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A grim discontent with healthcare in many Western countries is intensifying, exposing cracks in a strained system.

The recent murder of a US health insurance CEO, along with the dark wave of public sympathy for the assailant, warns us that health system inequity and failure may culminate in extreme ways.

Australia faces its own challenges: escalating medical costs and burdened public and private hospitals, even as international healthcare corporations post record profits. The growing corporatisation of healthcare, driven by insurance companies and hospital conglomerates, is a concerning glimpse of one possible future for medical care. A significant portion of Australian healthcare funding now leaves our shores for these international corporations and their shareholders.

Yet media coverage presents an unbalanced narrative. While corporate healthcare profits receive measured reporting, medical practitioners face scrutiny and criticism, frequently without evidence. I wrote the piece below in response to a two-year media campaign suggesting widespread billing fraud among Australian doctors, particularly anaesthetists and surgeons. Much of this reporting revealed misunderstandings of the health system and medical billing while ignoring how such stories serve corporate healthcare interests, even as the same corporations encourage attacks on doctors from the sidelines.

I submitted this op-ed to several Australian media outlets, but it remains unpublished. I'm sharing it here to contribute to a balanced understanding of the role of medical professionals in Australian healthcare.

Read more...

Three interesting recent studies looking at specific choices around anaesthetic technique. In the Canadian Journal of Anesthesia, da Silveira reviews the benefits of opioid-free laparoscopic surgery; in the Journal of Cardiothoracic and Vascular Anesthesia, Ford goes deep on the pros and cons of different anaesthetic techniques for AF ablation procedures; and finally in the JCA, Liu reports on a single-centre RCT investigating the beneficial effects of LMAs on atelectasis.

Opioid-Free Laparoscopic Surgery: Less Nausea, Similar Pain Control

An interesting meta-analysis from da Silveira et al. explores whether we can effectively manage minimally invasive abdominal surgery without using opioids - an important question given how common opioid-related side effects are.

This was a comprehensive systematic review and meta-analysis of 26 randomised controlled trials, including 2,025 patients. The researchers specifically compared opioid-free versus opioid-containing anesthesia in minimally invasive abdominal surgeries. They were particularly interested in looking at side effects like PONV and bradycardia, as well as pain control and recovery times.

The results were quite interesting. The authors found that opioid-free anaesthesia:

• Reduced PONV by 45% (from 24% to 13% / RR CI 0.40 to 0.74).
• Led to slightly lower immediate postoperative pain scores (though not clinically significant).
• Required less postoperative opioid use in the first 2 hours.
• Showed no difference in recovery room length of stay.
• Showed no increase in bradycardia, a previously noted concern when using intraoperative dexmedetomidine.

Read more...

The British Cycling Revolution: A Lesson in Marginal Gains

When Dave Brailsford was appointed Performance Director of British Cycling in 2003, he inherited a program defined by failure. The national team hadn't won Olympic gold since 1908, and no British cyclist had ever claimed victory in the Tour de France's 110-year-long history. The 39-year-old cyclist-turned-performance consultant would transform British cycling and our approach to improvement through an unexpectedly simple philosophy: the aggregation of marginal gains.

Growing up in one of the few English families in North Wales, Brailsford developed a perpetual drive to prove himself. "Somehow I always felt I did not quite fit in," he reflected. "So I always thought I must try harder than the others to be accepted, to be successful." This outsider mentality would fuel his pursuit of excellence.

Read on for how marginal gains relate to anaesthesia...

Kindness is the foundation of positive human relationships. Kindness is also the foundation of quality anaesthesia, framing not just the goals of care but the paths we tread to reach them: kindness to our patients, kindness to one's team, and kindness to oneself. Kindness is the oxygen that sustains our practice.

"[Kindness is] helpfulness towards someone in need, not in return for anything, nor for the advantage of the helper himself, but for that of the person helped." – Aristotle, Book II of Rhetoric

Like many anaesthetists, I often fixate on outcomes. Yet, the journey usually matters as much for patients as the destination. While modern medicine makes successful outcomes the lowest bar, the hospital experience shapes the patient's entire perception of care, sometimes turning a medical success into a perceived failure. When we centre our practice on kindness, we elevate both process and outcome, giving them equal weight.

Read on for anaesthesia and kindness...

We are now two and a half years into the COVID pandemic, and just beginning to see yet another case surge with the arrival of the BA.5 Omicron sub-variant. The good news just keeps coming! 😉

Along with new variants, 30 months has also given us a lot of research and data. Metajournal alone has indexed almost 39,000 COVID-related publications relevant to anaesthesia, pain, critical care and emergency medicine.

Of course that's a crazy volume of research to manage, with a pretty low signal-to-noise ratio. Sifting through that for quality and relevant studies is exactly what metajournal was designed for.

Here's a quick round-up of interesting COVID-related research...

RAT tests & infectiousness

As good quality, locally validated RAT tests become increasingly available, we are also collecting more data showing they are a good indicator of individual infectiousness at the moment in time the test is performed.

The article collection 'Does a COVID RAT-negative result mean non-infectious?' explores several of these studies, suggesting that a negative RAT is likely a reliable indicator of being non-infectious.

The bottom line...

A correctly-performed adequately-validated RAT, is likely a sensitive indictor of individual infectiousness at that specific moment in time. The reliability of a negative RAT will be improved if using the same manufacturer and technique as a previously positive test, and more so if there are several subsequent negative RATs.

Return to exercise after COVID?

A recent J Sci Med Sport editorial (Hughes 2022) from Australian elite sport, exercise medicine and sports cardiology experts, provides reassuring encouragement when returning to exercise after COVID recovery.

Read on for more on exercise after COVID...