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Latest & greatest articles for anaesthesia
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Clinical Anaesthesia is used to induce a temporary medical state of controlled unconsciousness, inducing a loss of sensation or awareness. There are three main types of Anaesthesia:
Local and Regional
Anaesthesia is primarily used during surgical procedures to block pain. While unconscious, blood flow and heart rate is monitored.
Research and development in the use of Anaesthesia has helped anesthesiologists in the progression of patient safety before and after surgery and medical procedures. The developments and research of Anaesthesia through the years has massively influences medicine and surgery today.
Case studies and clinical trials help aid researchers in the development of aftercare during postoperative recovery. Research is a vital part in the field of Anaesthesia, it allows anesthesiologists to improve the delivery of patient safety while unconscious.
Learn more on the emerging technology in Anaesthesia and the advancements in Anaesthesia practise by searching Trip.
Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery. Brain tumour surgery usually is carried out with the patient under general anaesthesia. Over past years, both intravenous and inhalational anaesthetic agents have been used, but the superiority of one agent over the other is a topic of ongoing debate. Early and rapid emergence from anaesthesia is desirable for most neurosurgical patients. With the availability of newer (...) intravenous and inhalational anaesthetic agents, all of which have inherent advantages and disadvantages, we remain uncertain as to which technique may result in more rapid early recovery from anaesthesia.To assess the effects of intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery.We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 6) in The Cochrane Library, MEDLINE via Ovid SP (1966 to June 2014
[Single Subcutaneous Palmar Injection vs. 2 Dorsal Injections for Finger Anaesthesia in Hand Surgery - Randomised Prospective Comparison of Application Pain and Efficacy]. This randomised prospective study compared pain during application and efficacy of the palmar subcutaneous single injection block (PSSIB) and the traditional dorsal 2 injection block (DTIB).During a 2 year period, a total of 190 patients with an average age of 43 years (18-82) and an isolated finger injury were included
Change in children's oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review. Dental caries has significant impact on children and their families and may necessitate treatment under general anaesthesia (GA). The use of oral health-related quality-of-life (OHRQoL) measures enables evaluation of dental treatment from a patient's perspective.This systematic review aimed to assess change in OHRQoL in children
Nitrous oxide-based versus nitrous oxide-free general anaesthesia and accidental awareness during general anaesthesia in surgical patients. Accidental awareness during general anaesthesia (AAGA) is when a patient unintentionally becomes conscious during a procedure performed with general anaesthesia and subsequently has explicit recall of this event. Incidence estimates for AAGA vary, with the most common estimate being one to two cases per 1000 general anaesthetics. Evidence linking nitrous (...) oxide use and an increased risk of AAGA has come from observational studies data but the literature is contradictory, with some studies finding a protective effect of nitrous oxide.To assess the effect of general anaesthesia including nitrous oxide on the risk of AAGA in patients aged five years and over.We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and trial registers ((www.clinicaltrials.gov), the WHO International Clinical Trials
Effect of regional versus local anaesthesia on outcome after arteriovenous fistula creation: a randomised controlled trial. Arteriovenous fistulae are the optimum form of vascular access in end-stage renal failure. However, they have a high early failure rate. Regional compared with local anaesthesia results in greater vasodilatation and increases short-term blood flow. This study investigated whether regional compared with local anaesthesia improved medium-term arteriovenous fistula (...) patency.This observer-blinded, randomised controlled trial was done at three university hospitals in Glasgow, UK. Adults undergoing primary radiocephalic or brachiocephalic arteriovenous fistula creation were randomly assigned (1:1; in blocks of eight) using a computer-generated allocation system to receive either local anaesthesia (0·5% L-bupivacaine and 1% lidocaine injected subcutaneously) or regional (brachial plexus block [BPB]) anaesthesia (0·5% L-bupivacaine and 1·5% lidocaine with epinephrine
2016LancetControlled trial quality: predicted high
Depth of anaesthesia monitoring during procedural sedation and analgesia: A systematic review and meta-analysis Processed electroencephalogram-based depth of anaesthesia monitoring devices provide an additional method to monitor level of consciousness during procedural sedation and analgesia. The objective of this systematic review was to determine whether using a depth of anaesthesia monitoring device improves the safety and efficacy of sedation.Systematic review and meta-analysis.Electronic (...) databases (CENTRAL; Medline; CINAHL) were searched up to May 2015.Randomised controlled trials that compared use of a depth of anaesthesia monitoring device to a control group who received standard monitoring during procedural sedation and analgesia were included. Study selection, data extraction and risk of bias assessment (Cochrane risk of bias tool) were performed by two reviewers. Safety outcomes were hypoxaemia, hypotension and adverse events. Efficacy outcomes were amount of sedation used
