Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 2025
Experiences of Australian anaesthetists and anaesthetic trainees of working whilst pregnant: Results of a national survey.
Changing medical workforce demographics emphasise the need to understand and effectively manage pregnancy in the workplace. An Australian survey exploring pregnancy experiences of specialists and trainees working in anaesthesia received 242 responses describing 549 pregnancies. One hundred and sixty-two (67%) of these respondents were aged 31-40 years, 185 (76%) were specialists and 159 (66%) reported one or two pregnancies. ⋯ Overall, 171 (71%) of respondents were satisfied with their experience of working in anaesthesia whilst pregnant. Thematic analysis of free text comments identified three major themes: workplace culture, maternal and fetal wellbeing, and career impacts on both pregnancy and family planning. Development of multilevel mechanisms to guide and support pregnant trainees and specialists in anaesthesia is recommended to address these findings.
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Anaesth Intensive Care · Feb 2025
Perioperative anaphylaxis in Malaysia: A nine-year retrospective study.
Diagnosis of perioperative anaphylaxis (POA) and identification of causative agents remain challenging. This study aimed to describe the estimated incidence, characteristics and causative agents of POA in Malaysia. This is a retrospective review of all cases of suspected POA referred to the only anaesthetic allergy centre in Malaysia from March 2014 to December 2022. ⋯ For antibiotics, the commonest causative agents were cefuroxime, ceftriaxone and amoxicillin/clavulanic acid. Using these data, the estimated incidence of Grades 2-4 POA over this period in Malaysia was approximately 1 in 30,000 anaesthetics. However, owing to the voluntary nature of reporting, it is possible that this is an underestimate, particularly in relation to some milder Grade 2 cases which may have gone unrecognised or unreported.
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Anaesth Intensive Care · Feb 2025
The elective use of percutaneous transtracheal oxygen insufflation for laryngeal surgery in a patient with a known difficult airway.
We report the case of successful elective percutaneous transtracheal oxygen insufflation in a patient with high-grade laryngeal stenosis, requiring repeat surgical laryngeal dilation, in the setting of multiple previous failed attempts at intubation and ventilation. This case report highlights the role of this technique as an initial management plan to provide general anaesthesia in a safe and simple way to patients with a known difficult airway. We also describe the use of an intravenous extension kit which allowed end-tidal carbon dioxide to be measured during transtracheal oxygen insufflation.
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Anaesth Intensive Care · Jan 2025
The Bruck inhaler: An ether inhaler misattributed to Ludwig Bruck, an Australian medical publisher and supplier of medical equipment.
The acquisition of an early ether inhaler stimulated research into several inhalers classified as Bruck inhalers. Ludwig Hermann Bruck was a German migrant who arrived in Australia in 1873. He became a medical publisher, importer of medical instruments, and made unique contributions to early Australian medical publishing, most significantly as the first publisher of The Australasian Medical Gazette. ⋯ Bruck committed suicide in August 1915 before the case was heard in court. We did not find any evidence that Bruck designed the inhaler later attributed to him. The Bruck inhaler is functionally similar to the Probyn-Williams inhaler and should therefore be regarded as a glass-domed version of this inhaler.
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Anaesth Intensive Care · Jan 2025
Effects of polymyxin B haemoperfusion on septic shock caused by Gram-positive bacteria.
Polymyxin B haemoperfusion is commonly used to adsorb endotoxins in septic shock caused by Gram-negative bacterial infections. Polymyxin B haemoperfusion has been reported to improve hypotension in Gram-positive bacterial infections; however, its efficacy and mechanism in treating such cases are unclear. We hypothesised that polymyxin B haemoperfusion would be equally effective in improving haemodynamics during Gram-positive bacterial infections as in Gram-negative bacterial infections. ⋯ Although there was no significant difference in the VIS in polymyxin B haemoperfusion between patients with GNR and GPC infections, there was a significant decrease in the VIS over time, even when GPC was the causative organism. In addition, the degree of reduction in the VIS was significantly different in both the GNR and GPC groups compared with that in the non-extracorporeally treated group. Thus, polymyxin B haemoperfusion for septic shock caused by GNR reduced the VIS and could be effective even in cases of GPC infection.