Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2023
Triggers for medical emergency team activation after non-cardiac surgery.
Deterioration after major surgery is common, with many patients experiencing a medical emergency team (MET) activation. Understanding the triggers for MET calls may help design interventions to prevent deterioration. We aimed to identify triggers for MET activation in non-cardiac surgical patients. ⋯ Hypotension was the most common trigger for MET calls after non-cardiac surgery. Deterioration frequently occurred within 24 h of PACU discharge. Future research should focus on prevention of hypotension and tachycardia after surgery.
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Anaesth Intensive Care · Jul 2023
Prophylactic cannula cricothyroidotomy and percutaneous oxygen insufflation with the Rapid-O2®: A simple and effective tool for enhancing safety in difficult airway management.
Prophylactic cannula cricothyroidotomy is a recognised technique for actual or potential difficult airway management, where it confers a number of technical and non-technical benefits. Oxygenation with this technique is traditionally achieved by way of pressure-regulated, high flow jet ventilation and requires specialised equipment and considerable expertise for safe use, neither of which are always readily available. As an alternative, we describe the management of two patients with progressive upper airway obstruction in whom prophylactic cannula cricothyroidotomy and oxygen insufflation were performed using equipment which we consider is safer, widely available and already familiar to most anaesthetists throughout Australia.
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Anaesth Intensive Care · Jul 2023
Historical ArticleThe development of albumin solutions in the Second World War.
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Anaesth Intensive Care · May 2023
The goals of care framework and the perioperative period: A practical approach.
The goals of care (GOC) framework (2014) is an illness phase categorisation system that enables limitations of medical treatment (LOMT) to be documented and communicated within a healthcare system. It incorporates a clinical assessment of illness phase and GOC discussion on aims and LOMT for an episode of care. Together, this results in documentation of a GOC category that guides treatment escalation decisions during episodes of patient deterioration. ⋯ A historical tendency for automatic and unilateral suspension of limitations during surgery may be susceptible to ethical or medicolegal challenge. This article highlights the difference between the GOC framework and 'not for resuscitation' framework, considers the unique considerations of the perioperative period and addresses misconceptions of the GOC framework in patients undergoing surgery. Finally, it provides an approach to the GOC framework for patients considered for surgery by emphasising illness phase assessment and the need for the GOC category to accurately reflect the clinical situation throughout the perioperative period, guiding treatment escalation intraoperatively and postoperatively.