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Latest & greatest articles for anesthesia
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Clinical anesthesia is used to induce a temporary medical state of controlled unconsciousness, inducing a loss of sensation or awareness. There are three main types of anesthesia:
Local and Regional
Anesthesia 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 anesthesia has helped anesthesiologists in the progression of patient safety before and after surgery and medical procedures. The developments and research of anesthesia 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 anesthesia, it allows anesthesiologists to improve the delivery of patient safety while unconscious.
Learn more on the emerging technology in anesthesia and the advancements in anesthesia practise by searching Trip.
Randomized clinical trial of immersive virtual reality tour of the operating theatre in children before anaesthesia A virtual reality (VR) tour of the operating theatre before anaesthesia could provide a realistic experience for children. This study was designed to determine whether a preoperative VR tour could reduce preoperative anxiety in children.Children scheduled for elective surgery under general anaesthesia were randomized into a control or VR group. The control group received (...) conventional information regarding anaesthesia and surgery. The VR group watched a 4-min video showing Pororo, the famous little penguin, visiting the operating theatre and explaining what is in it. The main outcome was preoperative anxiety, assessed using the modified Yale Preoperative Anxiety Scale (m-YPAS) before entering the operating theatre. Secondary outcomes included induction compliance checklist (ICC) and procedural behaviour rating scale (PBRS) scores during anaesthesia.A total of 69 children
Glucosamine reduces the inhibition of proteoglycan metabolism caused by local anaesthetic solution in human articular cartilage: an in vitro study We assessed whether local anaesthetics caused inhibition of proteoglycan metabolism in human articular cartilage and whether the addition of Glucosamine sulphate could prevent or allow recovery from this adverse effect on articular cartilage metabolism.Cartilage explants obtained from 13 femoral heads from fracture neck of femur patients (average age (...) to 70% (p = 0.004).Our results showed that all local anaesthetic solutions inhibited proteoglycan metabolism in articular cartilage and the addition of Glucosamine was able to reduce the inhibition of metabolism caused by 0.5% Bupivacaine. Intra-articular injection of local anaesthetics requires careful consideration of risks and benefits.
Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release: An International, Multicenter, Phase 3, Single-blinded, Randomized Noninferiority Trial Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been (...) reported for animal ischemia models.In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon
Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Randomized Comparison Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic (...) effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures.All patients having elective outpatient orthopedic forefoot procedures were invited to participate in the study. Patients were prospectively randomized to receive either an ultrasound-guided AB or PFB by a board-certified anesthesiologist prior to their procedure. Intraoperative conversion to general anesthesia and postanesthesia care unit (PACU) opioid requirements were
Babies Can Safely Breastfeed After Their Mothers Have Local Anesthesia for a Dental Procedure UTCAT3266, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Babies Can Safely Breastfeed After Their Mothers Have Local Anesthesia for a Dental Procedure Clinical Question Are babies whose mothers have local anesthesia for dental procedures at increased risk for ingesting the anesthetic? Clinical Bottom Line It is safe (...) for a mother to breastfeed after having local anesthesia for a dental procedure. This is based on a clinical study showing that the amount of lidocaine in the breast milk was low. Local anesthesia is widely used in all general dental practices and accepted by patients. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Giuliani/2001 7 nursing mothers between the ages of 23-39 Noncontrolled clinical study Key
Dichlorobenzyl alcohol and amylmetacresol and the local anaesthetic lidocaine (Triolif) - for sore throat Triolif® × Insert searchphrase to search the website Insert searchphrase to search the website > > > Triolif® Conclusion Triolif lozenges contain a combination of the antiseptic active substances, 2,4-dichlorobenzyl alcohol and amylmetacresol and the local anaesthetic lidocaine. Triolif is available over the counter (pharmacy-only) and is indicated for sore throat in adults and adolescents
Anesthetic Cream Use During Office Pessary Removal and Replacement: A Randomized Controlled Trial To estimate the effect of lidocaine-prilocaine cream on patient pain at the time of office pessary removal and reinsertion.In this double-blind, randomized placebo-controlled trial, participants undergoing routine pessary care in a urogynecology office at a tertiary referral center were randomized to application of 4 g of either lidocaine-prilocaine or placebo cream 5 minutes before pessary change
