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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.
of 'medication errors' range from 1 in 20 administration events 1 , to 1 in 133 2 anaesthesia episodes. Many of these reported events were protocol or process errors (including mislabelling or omission of an appropriate drug), however a proportion of these errors will result in an adverse event for the patient. More than 3 million anaesthetics are administered in Australia and New Zealand annually suggesting a substantial contribution to iatrogenic adverse events. Anaesthetists must be aware (...) anaesthetics. 5.2.2 Anaesthesia drug drawers and workspace should be organised formally with attention to orderliness and the position of ampoules. Where possible drugs of the same class should be stored in adjacent compartments. Standardisation within each institution, and ideally, each region, is highly desirable. 5.2.3 Many drugs used in anaesthesia are hazardous if inadvertently administered. It is important to separate drugs which are potent, and less frequently used, often emergency drugs, from those
Guidelines on Return to Anaesthesia Practice for Anaesthetists PS50 2017 Page 1 PS50 2017 Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines on Return to Anaesthesia Practice for Anaesthetists 1. INTRODUCTION Anaesthesia is a high acuity specialty that requires the ability to make rapid and accurate clinical assessments, often concurrently with time-critical management decisions as well as undertake a range of technical skills. Performance of tasks at optimal levels depends (...) anaesthetists whose absence from clinical anaesthesia practice has been sufficient to warrant a formal return to practice program. Its purpose is to guide anaesthetists and those assisting them in developing, monitoring and successfully completing a return to practice program. The overall aim is to ensure that the returning anaesthetist provides safe and up-to-date care. Each individual anaesthetist has a responsibility to ensure that this is the case. 3. SCOPE This document applies to all anaesthetists
Statement on Staffing of Accredited Departments of Anaesthesia PS42 2017 Page 1 PS42 2017 Australian and New Zealand College of Anaesthetists (ANZCA) Statement on Staffing of Accredited Departments of Anaesthesia 1. INTRODUCTION 1.1 Purpose and scope The Australian and New Zealand College of Anaesthetists (ANZCA) recognises the important role of anaesthesia departments providing training within the ANZCA training program. This document is intended to apply to anaesthesia departments accredited (...) staff have adequate allocated time for professional development. Anaesthetists who contribute more heavily to teaching, training, research and administration will require more sessions for clinical support activities. 2.1.1 Director of anaesthesia The director has a primary managerial responsibility to ensure that the department functions safely and efficiently. The director of anaesthesia must be a registered medical practitioner who holds the fellowship of ANZCA, or suitable anaesthesia
on the Handover Responsibilities of the Anaesthetist PS55 Recommendations on Minimum Facilities for Safe Administration of Anaesthesia in Operating Suites and other Anaesthetising Locations ANZCA Handbook for Training and Accreditation ANZCA Handbook for Training and Accreditation in the Affiliated Training Regions REFERENCES 1. Brull, SJ and Kopman, AF Current Status of Neuromuscular Reversal and Monitoring, Challenges and Opportunities. Anesthesiology. 2017; 126:00 –00 FURTHER READING Association (...) and Practice Parameters, American Society of Anesthesiologists. Standards for basic anaesthetic monitoring. Park Ridge: American Society of Anesthesiologists, latest edition. From: http://www.asahq.org. Accessed 12 October 2015. Short TG, O’Regan A, Lew J, Oh TE. Critical incident reporting in an anaesthetic department quality assurance programme. Anaesthesia 1992(47)3-7. The Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia
undergoing anaesthesia; whenever such monitors are applied blood pressure must be measured and recorded during anaesthesia at intervals as indicated in 5.6.1 above. A variety of cuff sizes must be available. 6.3.3. Continuous invasive blood pressure monitor - Equipment to provide continuous invasive blood pressure monitoring should be available. This generally refers to a monitor connected via a transducer to an intra-arterial line. 6.4. Monitoring of anaesthetic effect on the brain - When clinically (...) indicated, equipment to monitor the anaesthetic effect on the brain should be available for use on patients, especially those at high risk of awareness, during general anaesthesia. 6.5. Inhalational anaesthetic agent monitor - to identify and monitor the inspired and end-tidal concentration of inhalational anaesthetics must be in use for every patient undergoing general anaesthesia from an anaesthesia delivery system where inhalational anaesthetic agents are delivered. 6.6. Temperature monitor
Search ("Anesthesia, Local"[Mesh]) AND "Vasoconstrictor Agents"[Mesh] ("Anesthetics, Local/adverse effects"[Mesh]) AND "Vasoconstrictor Agents/adverse effects"[Mesh] Comments on The Evidence None of the studies presented state a specific amount of epinephrine in local anesthetics that has been proven through research to be safe or unsafe for patients of compromised cardiovascular status. Additionally, the studies lacking a comparison (Elad and Godzieba) to normotensive patients may reduce (...) Research Fails to Provide Recommended Limit of Epinephrine in Local Anesthetics Used in Cardiovascular-Compromised Patients for Dental Procedures UTCAT3263, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Research Fails to Provide Recommended Limit of Epinephrine in Local Anesthetics Used in Cardiovascular-Compromised Patients for Dental Procedures Clinical Question In patients with cardiovascular disease
in 12% to 18% of all children undergoing general anesthesia for surgery. This post-anesthetic phenomenon changes cognitive and psychomotor behavior, and puts pediatric patients and health care personnel at risk of injury. A newer drug, dexmedetomidine, is a selective alpha-2 agonist, which works in the brain and spinal cord that has sedative, analgesic and anxiolytic properties. Dexmedetomidine also has the ability to lower the overall anesthetic requirements by reducing sympathetic outflow (...) Effectiveness of preoperative intranasal dexmedetomidine, compared with oral midazolam, for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia: a systematic review. Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops
Intravenous Lidocaine Alleviates the Pain of Propofol Injection by Local Anesthetic and Central Analgesic Effects Lidocaine alleviates propofol injection pain. However, whether lidocaine works through a local anesthetic effect at the site of intravenous injection or through a systemic effect on the central nervous system remains unknown. This study aimed to determine the pain-alleviating mechanism of lidocaine.A randomized controlled study.A gastroscopy facility.The study was divided into two (...) vein. Lidocaine reduces propofol injection pain through both a local anesthetic effect and a central analgesic effect when the dosage reaches 1.5 mg/kg.
General Anesthesia Versus Conscious Sedation for Endovascular Treatment of Acute Ischemic Stroke: The AnStroke Trial (Anesthesia During Stroke) Retrospective studies have found that patients receiving general anesthesia for endovascular treatment in acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. In this prospective randomized single-center study, we investigated the impact of anesthesia technique on neurological outcome in acute (...) ischemic stroke patients.Ninety patients receiving endovascular treatment for acute ischemic stroke in 2013 to 2016 were included and randomized to general anesthesia or conscious sedation. Difference in neurological outcome at 3 months, measured as modified Rankin Scale score, was analyzed (primary outcome) and early neurological improvement of National Institutes of Health Stroke Scale and cerebral infarction volume. Age, sex, comorbidities, admission National Institutes of Health Stroke Scale score
Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia: A Randomized, Multicenter, Semiblinded, Noninferiority, Controlled Trial Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations.A multicenter, semiblinded (...) , noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. The primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those
