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Off-label use of drugs remains a concern for anaesthetists caring for children.
Sims C.
Publication Types:
PMID: 16398398 [PubMed - in process]
Serotonin syndrome and the anaesthetist.
Warmington A.
Publication Types:
PMID: 16398394 [PubMed - in process]
Effect of hyaluronidase and bicarbonate on local anaesthetic pH.
Walpole A, Symons JA.
Publication Types:
PMID: 16398393 [PubMed - in process]
Fibreoptic intubation skills among anaesthetists in New Zealand.
Dawson AJ, Marsland C, Baker P, Anderson BJ.
Department of Anaesthesia, Auckland City Hospital, Wellington Public Hospital and Auckland Children's Hospital, Auckland and Wellington, and Auckland University Medical School, Auckland, New Zealand.
The aim of this study was to investigate methods of practice, assess skill level, and evaluate attitudes towards fibreoptic intubation in the anaesthetic community of New Zealand. A postal survey questionnaire was sent to all vocationally registered anaesthetists in New Zealand and to all New Zealand anaesthetic trainees registered with the Australian and New Zealand College of Anaesthetists. There were 611 survey questionnaires posted and 386 (63%) respondents. Almost all respondents (98% of specialists, 100% of trainees) had access to fibreoptic equipment in public and 92% of respondents performed fibreoptic intubation. The median number of fibreoptic intubations performed per year was 3 for consultants and 4 for trainees. Respondents were either self taught or colleague taught (82%). Most learnt the technique on patients (92%). There were 14% who considered themselves experienced, 30% competent, 34% adequate and 20% novice. Skills were maintained by clinical patient mix in 73%. Fibreoptic intubation was considered a skill required by all anaesthetists in 87%, and 66% considered it the gold standard for expected difficult airways. Lack of clinical cases requiring the skill and lack of practice were identified as the primary barriers to skill development. Consultants had greater opportunity to learn fibreoptic intubation skills during daily practice than trainees. Only 18% of trainees had a formal airway management program available to them at their place of work. There appears to be a need to increase available opportunities to perform fibreoptic intubation to enable maintenance and improvement of fibreoptic skills in our community. A formalized program of teaching fibreoptic intubation may offer greater opportunity for learning and skill development.
PMID: 16398385 [PubMed - in process]
Anaesthetists' knowledge of the QT interval in a teaching hospital.
Marshall SD, Myles PS.
Alfred Hospital, Melbourne, Victoria, Australia.
Many drugs used in anaesthesia may prolong the QT interval of the electrocardiogram (ECG), and recent U.S. Food and Drug Administration guidelines mandate monitoring of the ECG before, during and after droperidol administration. We surveyed 41 trainee and consultant anaesthetists in our Department to determine current practice and knowledge of the QT interval to investigate if this is a practical proposition. A response rate of 98% (40/41) was obtained. The majority of respondents expressed moderate to high levels of confidence in interpreting the ECG, and this was related to years of training (rho 0.36, P=0.024). A total of 27 respondents (65%) were able to correctly identify the QT interval on a schematic representation of the ECG, trainees 70% vs consultants 60%, P=0.51. When asked to name drugs that altered the QT interval, droperidol was included by 11 of the 40 respondents (28%); trainees 10% vs consultants 45%, OR 7.4 (95% CI: 1.3-41), P=0.013. Torsades de Pointes was correctly identified as a possible consequence of a prolonged QT interval by 65% of trainees and 70% of consultants, P=0.83. The results suggest that QT interval measurement is not widely practised by anaesthetists, although its clinical significance is well known, and interpretation would be unreliable without further education.
PMID: 16398384 [PubMed - in process]
Debriefing after critical incidents for anaesthetic trainees.
Tan H.
Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia.