High initial concentration versus low initial concentration sevoflurane for inhalational induction of anaesthesia. Sevoflurane induction for general anaesthesia has been reported to be safe, reliable and well accepted by patients. Sevoflurane induction uses either low or high initial concentrations. The low initial concentration technique involves initially administering a low concentration of sevoflurane and gradually increasing the concentration of the dose until the patient is anaesthetized (...) . The high initial concentration technique involves administering high concentrations from the beginning, then continuing with those high doses until the patient is anaesthetized. This review was originally published in 2013 and has been updated in 2016.We aimed to compare induction times and complication rates between high and low initial concentration sevoflurane anaesthetic induction techniques in adults and children who received inhalational induction for general anaesthesia. We defined 'high
Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. In a review and meta-analysis conducted in 1993, psychological preparation was found to be beneficial for a range of outcome variables including pain, behavioural recovery, length of stay and negative affect. Since this review, more detailed bibliographic searching has become possible, additional studies testing psychological preparation for surgery have been completed and hospital (...) randomized controlled trials of adult participants (aged 16 or older) undergoing elective surgery under general anaesthesia. We excluded studies focusing on patient groups with clinically diagnosed psychological morbidity. We did not limit the search by language or publication status. We included studies testing a preoperative psychological intervention that included at least one of these seven techniques: procedural information; sensory information; behavioural instruction; cognitive intervention
Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. People with a low platelet count (thrombocytopenia) often require lumbar punctures or an epidural anaesthetic. Lumbar punctures can be diagnostic (haematological malignancies, epidural haematoma, meningitis) or therapeutic (spinal anaesthetic, administration of chemotherapy). Epidural catheters are placed for administration of epidural anaesthetic (...) . Current practice in many countries is to correct thrombocytopenia with platelet transfusions prior to lumbar punctures and epidural anaesthesia, in order to mitigate the risk of serious procedure-related bleeding. However, the platelet count threshold recommended prior to these procedures varies significantly from country to country. This indicates significant uncertainty among clinicians of the correct management of these patients. The risk of bleeding appears to be low but if bleeding occurs it can
Supplemental oxygen for caesarean section during regional anaesthesia. Supplementary oxygen is routinely administered to low-risk pregnant women during an elective caesarean section under regional anaesthesia; however, maternal and foetal outcomes have not been well established. This is an update of a review first published in 2013.The primary objective was to determine whether supplementary oxygen given to low-risk term pregnant women undergoing elective caesarean section under regional (...) anaesthesia can prevent maternal and neonatal desaturation. The secondary objective was to compare the mean values of maternal and neonatal blood gas levels between mothers who received supplementary oxygen and those who did not (control group).We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, issue 11), MEDLINE (1948 to November 2014) and EMBASE (1980 to November 2014). The original search was first performed in February 2012. We reran the search in CENTRAL, MEDLINE, EMBASE
Spectral entropy monitoring for adults and children undergoing general anaesthesia. Anaesthetic drugs during general anaesthesia are titrated according to sympathetic or somatic responses to surgical stimuli. It is now possible to measure depth of anaesthesia using electroencephalography (EEG). Entropy, an EEG-based monitor can be used to assess the depth of anaesthesia using a strip of electrodes applied to the forehead, and this can guide intraoperative anaesthetic drug administration.The (...) primary objective of this review was to assess the effectiveness of entropy monitoring in facilitating faster recovery from general anaesthesia. We also wanted to assess mortality at 24 hours, 30 days, and one year following general anaesthesia with entropy monitoring.The secondary objectives were to assess the effectiveness of the entropy monitor in: preventing postoperative recall of intraoperative events (awareness) following general anaesthesia; reducing the amount of anaesthetic drugs used
Anaesthesia for hip fracture surgery in adults. The majority of people with hip fracture are treated surgically, requiring anaesthesia.The main focus of this review is the comparison of regional versus general anaesthesia for hip (proximal femoral) fracture repair in adults. We did not consider supplementary regional blocks in this review as they have been studied in another review.We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2014, Issue 3 (...) ), MEDLINE (Ovid SP, 2003 to March 2014) and EMBASE (Ovid SP, 2003 to March 2014).We included randomized trials comparing different methods of anaesthesia for hip fracture surgery in adults. The primary focus of this review was the comparison of regional anaesthesia versus general anaesthesia. The use of nerve blocks preoperatively or in conjunction with general anaesthesia is evaluated in another review. The main outcomes were mortality, pneumonia, myocardial infarction, cerebrovascular accident, acute
