads to increased morbidity in a dose-dependent fashion, while preoperative carbohydrate loading attenuates insulin resistance, minimises protein loss and improves postoperative muscle function. ⋯ Clinical studies evaluating nutritional interventions have been marred by conflicting data, which may be due to small sample sizes, as well as heterogeneity of patients and surgical procedures. At present, it is known that carbohydrate loading is safe and improves patients' wellbeing, but does not appear to influence length of hospital stay or rate of postoperative complications. This should be appreciated before its routine inclusion in ERAS programs.
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Anaesth Intensive Care · Sep 2018
Attitudes and self-reported end-of-life care of Australian and New Zealand intensive care doctors in the context of organ donation after circulatory death.
The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals' attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors' attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD donors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses collected between 29 April and 10 June 2016. ⋯ There was an association between organ donation professional education courses, familiarity with national guidelines and positive attitudes to certain attributes of attitude to DCD. Regression models demonstrated the attitude to DCD may predict intensive care doctors' palliative medication prescription rationales at the end of life of the DCD donor. Intensive care doctors in ANZ adopt a morally neutral attitude to DCD where they recognise the importance of organ donation, and support and conduct DCD as a part of good end-of-life care.
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Anaesth Intensive Care · Sep 2018
Comparative StudyInhalational versus propofol-based total intravenous anaesthesia: practice patterns and perspectives among Australasian anaesthetists.
Increasing evidence suggests that total intravenous anaesthesia (TIVA) may be the preferred anaesthetic for cancer resection surgery. To assist the preparation of a randomised controlled trial (RCT) examining Volatile (versus TIVA) Anaesthesia and Perioperative Outcomes Related to Cancer (VAPOR-C) we developed an 18-question electronic survey to investigate practice patterns and perspectives (emphasising indications, barriers, and impact on cancer outcomes) of TIVA versus inhalational general anaesthesia in Australasia. The survey was emailed to 1,000 (of 5,300 active Fellows) randomly selected Australian and New Zealand College of Anaesthetists (ANZCA) Fellows. ⋯ Anaesthetists are willing to use TIVA for indications where sufficient evidence supports a meaningful level of improvement in clinical outcome. The survey explores attitudes towards use of TIVA for cancer surgery and demonstrates equipoise in anaesthetists' opinions regarding this indication. The inconsistent use of TIVA in Australasia, minimal barriers to its use, and the equipoise in anaesthetists' opinions regarding the effect of TIVA versus inhalational anaesthesia on cancer outcomes support the need for a large prospective RCT.
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Anaesth Intensive Care · Sep 2018
Introduction of a mandatory pre-block safety checklist into a regional anaesthesia block room service: a quality improvement project.
Wrong-side block is an uncommon yet potentially preventable complication of regional anaesthesia. One strategy for reducing the incidence of wrong-side block is to introduce an additional check into the pre-block workflow in the form of a block 'time out' or 'stop before you block'. In the aftermath of a wrong-side block incident at our institution, the mandatory use of a pre-block safety checklist was successfully introduced into the workflow of the block room. ⋯ This was achieved without any negative effect on block efficacy, theatre efficiency, complication rates or patient satisfaction. The high rate of checklist utilisation was associated with an increased rate of ultrasound video documentation. This suggests that there may be collateral benefit to using a pre-block safety checklist in addition to merely reducing the risk of wrong-side block.