Anaesthesia and intensive care
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Anaesth Intensive Care · Sep 2021
ReviewHistory of non-physician anaesthesia providers in Papua New Guinea: from heil tultuls to Anaesthetic Scientific Officers.
The most recent estimates, published in 2016, have indicated that around 70% of anaesthesia providers in Papua New Guinea are non-physician anaesthetic providers and that they administer over 90% of anaesthetics, with a significant number unsupervised by a physician anaesthetist. Papua New Guinea has a physician anaesthetist ratio estimated to be 0.25 per 100,000 population, while Australia and New Zealand have a ratio of 19 physician anaesthetists per 100,000, which is 75 times that of Papua New Guinea. To reach a ratio of seven per 100,000, recommended as the minimum acceptable by the Lancet Commission in 2016, there will need to be over 35 practitioners trained per annum until 2030, at a time when the average annual numbers of recent years are less than three physicians and less than five non-physician anaesthetic providers. We review the development of anaesthesia administered by non-physician indigenous staff and the stages of development from heil tultuls, dokta bois, liklik doktas, native medical assistants, aid post orderlies, and Anaesthetic Technical Officers up to the current Anaesthetic Scientific Officers having attained the Diploma in Anaesthetic Science from the University of Papua New Guinea.
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Anaesth Intensive Care · Sep 2021
ReviewHepatitis C virus infection and anaesthesia practice: A narrative review.
This paper reviews the natural and treated history of hepatitis C virus infection, the interactions between current therapies and anaesthesia medications, and the implications of occupational exposure and infection to anaesthetists in light of significant changes in treatment. In the past decade, the introduction of new direct acting antiviral medications has seen high cure rates with a sustained viral response across all virus genotypes. These medications are well tolerated with minimal side-effects. ⋯ As anaesthetists may practise exposure-prone procedures, regular screening for hepatitis C virus infection remains recommended to enable both patient protection and treatment of the anaesthetist prior to the development of any long-term complications of hepatitis C virus infection. Similarly, early diagnosis and treatment of occupationally acquired hepatitis C virus infection after body fluid exposure is associated with high cure rates with minimal risk of long-term liver damage. Although hepatitis C virus infection remains a significant public health issue in Australia and New Zealand, improvements in outcomes as a result of new treatment regimens have allowed the World Health Organization to target the elimination of hepatitis C virus infection as a public health threat by 2030, and public health strategies are being implemented to achieve this goal.
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Anaesth Intensive Care · Sep 2021
ReviewPerioperative implications of newer generation drug-eluting coronary stents: A narrative review.
Newer generation drug-eluting stents are the most commonly inserted stent in the setting of percutaneous coronary intervention. This narrative review focuses on the evidence underpinning the perioperative management of patients with newer generation drug-eluting stents undergoing non-cardiac surgery. Six studies reported the incidence of major adverse cardiovascular events according to the time interval from percutaneous coronary intervention to non-cardiac surgery, and the comparative risks of newer and first generation drug-eluting stents. ⋯ However, the possibility of increased risk cannot be excluded as most studies were inadequately powered. The thrombotic risk is substantially reduced in patients with fourth (polymer free) generation drug-eluting stents, and urgent non-cardiac surgery can be considered one month after percutaneous coronary intervention. Larger multicentre studies are needed to define the optimal window for non-cardiac surgery after percutaneous coronary intervention and provide definitive perioperative strategies for patients presenting for non-cardiac surgery after the implantation of newer generation drug-eluting stents.
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Anaesth Intensive Care · Jul 2021
ReviewAirway management in the adult patient with COVID-19: High flow nasal oxygen or not? A summary of evidence and local expert opinion.
The use of high flow nasal oxygen in the care of COVID-19-positive adult patients remains an area of contention. Early guidelines have discouraged the use of high flow nasal oxygen therapy in this setting due to the risk of viral spread to healthcare workers. However, there is the need to balance the relative risks of increased aerosol generation and virus transmission to healthcare workers against the role high flow nasal oxygen has in reducing hypoxaemia when managing the airway in high-risk patients during intubation or sedation procedures. ⋯ However, given the limited safety data, we recommend a cautious approach. For intubation in the COVID-positive or suspected COVID-positive patient we support the use of high flow nasal oxygen to extend time to desaturation in the at-risk groups, which include the morbidly obese, those with predicted difficult airways and patients with significant hypoxaemia, ensuring well-fitted high flow nasal oxygen prongs with staff wearing full personal protective equipment. For sedation cases, we support the use of high flow nasal oxygen when there is an elevated risk of hypoxaemia (e.g. bariatric endoscopy or prone-positioned procedures), but recommend securing the airway with a cuffed endotracheal tube for the longer duration procedures when theatre staff remain in close proximity to the upper airway, or considering the use of a surgical mask to reduce the risk of exhaled particle dispersion.
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Anaesth Intensive Care · May 2021
ReviewApplications of 3D printing in critical care medicine: A scoping review.
Although a wide range of medical applications for three-dimensional printing technology have been recognised, little has been described about its utility in critical care medicine. The aim of this review was to identify three-dimensional printing applications related to critical care practice. A scoping review of the literature was conducted via a systematic search of three databases. ⋯ Several studies relating to the use of three-dimensional printing model simulations for spinal and neuraxial procedures reported a high degree of realism, including ultrasonography applications three-dimensional printing technologies. This scoping review identified several novel applications for three-dimensional printing in critical care medicine. Three-dimensional printing technologies have been under-utilised in critical care and provide opportunities for future research.