Guidelines on Quality Assurance and Quality Improvement in Anaesthesia Background Paper PS58 BP 2018 Page 1 PS58 BP 2018 Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines on Quality Assurance and Quality Improvement in Anaesthesia Background Paper 1. INTRODUCTION This document, previously TE09, was reprinted in 2012 as PS58; however, it was not reviewed at that time. With rising community expectations as well as the emphasis of continuing professional development (CPD (...) healthcare are encapsulated in the acronym STEEEP TM (Safety, Timeliness, Efficiency, Efficacy, Equitability, Patient-centredness). 2. PURPOSE The pursuit of QA and QI is desirable and strongly encouraged. It is an integral part of ANZCA’s Mission. Given the differing environments and clinical practices of fellows the intention of the accompanying guidelines is to inform fellows and to facilitate them achieving the highest level of quality care in anaesthesia, perioperative medicine, and pain medicine. 3
Guidelines on Quality Assurance and Quality Improvement in Anaesthesia PS58 2018 Page 1 PS58 2018 Guidelines on Quality Assurance and Quality Improvement in Anaesthesia 1. PURPOSE The aim of these guidelines is to assist practitioners in achieving the highest quality of care for their patients through an understanding of Quality Assurance (QA) and Quality Improvement (QI). 2. INTRODUCTION 2.1. It is incumbent upon Fellows at an individual, departmental and institutional level to contribute (...) responsibility for all clinicians. Compliance with the College’s CPD standard is mandated by the Medical Board of Australia for all registered specialist anaesthetists and specialist pain medicine physicians practising in Australia, and participation in the program is mandated by the Medical Council of New Zealand for vocationally registered anaesthetists and pain medicine physicians practising in New Zealand. 2.7. Research underpins the scientific advances that progress anaesthesia, pain management
Guidelines on Pre-Anaesthesia Consultation and Patient Preparation Background Paper PS07 BP 2016 Page 1 PS07 BP 2016 Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines on Pre-Anaesthesia Consultation and Patient Preparation Background Paper PURPOSE OF REVIEW PS07 Recommendations for Pre-Anaesthesia Consultation and Patient Preperation was last reviewed in 2008. The document review has incorporated the following events: ? Updating the format to align with the other ANZCA (...) for the Development and Review of Professional Documents which describes the current categories of professional documents: “Guidelines” offer advice on clinical and non-clinical aspects of the practice of anaesthesia and perioperative medicine, reflecting expert consensus and supported by other evidence when available. “Policies” deal with matters within the authority and control of the College. “Statements” define the position of the College on certain matters. 1.2. Since 2008 (last PS07 review) a number of new
Regional versus general anaesthesia for improved cognitive function after procedures other than cardiac surgery or neurosurgery in adult and paediatric patients. This is the protocol for a review and there is no abstract. The objectives are as follows: The objective of this review is to compare the effects of regional versus general anaesthesia on cognitive function after procedures other than cardiac surgery or neurosurgery in adult and in paediatric patients.
Guidelines on Pre-Anaesthesia Consultation and Patient Preparation PS07 2016 Page 1 PS07 2016 Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines on Pre-Anaesthesia Consultation and Patient Preparation 1. INTRODUCTION Adequate pre-anaesthesia consultation has been identified as an important factor in patient safety. The terms “pre-anaesthesia consultation” and “anaesthesia” in this document refer not only to situations pertinent to the administration of general anaesthesia (...) but also includes those related to regional anaesthesia/analgesia and sedation. Consultation with a patient prior to anaesthesia by an anaesthetist or a medical practitioner whose scope of practice includes anaesthesia is essential (see PS57 Statement on the Duties of an Anaesthetist, PS59 Statement on Roles in Anaesthesia and Perioperative Care, and Good Medical Practice: A Code of Conduct for Doctors in Australia 1 ). “Consultation” differs from “assessment” in that an assessment (medical or nursing
Use of platelet transfusions prior to lumbar punctures or epidural anaesthesia for the prevention of complications in people with thrombocytopenia. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of different platelet transfusion thresholds prior to the insertion of a lumbar puncture or epidural anaesthesia in people with thrombocytopenia (low platelet count).
Sedation versus general anaesthesia for provision of dental treatment to patients younger than 18 years. A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed by the use of a general anaesthetic in children; however, use of sedation may lead to reduced morbidity and cost. The aim of this review was to compare the efficiency of sedation versus (...) general anaesthesia (GA) for provision of dental treatment to children and adolescents younger than 18 years. This review was originally published in 2009 and was updated in 2012 and again in 2015.We will evaluate morbidity and effectiveness of sedation versus GA for provision of dental treatment to patients younger than 18 years. If data become available, we will analyse the cost-effectiveness of different interventions. If data are not available, we will obtain crude estimates of cost.Morbidity can
Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomised clinical trial. The purpose of this study was to compare the use of a traditional syringe (TS) and the DentalVibe (DV) Injection Comfort System on the pain of needle insertion and injection of supraperiosteal (SP) anaesthesia into the mandibles and maxillas of children aged 6-12 years.The study was a randomised, controlled, crossover clinical trial (...) , comprising 60 children requiring an operative procedure with SP anaesthesia on both their mandibular and maxillary molars, bilaterally. One of the molars was treated with a TS, and the contralateral tooth was treated with the DV for both arches. On each visit, subjective and objective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Face, Leg, Activity, Cry, Consolability Scale. Patients were asked which technique they preferred. The data were analysed using Wilcoxon signed-rank