Sequential compression pump effect on hypotension due to spinal anesthesia for cesarean section: A double blind clinical trial Spinal anesthesia (SA) is a standard technique for cesarean section. Hypotension presents an incident of 80-85% after SA in pregnant women.To determine the effect of intermittent pneumatic compression of lower limbs on declining spinal anesthesia induced hypotension during cesarean section.This double-blind clinical prospective study was conducted on 76 non-laboring (...) parturient patients, aged 18-45 years, with the American Society of Anesthesiologist physical status I or II who were scheduled for elective cesarean section at Razi Hospital, Ahvaz, Iran from December 21, 2015 to January 20, 2016. Patients were divided into treatment mechanical pump (Group M) or control group (Group C) with simple random sampling. Fetal presentation, birth weight, Apgar at 1 and 5 min, time taken for pre-hydration (min), pre-hydration to the administration of spinal anesthesia (min
Position in the second stage of labour for women without epidural anaesthesia. For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting, kneeling) or lying down (lateral (Sim's) position, semi-recumbent, lithotomy position, Trendelenburg's position) have advantages for women giving birth to their babies. This is an update of a review previously published in 2012, 2004 and 1999.To determine the possible benefits and risks of the use (...) of different birth positions during the second stage of labour without epidural anaesthesia, on maternal, fetal, neonatal and caregiver outcomes.We searched Cochrane Pregnancy and Childbirth's Trials Register (30 November 2016) and reference lists of retrieved studies.Randomised, quasi-randomised or cluster-randomised controlled trials of any upright position assumed by pregnant women during the second stage of labour compared with supine or lithotomy positions. Secondary comparisons include comparison
New global surgical and anaesthesia indicators in the World Development Indicators dataset 29225929 2018 11 13 2059-7908 2 2 2017 BMJ global health BMJ Glob Health New global surgical and anaesthesia indicators in the World Development Indicators dataset. e000265 10.1136/bmjgh-2016-000265 Raykar Nakul P NP Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Program in Global Surgery and Social Change, Harvard Medical School, Boston (...) . Leather Andrew J M AJM King's Centre for Global Health, King's Health Partners and King's College London, London, UK. McQueen K A Kelly KAK Vanderbilt Anesthesia Global Health & Development, Nashville, Tennessee, USA. Department of Anesthesia, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Mukhopadhyay Swagoto S Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA. Department of Surgery, University of Connecticut School of Medicine, Hartford
Comparative experimental study on two designed intravenous anaesthetic combinations in dogs The goal of the present study is to design a good anaesthetic program for dogs which can lead to optimal anaesthesia with no or minimal post-operative adverse effects. For this purpose, we designed two anaesthetic combinations and compared their effects in Mongrel dogs: combination 'A' consisting of atropine, xylazine, ketamine plus propofol, and combination 'B' consisting of atropine, diazepam, ketamine (...) plus propofol. The onset and duration of anaesthesia induction, the duration of maintenance as well as the period of recovery were recorded and compared for both combinations. Furthermore, heart rate, respiratory rate, body temperature as well as blood picture were analyzed before and after administration of the proposed anaesthetic regimens. Administration of combination 'A' lead to rapid onset, within seconds, and induction of anaesthesia. The anaesthetic effect was maintained for approximately
__________________________________________________________________________________ For further information: Prof Andrew R Wolf, President APAGBI firstname.lastname@example.org References:  Andropoulos DB, Greene MF. Anesthesia and Developing Brains - Implications of the FDA Warning. N Engl J Med 2017.  Creeley CE. From Drug-Induced Developmental Neuroapoptosis to Pediatric Anesthetic Neurotoxicity-Where Are We Now? Brain Sci 2016;6(3).  Davidson A. The effect of anaesthesia on the infant brain. Early Hum Dev 2016;102:37-40.  Davidson AJ, Disma N, de Graaff JC, Withington DE (...) the Association between Surgery in Early Life and Child Development at Primary School Entry. Anesthesiology 2016;125(2):272-279.  Sun LS, Li G, Miller TL, Salorio C, Byrne MW, Bellinger DC, Ing C, Park R, Radcliffe J, Hays SR, DiMaggio CJ, Cooper TJ, Rauh V, Maxwell LG, Youn A, McGowan FX. Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA 2016;315(21):2312-2320.  