Nicole L Tan, Robert Gotmaker, Michael J Barrington
BACKGROUND: Local infiltration analgesia (LIA) is commonly used in anterior total hip arthroplasty (THA) surgery; however, evidence for its efficacy is lacking. We hypothesized that LIA with 0.2% ropivacaine when compared with injection of placebo (0.9% saline) would improve patient quality of recovery on postoperative day (POD) 1, as measured by the Quality of Recovery-15 (QoR-15) score. METHODS: Patients scheduled to have a primary unilateral anterior THA with a single surgeon in a tertiary level metropolitan hospital were randomized to receive LIA with either 2...
December 2019: Anesthesia and Analgesia
Tanisha Jowsey, Peter Beaver, Jennifer Long, Ian Civil, A L Garden, Kaylene Henderson, Alan Merry, Carmen Skilton, Jane Torrie, Jennifer Weller
AIM: NetworkZ is a simulation-based multidisciplinary team-training programme designed to enhance patient safety by improving communication and teamwork in operating theatres (OTs). In partnership with the Accident Compensation Corporation, its implementation across New Zealand (NZ) began in 2017. Our aim was to explore the experiences of staff - including the challenges they faced - in implementing NetworkZ in NZ hospitals, so that we could improve the processes necessary for subsequent implementation...
October 31, 2019: BMJ Open
Jennifer Weller, Jennifer Anne Long, Peter Beaver, David Cumin, Chris Frampton, Alexander L Garden, Matthew Moore, Craig S Webster, Alan Merry
INTRODUCTION: NetworkZ is a national, insurer-funded multidisciplinary simulation-based team-training programme for all New Zealand surgical teams. NetworkZ is delivered in situ, using full-body commercial simulators integrated with bespoke surgical models. Rolled out nationally over 4 years, the programme builds local capacity through instructor training and provision of simulation resources. We aim to improve surgical patient outcomes by improving teamwork through regular simulation-based multidisciplinary training in all New Zealand hospitals...
February 19, 2020: BMJ Open
Jennifer Weller, Robert Henderson, Craig S Webster, Boaz Shulruf, Jane Torrie, Elaine Davies, Kaylene Henderson, Chris Frampton, Alan F Merry
BACKGROUND: Effective teamwork is important for patient safety, and verbal communication underpins many dimensions of teamwork. The validity of the simulated environment would be supported if it elicited similar verbal communications to the real setting. The authors hypothesized that anesthesiologists would exhibit similar verbal communication patterns in routine operating room (OR) cases and routine simulated cases. The authors further hypothesized that anesthesiologists would exhibit different communication patterns in routine cases (real or simulated) and simulated cases involving a crisis...
January 2014: Anesthesiology
D R McIlroy, M T V Chan, S K Wallace, J A Symons, E G Y Koo, L C Y Chu, P S Myles
BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) is a common complication with associated serious morbidity and mortality. Endothelial dysfunction might play an important role in MINS, and its rapid assessment could provide a novel method of risk stratification before surgery. METHODS: We studied 238 subjects scheduled to undergo intermediate or high-risk surgery in a two-centre prospective study to determine whether preoperative endothelial dysfunction identified by a reactive hyperaemia-peripheral arterial tonometry (RH-PAT) index could provide effective risk stratification for MINS, defined as serum troponin ≥0...
January 2014: British Journal of Anaesthesia
P J Devereaux, Bruce M Biccard, Alben Sigamani, Denis Xavier, Matthew T V Chan, Sadeesh K Srinathan, Michael Walsh, Valsa Abraham, Rupert Pearse, C Y Wang, Daniel I Sessler, Andrea Kurz, Wojciech Szczeklik, Otavio Berwanger, Juan Carlos Villar, German Malaga, Amit X Garg, Clara K Chow, Gareth Ackland, Ameen Patel, Flavia Kessler Borges, Emilie P Belley-Cote, Emmanuelle Duceppe, Jessica Spence, Vikas Tandon, Colin Williams, Robert J Sapsford, Carisi A Polanczyk, Maria Tiboni, Pablo Alonso-Coello, Atiya Faruqui, Diane Heels-Ansdell, Andre Lamy, Richard Whitlock, Yannick LeManach, Pavel S Roshanov, Michael McGillion, Peter Kavsak, Matthew J McQueen, Lehana Thabane, Reitze N Rodseth, Giovanna A Lurati Buse, Mohit Bhandari, Ignacia Garutti, Michael J Jacka, Holger J Schünemann, Olga Lucía Cortes, Pierre Coriat, Nazari Dvirnik, Fernando Botto, Shirley Pettit, Allan S Jaffe, Gordon H Guyatt
IMPORTANCE: Little is known about the relationship between perioperative high-sensitivity troponin T (hsTnT) measurements and 30-day mortality and myocardial injury after noncardiac surgery (MINS). OBJECTIVE: To determine the association between perioperative hsTnT measurements and 30-day mortality and potential diagnostic criteria for MINS (ie, myocardial injury due to ischemia associated with 30-day mortality). DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of patients aged 45 years or older who underwent inpatient noncardiac surgery and had a postoperative hsTnT measurement...