This survey investigated the need, and the availability, of debriefing after critical incidents for training anaesthetists. A cross-sectional postal survey of all Australian anaesthetic trainees was conducted in May 2002. Four hundred and nineteen responses were analysed (response rate 64%). Debriefing after a critical incident was perceived by most trainees to be useful, however 36% (n = 149) had never been debriefed. Trainees ranked their preferred content for a debriefing as 'anaesthetic issues' followed by the 'psychological impact of the incident' 'patient issues' and 'surgical issues'. Almost half of respondents reported that they did not feel supported by their anaesthetic department after a negative outcome incident. Trainees who had debriefings were more likely to feel supported by senior colleagues. Debriefing after critical incidents should be an integral part of the supervision of anaesthetic trainees.
PMID: 16398383 [PubMed - in process]
The influence of the current medicolegal climate on New South Wales anaesthetic practice.
Beckmann LA.
Department of Anaesthesia, Royal Brisbane and Women's Hospitals, Brisbane, Queensland.
A survey was posted to all New South Wales and Provisional Fellows of the Australian and New Zealand College of Anaesthetists to assess the influence of the current medicolegal climate on their anaesthetic practice. Information collected included demographics, opinions regarding the current medico-legal climate, medical defence organizations, and the implications for anaesthetic practice. The response rate was 78% (640/820). Nearly all (95.3%) were concerned about the current medical indemnity crisis and 80.5% felt concerned about the financial security of medical insurers. Of all these respondents 23.6% had personal experience of litigation and 73.6% expected to have a claim made against them during their career: Respondents spent an average of 8.3% of their gross annual income on medical insurance premiums and 47.2% are concerned about the viability of their practice given the rising costs of medical insurance. Obstetric anaesthesia was the most common area of practice to be ceased due to medicolegal concerns. In the next two years, 20.2% of obstetric anaesthetists who responded intend to cease practice. In the past two years, 3.1% of respondents retired due to their litigation concerns, while 12.8% (average age 56.7y) are intending to retire in the next two years for the same reasons. Changes to the conduct of the preoperative consultation were common. Other changes to practice included more thorough documentation of complications (50.8%) and a strong reluctance to perform neuraxial blocks (54%). This survey suggests that anaesthetists are concerned about the current medicolegal climate and as a result, some are retiring earlier and giving up high-risk areas of practice.
PMID: 16398382 [PubMed - in process]
Evaluation of the SLIPA (streamlined liner of the pharynx airway), a single use supraglottic airway device, in 60 anaesthetized patients undergoing minor surgical procedures.
Hein C, Plummer J, Owen H.
Department of Anaesthesia and Pain Management, Flinders University, Bedford Park, South Australia.
The Streamlined Liner of the Pharyngeal Airway, SLIPA (Hudson RCI) is a new disposable supraglottic airway device that has no inflatable cuff and has features designed to reduce aspiration risk. This study aimed to assess the insertion success and effectiveness of the SLIPA in 60 patients who presented for elective surgery. Ethics committee approval was obtained. Patients were excluded if they were less than 18 years, had not provided written consent or were at risk of pulmonary aspiration. The first 20 SLIPA were inserted by the principal investigator (Group A) followed by another 40 inserted by medical officers and anaesthetists of varying experience (Group B). Twenty-one males and 39 females were recruited into the study. Median time to ventilation was 20.4 seconds in Group A (range 12.9-109) and 24.8 seconds in Group B (range 8.2-82.5). Overall success rate was 100% in Group A and 92.5% in Group B. The lowest recorded SpO2 was 91% in Group B. The incidence of blood and sore throat score >3 (0-10 scale) was 23% and 7% respectively (Groups A and B). Group B reported that use of the device was very easy in 16%, easy in 76%, difficult in 5%, and very difficult in 3%. The SLIPA proved to be a reliable airway providing adequate ventilation in both spontaneous breathing and assisted respiration. Most users found the SLIPA to be easy or very easy to use.
PMID: 16398381 [PubMed - in process]
Comparison of forced-air warming and radiant heating during transurethral prostatic resection under spinal anaesthesia.
Torrie JJ, Yip P, Robinson E.
Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.
