Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2020
Review Case ReportsAnaphylaxis to intravenous paracetamol containing povidone. A case report and narrative review of excipient allergy related to anaesthesia.
Investigation of intraoperative anaphylaxis includes the exclusion of potential trigger agents the individual was exposed to within a plausible interval preceding the reaction. Occasionally, none of these agents will test positive. In this situation it is important to consider that excipients may be responsible for anaphylaxis, that the dilutions prepared to test the medication may not contain an appropriate concentration of the excipient to induce a positive skin reaction, or if an alternative formulation of the medication is tested, it may not contain the culprit excipient. ⋯ Different brands of the same drug may contain different excipients. When testing for anaphylaxis with such compounds one must be sure the dilution is appropriate for both the parent compound and the excipient to ensure the accuracy of skin-prick and intradermal testing. This case demonstrates the potential for excipients to cause severe allergy and the importance of detailed history pertaining to previous allergic episodes as even the most unlikely of medications can potentially result in anaphylaxis due to excipients.
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Anaesth Intensive Care · Sep 2020
Smartphone use and perceptions of their benefit and detriment within Australian anaesthetic practice.
The primary aim of this study was to evaluate the perceptions of Australian anaesthetists in relation to smartphone use within anaesthetic practice. In particular, we aimed to assess the frequency of smartphone use, the types and number of smartphone applications used, how reliant anaesthetists perceive themselves to be on smartphones and whether they perceive them to be a factor that aids or distracts from their practice. Secondly, we assessed whether there is an association between the type, frequency, reliance and perceptions of smartphone use and the years of experience as an anaesthetist. ⋯ This phenomenon was particularly apparent in those who had been a consultant anaesthetist for less than three years. Furthermore, those who had been a consultant anaesthetist for less than three years were more likely to have more smartphone apps relating to anaesthetics, use them more often and rely on them to a greater degree. Our results highlight the ubiquitous and perceived useful nature of smartphones in anaesthetic practice.
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Anaesth Intensive Care · Sep 2020
A prospective six-month audit of airway incidents during anaesthesia in twelve tertiary level hospitals across Australia and New Zealand.
This audit of airway incidents was conducted over six months in 12 tertiary level hospitals across Australia and New Zealand. During that time, 131,233 patients had airway management and 111 reports were submitted (incidence 0.08%). The airway incidents included a combination of difficult airway management (83), oxygen desaturation (58), aspiration (19), regurgitation (14), laryngospasm (16), airway bleeding (10), bronchospasm (5) and dental injury (4), which gave a total of 209 events in 111 reports. ⋯ Sedation and monitored anaesthesia care were associated with lower RRs (RR 0.49 and RR 0.73 versus GA, respectively). Inadequate airway assessment, poor judgement and poor planning appeared to be contributors to these events. Future teaching and research should focus on these areas to further improve airway management and patient safety.
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Anaesth Intensive Care · Sep 2020
Observational StudyEfficacy of height-based formula to predict insertion depth of left-sided double lumen tube: A prospective observational study.
The insertion depth of the left-sided double-lumen tube needs careful positioning and bronchoscopic confirmation. Several formulae based on body height have been used for estimating the optimal insertion depth of a left-sided double-lumen tube. We conducted this prospective study to test the hypothesis that our earlier developed height-based formula (0.25 × body height0.916) could predict the accurate insertion depth of a left-sided double-lumen tube. ⋯ The left-sided double-lumen tube was withdrawn or advanced in 18.2% and 12.1%, respectively, to achieve the optimal insertion depth. We found that our formula provided satisfactory positioning in about 70% of patients and that in the remaining patients, the adjustments required to achieve satisfactory positioning under fibreoptic bronchoscope guidance were minimal. Nevertheless, as it is not possible to predict which patients will have a satisfactory tube position, bronchoscopic confirmation for the final positioning is still required.
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Anaesth Intensive Care · Sep 2020
Surgical prehabilitation using mobile health coaching in patients with obesity: A pilot study.
Many patients spend months waiting for elective procedures, and many have significant modifiable risk factors that could contribute to an increased risk of perioperative morbidity and mortality. The minimal direct contact that usually occurs with healthcare professionals during this period represents a missed opportunity to improve patient health and surgical outcomes. Patients with obesity comprise a large proportion of the surgical workload but are under-represented in prehabilitation studies. ⋯ The cost was A$1.20 per patient per month. Our study showed improvement in some of the risk factors for perioperative morbidity and mortality. With improved methods to increase enrolment, our overall impression is that text message-based mobile health prehabilitation may be a feasible, cost-effective and worthwhile intervention for patients with obesity.