April 25, 2017: JAMA
Craig M Ironfield, Michael J Barrington, Roman Kluger, Brian Sites
INTRODUCTION: Peripheral nerve blockade (PNB) is associated with superior outcomes compared with opioids; however, little is known regarding patients' perceptions of the care they have received. Patient satisfaction is emerging as an important indicator of quality of health care, and identifying deficiencies in discrete aspects of satisfaction may allow targeted interventions to improve quality. In this study, we analyze data relevant to patient satisfaction from the International Registry of Regional Anesthesia...
January 2014: Regional Anesthesia and Pain Medicine
J M Weller, M Henning, N Civil, L Lavery, M J Boyd, B Jolly
When evaluating assessments, the impact on learning is often overlooked. Approaches to learning can be deep, surface and strategic. To provide insights into exam quality, we investigated the learning approaches taken by trainees preparing for the Australian and New Zealand College of Anaesthetists (ANZCA) Final Exam. The revised two-factor Study Process Questionnaire (R-SPQ-2F) was modified and validated for this context and was administered to ANZCA advanced trainees. Additional questions were asked about perceived value for anaesthetic practice, study time and approaches to learning for each exam component...
September 2013: Anaesthesia and Intensive Care
Andrew J Davidson, Neil S Morton, Sarah J Arnup, Jurgen C de Graaff, Nicola Disma, Davinia E Withington, Geoff Frawley, Rodney W Hunt, Pollyanna Hardy, Magda Khotcholava, Britta S von Ungern Sternberg, Niall Wilton, Pietro Tuo, Ida Salvo, Gillian Ormond, Robyn Stargatt, Bruno Guido Locatelli, Mary Ellen McCann
BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (GA) on neurodevelopment. A secondary aim is to compare rates of apnea after anesthesia. METHODS: Infants aged 60 weeks or younger, postmenstrual age scheduled for inguinal herniorrhaphy, were randomized to RA or GA...
July 2015: Anesthesiology
Vanessa A Olbrecht, Justin Skowno, Vanessa Marchesini, Lili Ding, Yifei Jiang, Christopher G Ward, Gaofeng Yu, Huacheng Liu, Bernadette Schurink, Laszlo Vutskits, Jurgen C de Graaff, Francis X McGowan, Britta S von Ungern-Sternberg, Charles Dean Kurth, Andrew Davidson
BACKGROUND: General anesthesia during infancy is associated with neurocognitive abnormalities. Potential mechanisms include anesthetic neurotoxicity, surgical disease, and cerebral hypoxia-ischemia. This study aimed to determine the incidence of low cerebral oxygenation and associated factors during general anesthesia in infants. METHODS: This multicenter study enrolled 453 infants aged less than 6 months having general anesthesia for 30 min or more. Regional cerebral oxygenation was measured by near-infrared spectroscopy...
January 2018: Anesthesiology
Kiran Shekar, Jason A Roberts, Sussan Ghassabian, Daniel V Mullany, Steven C Wallis, Maree T Smith, John F Fraser
No abstract text is available yet for this article.
March 2013: Journal of Antimicrobial Chemotherapy
Nan Xie, Fabio P Gomes, Vandana Deora, Kye Gregory, Tharindu Vithanage, Zeyad D Nassar, Peter J Cabot, David Sturgess, Paul N Shaw, Marie-Odile Parat
In this study, we quantified the ability of opioids present in biological samples to activate the μ-opioid receptor and TLR4 using cell-based assays. Each assay was standardised, in the presence of plasma, using morphine, its μ receptor-active metabolite morphine-6 glucuronide (M6G) and its μ receptor-inactive, but TLR4-active metabolite morphine-3 glucuronide (M3G). Specificity was verified using antagonists. Morphine- and M6G-spiked plasma samples exhibited μ receptor activation, which M3G-spiked plasma lacked...
March 2017: Brain, Behavior, and Immunity
David Belavy, Nana Sunn, Queenie Lau, Thomas Robertson
BACKGROUND: Ultrasound gels may contain propylene glycol and glycerol, which are neurotoxic in high concentrations. If the needle passes through gel during regional anesthesia, gel may be injected near the nerve. It is unknown if this practice poses a risk for neurotoxicity. Using an animal model, we assessed the histological changes of perineural propylene glycol on nerves. We then assessed three commonly used sterile gels for evidence of neurotoxicity. METHODS: Micro-ultrasound guided perineural sciatic nerve injections were performed in mice...