Perioperative Management of Elderly Patients with Gastrointestinal Malignancies: The Contribution of Anesthesia Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup.We provide a brief
Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. It can be associated with nausea or vomiting and may pose serious risks to the mother (unconsciousness, pulmonary aspiration) and baby (hypoxia, acidosis, neurological injury).To assess the effects of prophylactic interventions for hypotension following spinal anaesthesia for caesarean section.We searched (...) Cochrane Pregnancy and Childbirth's Trials Register (9 August 2016) and reference lists of retrieved studies.Randomised controlled trials, including full texts and abstracts, comparing interventions to prevent hypotension with placebo or alternative treatment in women having spinal anaesthesia for caesarean section. We excluded studies if hypotension was not an outcome measure.Two review authors independently assessed study quality and extracted data from eligible studies. We report 'Summary
Intraoperative "Analgesia Nociception Index"-Guided Fentanyl Administration During Sevoflurane Anesthesia in Lumbar Discectomy and Laminectomy: A Randomized Clinical Trial The "Analgesia Nociception Index" (ANI; MetroDoloris Medical Systems, Lille, France) is a proposed noninvasive guide to analgesia derived from an electrocardiogram trace. ANI is scaled from 0 to 100; with previous studies suggesting that values ≥50 can indicate adequate analgesia. This clinical trial was designed (...) to investigate the effect of intraoperative ANI-guided fentanyl administration on postoperative pain, under anesthetic conditions optimized for ANI functioning.Fifty patients aged 18 to 75 years undergoing lumbar discectomy or laminectomy were studied. Participants were randomly allocated to receive intraoperative fentanyl guided either by the anesthesiologist's standard clinical practice (control group) or by maintaining ANI ≥50 with boluses of fentanyl at 5-minute intervals (ANI group). A standardized
statement with the ACSQHC supporting user-applied labelling standardisation for all injectable medicines and fluids 4 . In New Zealand PHARMAC is considering labelling recommendations. 3.2.3 With the increasing use of infusions for anaesthesia as well as for regional analgesia there is the potential for drug errors to occur. To minimise these errors, it is advisable to ensure that devices delivering intravenous medications are readily differentiated from those delivering local anaesthetics. Colour (...) drug events. Anesthesiology. 2016;124(1): 25-34. doi: 10.1097/ALN.0000000000000904 2. Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care [serial online]. 2001;29(5):494-500. From: http://www.aaic.net.au.ezproxy.anzca.edu.au/Document/?D=2000210. Accessed 12 October 2016 3. Department of Health, Therapeutic Goods Administration [Internet] 2016 From: https://www.legislation.gov.au/Details/F2016L01285 4
Guidelines on Return to Anaesthesia Practice for Anaesthetists Background Paper PS50 BP 2017 Page 1 PS50 BP Australian and New Zealand College of Anaesthetists (ANZCA) Guidelines on Return to Anaesthesia Practice for Anaesthetists Background Paper 1. PURPOSE OF REVIEW PS50 was originally promulgated in 2004 and re-published without revision in 2013. The current review has been undertaken to fulfill the following: 1.1 Meet ANZCA’s mission “to serve the community by fostering safe and high (...) quality patient care in anaesthesia, perioperative medicine and pain medicine; 1.2 Provide support to anaesthetists who are returning to anaesthesia practice after absence for any reason; 1.3 Assist regulatory authorities and other bodies who have mandated return to practice programs for anaesthetists. The title of the document has been changed from PS50 Recommendations on Practice Re-entry for a Specialist Anaesthetist to PS50 Guidelines on Return to Anaesthesia Practice for an Anaesthetist
Statement on Staffing of Accredited Departments of Anaesthesia Background Paper PS42 BP 2016 Page 1 PS42 BP 2016 Australian and New Zealand College of Anaesthetists (ANZCA) Statement on Staffing of Accredited Departments of Anaesthesia Background Paper 1. PURPOSE OF REVIEW This professional document was reviewed in 2013 as part of the usual five year review cycle. There had been changes in terminology and the employment environment and, as a consequence, the document required updating to meet (...) contemporary expectations. 2. BACKGROUND This document applies to accredited departments of anaesthesia. These departments provide the majority of training within the ANZCA training program. They should be adequately staffed to provide this training, particularly in regard to providing adequate supervision of trainees. The department must provide a safe high quality clinical service and be able to effectively manage the service. Consequently, though the document primarily addresses anaesthesia staff
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