Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2024
Experiences and outcomes of patients participating in a perioperative shared decision-making pathway.
The Complex Decision Pathway (CDP) is a novel perioperative shared decision-making pathway that was established in the Bay of Plenty, New Zealand in 2018. Unique features of the pathway include the use of a structured communication tool to facilitate a goals-of-care conversation in addition to medical assessment, and the use of a tikanga Māori framework for Māori patients. From May 2019 until May 2022, 81 patients attending the CDP clinic were recruited to a prospective study of their demographics, health status and experience at the time of presentation, along with outcomes and opinions over the subsequent 12 months. ⋯ Participants who chose, or were recommended, not to undergo surgery were older, more comorbid and had worse outcomes over the subsequent 12 months. Qualitative data suggested an overall positive patient experience of the pathway, and an economic analysis demonstrated its cost-effectiveness. Overall, the data presented here suggested that the CDP assisted in risk-stratifying patients into operative and non-operative groups, provided a positive patient experience, and was a cost-effective intervention.
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Anaesth Intensive Care · Nov 2024
Case ReportsA case of cardiorespiratory collapse following bilateral sub-Tenon's blocks from brainstem anaesthesia.
Sub-Tenon's block has a superior safety profile and life-threatening complications such as cardiovascular collapse and brainstem anaesthesia are extremely rare. We report a case of cardiorespiratory collapse following bilateral sub-Tenon's blocks at the conclusion of a laser photocoagulation procedure under general anaesthesia. The cause was most likely brainstem anaesthesia. ⋯ It highlights the importance of maintaining vigilance following an eye block. Attention should not falter upon completing a block or at the conclusion of a case, regardless of its type or safety profile. This case also illustrates how the presence of general anaesthesia may obscure and delay the diagnosis of brainstem anaesthesia.
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Anaesth Intensive Care · Nov 2024
A comprehensive audit of difficult airway trolleys in selected Victorian hospitals.
This study aimed to assess the availability, design, and contents of difficult airway trolleys in hospitals in Victoria, Australia. A survey audit was conducted with a 92.3% reply rate, and the responses from 22 major Victorian hospitals were analysed. The results showed that difficult airway trolleys were available in 100% of operating theatres, emergency departments and intensive care units, and the rate of standardisation was high. ⋯ The carriage of non-essential items was reduced compared with earlier audits. However, there was heterogeneity in the brands of supraglottic airway devices, videolaryngoscopes and cognitive aids used. The study highlights the need for ongoing improvement to the organization and content of difficult airway trolleys, and for further discussion regarding the safety of equipment variation across institutions.
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Anaesth Intensive Care · Nov 2024
A cross-sectional study of the relationship between iron deficiency anaemia and chronic pain.
Iron deficiency and iron deficiency anaemia are frequently under-recognised in chronic conditions with non-specific symptoms, including fatigue. This study aimed to assess the prevalence of iron deficiency with or without anaemia in chronic pain patients, and the association between iron deficiency status, fatigue and health-related quality of life. Eighty-two patients attending chronic pain outpatient appointments were recruited into this cross-sectional study. ⋯ There was no significant association between iron deficiency status and the functional assessment of chronic illness therapy fatigue scale score or 36-item short form survey domain scores. There was a high prevalence of iron deficiency in this group of chronic pain patients, while the prevalence of iron deficiency anaemia was low. There was no statistically significant association found between iron deficiency status and fatigue or quality of life measures.
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Anaesth Intensive Care · Nov 2024
Maximising environmental sustainability on the return to in-person conferencing: Report from a 2500-person anaesthesia meeting in Sydney, Australia.
The COVID-19 pandemic disrupted medical conferences, where restrictions on public gatherings resulted in the postponement or cancellation of in-person meetings. Virtual events emerged as a substitute, providing a mechanism for scientific collaboration and continuing medical education with the additional benefit of low environmental impact. However, digital events may not meet all the needs of delegates, such as professional networking and social connection. ⋯ Post-event calculations assessed the conference as better than carbon-neutral; however, delegate travel was not included in the analysis and therefore this result is tempered. Off-site workshops including virtual offerings were also not included in the analysis. We encourage medical conference organisers to collaborate with all stakeholders to embed low carbon-generation choices for their meetings where education, networking and social needs are also met.