September 3, 2013: BMC Anesthesiology
Megan Allen, Kate Leslie, Geoffrey Hebbard, Ian Jones, Tejinder Mettho, Paul Maruff
PURPOSE: This study aimed to determine if the incidence of recall was equivalent between light and deep sedation for colonoscopy. Secondary analysis included complications, patient clinical recovery, and post-procedure cognitive impairment. METHODS: Two hundred patients undergoing elective outpatient colonoscopy were randomized to light (bispectral index [BIS] 70-80) or deep (BIS < 60) sedation with propofol and fentanyl. Recall was assessed by the modified Brice questionnaire, and cognition at baseline and discharge was assessed using a Cogstate test battery...
November 2015: Canadian Journal of Anaesthesia
A H Konstantatos, G Imberger, M Angliss, C H K Cheng, A Z Y Meng, M T V Chan
BACKGROUND: The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia. METHODS: Matched cohorts of patients from Hong Kong (n=68) and Australia (n=68) were recruited. Patient attitudes and expectations to pain management documented. After operation, all patients received i...
November 2012: British Journal of Anaesthesia
Syb Wen, Azy Peng, S Boyle, S Cai, L Pope, M T Tran, T G Short, A Aneman, M Jaeger, A Chuan
This prospective pilot study evaluated whether low preoperative cerebral tissue oxygen saturation is associated with unfavourable outcomes after major elective non-cardiac surgery. Eighty-one patients over 60 years of age, American Society of Anesthesiologists physical status 3 or 4, were recruited. Resting cerebral tissue oxygen saturation was recorded on room air, and after oxygen supplementation, using cerebral oximetry. The primary outcome was 30-day major adverse event of combined mortality or severe morbidity, and the secondary outcome was 30-day new disability...
March 2017: Anaesthesia and Intensive Care
T D Phan, R Kluger, C Wan, D Wong, A Padayachee
This study compared the cardiac output responses to haemodynamic interventions as measured by three minimally invasive monitors (Oesophageal Doppler Monitor the VigileoFlotrac and the LiDCOrapid) to the responses measured concurrently using thermodilution, in cardiac surgical patients. The study also assessed the precision and bias of these monitors in relation to thermodilution measurements. After a fluid bolus of at least 250 ml, the measured change in cardiac output was different among the devices, showing an increase with thermodilution in 82% of measurements, Oesophageal Doppler Monitor 68%, VigileoFlotrac 57% and LiDCOrapid 41%...
November 2011: Anaesthesia and Intensive Care
Sarah McNab, Trevor Duke, Mike South, Franz E Babl, Katherine J Lee, Sarah J Arnup, Simon Young, Hannah Turner, Andrew Davidson
BACKGROUND: Use of hypotonic intravenous fluid to maintain hydration in children in hospital has been associated with hyponatraemia, leading to neurological morbidity and mortality. We aimed to assess whether use of fluid solutions with a higher sodium concentration reduced the risk of hyponatraemia compared with use of hypotonic solutions. METHODS: We did a randomised controlled double-blind trial of children admitted to The Royal Children's Hospital (Melbourne, VIC, Australia) who needed intravenous maintenance hydration for 6 h or longer...
March 28, 2015: Lancet
S Salman, E K Y Tang, L C Cheung, M N Nguyen, D Sommerfield, L Slevin, L Y Lim, B S von Ungern Sternberg
Midazolam is one of many bitter drugs where provision of a suitable oral paediatric formulation, particularly in the pre-anaesthetic setting, remains a challenge. To overcome this problem, a novel chocolate-based tablet formulation has been developed with positive pre-clinical results. To further investigate the potential of this formulation, 150 children aged 3-16 years who were prescribed midazolam as a premedication were randomly assigned to receive 0.5 either as the novel formulation or an intravenous solution given orally, which is the current standard at our institution...
December 2018: Anaesthesia
Jennifer M Weller, Tanisha Jowsey, Carmen Skilton, Derryn A Gargiulo, Oleg N Medvedev, Ian Civil, Jacqueline A Hannam, Simon J Mitchell, Jane Torrie, Alan F Merry
While the WHO Surgical Safety Checklist (the Checklist) can improve patient outcomes, variable administration can erode benefits. We sought to understand and improve how operating room (OR) staff use the Checklist. Our specific aims were to: determine if OR staff can discriminate between good and poor quality of Checklist administration using a validated audit tool (WHOBARS); to determine reliability and accuracy of WHOBARS self-ratings; determine the influence of demographic variables on ratings and explore OR staff attitudes to Checklist administration...
December 16, 2018: BMJ Open
2020-04-09 03:30:03
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