Vutskits L, Xie Z. Lasting impact of general anaesthesia
Intraoperative Completion Studies, Local Anesthesia, and Antiplatelet Medication Are Associated With Lower Risk in Carotid Endarterectomy In Germany, all surgical and endovascular procedures on the carotid bifurcation must be documented in a statutory nationwide quality assurance database. We aimed to analyze the association between procedural and perioperative variables and in-hospital stroke or death rates after carotid endarterectomy.Between 2009 and 2014, overall 142 074 elective carotid (...) . In the multivariable analysis, lower risks of stroke or death were independently associated with local anesthesia (versus general anesthesia: RR, 0.85; 95% confidence interval [CI], 0.75-0.95), carotid endarterectomy with patch plasty compared with primary closure (RR, 0.71; 95% CI, 0.52-0.97), intraoperative completion studies by duplex ultrasound (RR, 0.74; 95% CI, 0.63-0.88) or angiography (RR, 0.80; 95% CI, 0.71-0.90), and perioperative antiplatelet medication (RR, 0.83; 95% CI, 0.71-0.97). No shunting
for patients undergoing open or laparoscopic surgery; new anaesthetic concerns accompany robotic assisted surgery.To assess outcomes related to the choice of total intravenous anaesthesia (TIVA) or inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic gynaecological, urological or gastroenterological surgery.We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016 Issue 5), Ovid MEDLINE (1946 to May 2016), Embase via OvidSP (1982 to May 2016 (...) Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery. Rapid implementation of robotic transabdominal surgery has resulted in the need for re-evaluation of the most suitable form of anaesthesia. The overall objective of anaesthesia is to minimize perioperative risk and discomfort for patients both during and after surgery. Anaesthesia for patients undergoing robotic assisted surgery is different from anaesthesia
performance in adolescence. There may be vulnerable groups that are at higher risk. Conflicts of interest: the authors had no conflicts of interest. Funding source: various grants from Swedish institutions. Critical Commentary Justification: data from animal model studies suggest that exposure to anaesthetic agents at early ages causes neuronal apoptosis and long-term learning and memory impairment. 1 Since millions of children require anaesthesia for surgical interventions every year, these findings have (...) anestésicos versus retrasos en los procedimientos indicados que podrían ser perjudiciales para los pacientes. Referencias 1 Andropoulos DB, Greene MF. Anesthesia and developing brains – Implications of the FDA warning. NEJM. 2017. DOI: 10.1056/NEJMp1700196 2 Davidson AJ, Disma N, de Graaff JC, Withington DE, Dorris L, Bell G, et al . Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled
patients requiring bilateral local anesthetic injections. Randomized Controlled Trial Key results The split-mouth study evaluated anticipated and actual pain for inferior-alveolar, palatal, long buccal, and infraorbital injections given via an intraoral vibration device. Actual pain upon injection was significantly less than anticipated pain for inferior alveolar (P Evidence Search ("pain"[MeSH Terms] OR "pain"[All Fields]) AND ("local anaesthesia"[All Fields] OR "anesthesia, local"[MeSH Terms (...) Research indicates Reduction of Pain upon Inferior Alveolar and Infraorbatial injection Using Vibrating Intraoral Local Anesthetic Devices UTCAT3207, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Research indicates Reduction of Pain upon Inferior Alveolar and Infraorbatial injection Using Vibrating Intraoral Local Anesthetic Devices Clinical Question In patients with fear of dental injections, do vibrating intraoral
Liposomal Bupivacaine May Prove to Provide Adequate Long-Term Local Anesthesia UTCAT3208, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Liposomal Bupivacaine May Prove to Provide Adequate Long-Term Local Anesthesia Clinical Question Is liposomal bupivacaine (Exparel) effective in providing extended local anesthesia and reducing post-operative opioid use in a variety of dental procedures? Clinical Bottom Line (...) For patients receiving endodontic care or third molar extractions, there is not enough evidence to support the conclusion that liposomal bupivacaine is any more effective than other anesthesia medications. This is supported by a randomized double-blinded study in which buccal infiltration of liposomal bupivacaine was shown to not achieve clinically relevant levels of anesthesia for prolonged periods of time. A systematic review of liposomal bupivacaine showed inconclusive evidence to support that liposomal