Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 2024
Simulated impact of lift car sizes on transport of critical care patients: Informing the design of the New Dunedin Hospital.
The New Dunedin Hospital (NDH) is New Zealand's largest health infrastructure build. Here we describe the use of a simple simulation-based hospital design exercise to inform the appropriate lift car size for critical care intrahospital transfers in the NDH. The intensive care unit (ICU) user group tested a series of entries and exits of simulated complex patient transfers in mocked-up lift cars of three different dimensions. ⋯ The resultant clinical recommendations for the dimensions of a critical care lift car surpass current international health architecture guidelines and may help to inform future updates. The NDH project benefited from an objective assessment of risk, in language familiar to clinicians and healthcare architects. The outcome was an upsizing of the two ICU-capable lifts.
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Anaesth Intensive Care · Apr 2024
Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists perioperative anaphylaxis management guideline 2022.
Perioperative anaphylaxis is a potentially life-threatening emergency that requires prompt recognition and institution of life-saving therapy. The Australian and New Zealand College of Anaesthetists and Australian and New Zealand Anaesthetic Allergy Group have partnered to develop the anaphylaxis management guideline along with crisis management cards that are recommended for use in suspected anaphylaxis in the perioperative setting. This is the third version of these guidelines with the second version having been published in 2016. This article contains the revised Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists perioperative anaphylaxis management guideline, with a brief review of the current evidence for the management of anaphylaxis in the perioperative environment.
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Anaesth Intensive Care · Mar 2024
A case series of the Royal Perth Hospital cannula-first approach in the 'can't intubate, can't oxygenate' scenario.
At the Royal Perth Hospital, we have been developing and teaching a can't intubate, can't oxygenate (CICO) rescue algorithm for over 19 years, based on live animal simulation. The algorithm involves a 'cannula-first' approach, with jet oxygenation and progression to scalpel techniques if required in a stepwise fashion. There is little reported experience of this approach to the CICO scenario in humans. ⋯ We recommend that institutions teach and practice this approach; we believe it is effective, safe and minimally invasive when undertaken by clinicians who have been trained in it and have immediate access to the requisite equipment. The equipment is low cost, comprising a 14G Insyte cannula, saline, 5 ml syringe and a Rapid-O2. Training can be provided using low-fidelity manikins or part-task trainers.
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Anaesth Intensive Care · Mar 2024
Case ReportsPercutaneous electrical nerve stimulation in post-mastectomy neuropathic pain: A case report.
Post-mastectomy pain syndrome (PMPS) is a type of chronic postsurgical pain that can be severe, debilitating and frequently encountered in clinical practice. Multiple studies have focused on prevention, identifying risk factors and treating this condition. Nonetheless, PMPS remains a complex condition to treat effectively. In this case report, we describe the use of percutaneous electrical nerve stimulation in a breast cancer patient who experienced PMPS refractory to conventional treatments.
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Anaesth Intensive Care · Mar 2024
ReviewRetinal artery occlusion after ophthalmic surgery under regional anaesthesia: A narrative review.
Two recent cases of central retinal artery occlusion under otherwise uncomplicated sub-Tenon's block that resulted in significant visual loss after cataract surgery prompted us to undertake a literature review of such cases. We identified 97 cases of retinal artery occlusion after ophthalmic surgery under regional anaesthesia that had no immediate signs of block-related complications. These occurred after various intraocular (87%) and extraocular (13%) operations, across a wide range of ages (19-89 years) on patients with (59%) or without (39%) known risk factors. ⋯ Various mechanisms were postulated; however, the cause was likely to be multifactorial due to patient, surgical and anaesthetic risk factors, especially in those with compromised retinal circulation. As there were no definite risk factors identified, no specific recommendations could be made to avoid this devastating outcome. We have provided rationales for some general considerations, which may reduce this risk, and propose anaesthetic options for ophthalmic surgery on the fellow eye if required, based both on our literature review and our personal experience.