Forced-air warming is commonly used to warm patients intraoperatively, but may not achieve normothermia during a short procedure. Comparative trials of a new radiant warming device in general anaesthesia (Suntouch, Fisher and Paykel, Auckland, New Zealand) have had conflicting results. We conducted a randomized controlled trial to compare the efficacy and thermal comfort of the Suntouch radiant warmer and forced-air warming in patients at high risk of hypothermia during neuraxial blockade. With ethics committee approval, 60 patients having transurethral resection of the prostate under spinal were randomized to either radiant warming or forced-air warming. All intravenous and irrigation fluids were warmed but pre-warming was not used. The final intraoperative rectal temperatures for the radiant warming and forced-air warming groups were 36.1 degrees C and 36.4 degrees C respectively (P= 0.03). A large proportion of patients in both groups (46% and 33% respectively, P=0.3) were hypothermic (<36 degrees C) on arrival in the post-anaesthesia care unit. No other patient variables were significantly different. Neither warming device reliably prevented hypothermia, although forced-air warming was slightly superior.
PMID: 16398377 [PubMed - in process]
A randomized trial of ultrasound-guided brachial plexus anaesthesia in upper limb surgery.
Soeding PE, Sha S, Royse CE, Marks P, Hoy G, Royse AG.
Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, D Melbourne, Victoria, Australia.
Ultrasound guidance allows real-time identification of relevant anatomy and needle position when performing brachial plexus regional anaesthesia. The aim of this investigation was to determine whether the use of surface ultrasound could improve the quality of brachial plexus anaesthesia for upper limb surgery. Forty patients were randomized to either conventional "landmark-based" plexus anaesthesia, or to an ultrasound-guided approach using a 13 mHz linear array transducer Both interscalene and axillary techniques were used. The use of ultrasound significantly improved the onset and completeness of sensory (P=0.011) and motor (P=0.002) block. Ultrasound guidance also significantly reduced (P=0.012) the incidence of paraesthesia during the performance of the blocks. Ultrasound guidance increases the quality of sensory and motor blockade in brachial plexus regional anaesthesia, and by reducing the incidence of paraesthesia during performance of the blocks, may confer greater safety.
PMID: 16398375 [PubMed - in process]
Ultrasound in regional anaesthesia--removing the blindfold?
Cronin K.
Publication Types:
PMID: 16398374 [PubMed - in process]
[Depth of anaesthesia during intubation Comparison between propofol and thiopentone.]
[Article in German]
Beck CE, Pohl B, Janda M, Bajorat J, Hofmockel R.
Klinik und Poliklinik fur Anasthesiologie und Intensivtherapie, Universitat, Rostock.
In order to study the depth of anaesthesia during endotracheal intubation, 30 patients received either thiopentone or propofol for anaesthesia induction. The BIS value as a parameter for the depth of anaesthesia and the rate pressure product (RPP) were aquired online. Patients who received thiopentone for anaesthesia induction showed significantly higher BIS values at the moment of intubation and reached BIS values >60 significantly more frequently than patients receiving propofol. The RPP in the propofol group lay significantly below that of the thiopentone patients. For all patients there was an mean increase in BIS values of 8 index points and an increase in the RPP. Therefore, BIS values around 50 should be achieved before intubation in order to avoid the critical BIS value for awareness of >60 despite the increase caused by the intubation procedure. Within 24 h of intubation all patients were interviewed for possible signs of awareness. None of the patients was able to remember the intubation or reported other experiences that indicated an unconscious awareness. Nevertheless, the progress of BIS values in a standardized intubation as performed in the normal clinical routine, shows that the use of thiopentone for initiating anaesthesia results in a very flat level of anaesthesia during intubation. The risk for patients to experience awareness should therefore, not be underestimated. Therefore, when using thiopentone it is recommended to also use a rapid acting muscle relaxant or to select a high ED95 to compensate for the flat level of anaesthesia. Alternatively, repetetive boluses of the hypnotic shortly before intubation should be considered or to revert to propofol. The dosage and pharmacokinetics of the analgesic should also be taken into consideration because an insufficient analgesia leads to a faster flattening of the depth of anaesthesia.
PMID: 16408231 [PubMed - as supplied by publisher]
Molecular targets underlying general anaesthesia.
Franks NP.
1Biophysics Section, The Blackett Laboratory, Imperial College London, London SW7 2AZ.
The discovery of general anaesthesia, over 150 years ago, revolutionised medicine. The ability to render a patient unconscious and insensible to pain made modern surgery possible and general anaesthetics have become both indispensible as well as one of the most widely used class of drugs. Their extraordinary chemical diversity, ranging from simple chemically inert gases to complex barbiturates, has baffled pharmacologists, and ideas about how they might work have been equally diverse. Until relatively recently, thinking was dominated by the notion that anaesthetics acted 'nonspecifically' by dissolving in the lipid bilayer portions of nerve membranes. While this simple idea could account for the chemical diversity of general anaesthetics, it has proven to be false and it is now generally accepted that anaesthetics act by binding directly to sensitive target proteins. For certain intravenous anaesthetics, such as propofol and etomidate, the target has been identified as the GABA(A) receptor, with particular subunits playing a crucial role. For the less potent inhalational agents, the picture is less clear, although a relatively small number of targets have been identified as being the most likely candidates. In this review, I will describe the work that led up to the identification of the GABA(A) receptor as the key target for etomidate and propofol and contrast this with current progress that has been made in identifying the relevant targets for other anaesthetics, particularly the inhalational agents.British Journal of Pharmacology (2006) 147, S72-S81. doi:10.1038/sj.bjp.0706441.
PMID: 16402123 [PubMed - in process]
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TC-2559 excites dopaminergic neurones in the ventral tegmental area by stimulating alpha4beta2-like nicotinic acetylcholine receptors in anaesthetised rats.
Wang Y, Sherwood JL, Miles CP, Whiffin G, Lodge D.
[1] 1Lilly Research Centre, Eli Lilly & Co. Ltd, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH [2] 2Research Centre for Medicinal Chemistry and Chemical Biology, Chongqing Technology and Business University, Chongqing 400067, China.
The in vivo effects of a selective partial agonist for neuronal nicotinic acetylcholine receptor (nAChRs) alpha4beta2 subtype, TC-2559, characterised recently in in vitro preparations, have been profiled. The brain bioavailability of TC-2559 and its effects on the spontaneous firing and bursting properties of the dopaminergic (DAergic) neurones recorded extracellularly in the ventral tegmental area (VTA) were studied following systemic administration in anaesthetised rats.Cumulative doses of TC-2559 (0.021-1.36 mg kg(-1), i.v.) increased both the firing and bursting activities of VTA DA neurones. The effect of bolus doses of TC-2559 of 0.66 or 1.32 mg kg(-1), i.v., was approximately equivalent to that of 0.0665 mg kg(-1), i.v. nicotine.The excitation evoked by both nicotine and TC-2559 was fully reversed by DHbetaE (0.39-0.77 mg kg(-1), i.v.), an alpha4beta2-subtype-preferring nicotinic antagonist, and application of nicotine after DHbetaE failed to evoke any excitation. MLA (0.23 mg kg(-1), i.v.), an alpha7 selective antagonist, failed to alter TC-2559-evoked excitation and bursting activities, and a novel alpha7 agonist (PSAB-OFP; 0.23 mg kg(-1), i.v.) was also without effect.The present results indicated that TC-2559 fully mimics nicotine by increasing both the excitability and bursting behaviour of VTA DA neurones, effects that are predominantly due to activation of alpha4beta2-like nAChRs.TC-2559 has been demonstrated to be a useful in vivo pharmacological tool for studying the alpha4beta2 subtype of nicotinic receptor.British Journal of Pharmacology advance online publication, 9 January 2006; doi:10.1038/sj.bjp.0706621.
PMID: 16402043 [PubMed - as supplied by publisher]
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