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Anaesth Intensive Care 2022 May 15:310057X211061158. Epub 2022 May 15.

Sydney Medical School, University of Sydney, Sydney, Australia.

Robot-assisted laparoscopic prostatectomy requires a pneumoperitoneum combined with steep Trendelenburg positioning, and these conditions can be associated with impairment of cerebral autoregulation. The objective of this study was to determine if choice of anaesthetic agent affects the preservation of cerebral autoregulation during robot-assisted laparoscopic prostatectomy. We randomly assigned 30 patients to maintenance of general anaesthesia with either propofol or sevoflurane. Read More

Anaesth Intensive Care 2022 May 12:310057X211069383. Epub 2022 May 12.

Department of Anaesthesia and Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.

Anaesth Intensive Care 2022 May 12:310057X211066927. Epub 2022 May 12.

School of Veterinary and Life Sciences, Murdoch University, Murdoch, Australia.

Live animal models can be used to train anaesthetists to perform emergency front-of-neck-access. Cannula cricothyroidotomy success reported in previous wet lab studies contradicts human clinical data. This prospective, observational study reports success of a cannula-first 'can't intubate, can't oxygenate' algorithm for impalpable anatomy during high fidelity team simulations using live, anaesthetised pigs. Read More

Anaesth Intensive Care 2022 May 12:310057X211053644. Epub 2022 May 12.

Anesthesiology and Critical Care, Faculty of Medicine Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.

Dantrolene is currently the only drug known to specifically treat malignant hyperthermia (MH) crises. Although dantrolene attenuates Ca disorders by acting mainly on the ryanodine receptor type 1 (RYR1), some patients who manifest MH without variants have also been successfully treated with dantrolene. Thus, dantrolene appears to have an inhibitory effect on patients with and without variants. Read More

Anaesth Intensive Care 2022 May 12:310057X211059191. Epub 2022 May 12.

Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.

This study aimed to investigate whether there was an association between an unanticipated prolonged post-anaesthesia care unit (PACU) length of stay and early postoperative deterioration, as defined as the need for a rapid response team activation, within the first seven days of surgery. We conducted a single-centre retrospective cohort study of adult surgical patients, who stayed at least one night in hospital, and were not admitted to critical care immediately postoperatively, between 1 July 2017 and 30 June 2019. A total of 11,885 cases were analysed. Read More

Anaesth Intensive Care 2022 May 12:310057X211060845. Epub 2022 May 12.

Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.

Anaesth Intensive Care 2022 05;50(3):150-152

Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia.

Anaesth Intensive Care 2022 05 31;50(3):153-158. Epub 2022 Mar 31.

Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia.

Anaesth Intensive Care 2022 May 18;50(3):197-203. Epub 2022 Mar 18.

Department of Anaesthesia and Perioperative Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Australia.

At teaching hospitals, consultants must provide effective supervision, including appropriate selection of teaching cases, such that the outcomes achieved by trainees are similar to that of consultants. Numerous studies in the surgical literature have compared patient outcomes when surgery is performed by consultant surgeons or surgical trainees but, to our knowledge, none exist in the field of anaesthesia. We aimed to compare analgesia outcomes of regional anaesthesia when performed by supervised trainees versus consultants. Read More

Anaesth Intensive Care 2022 Mar 18:310057X211055743. Epub 2022 Mar 18.

Department of Anesthesiology, University of Illinois, Chicago, IL, USA.

Anaesth Intensive Care 2022 May 18;50(3):234-242. Epub 2022 Mar 18.

Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.

The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. Read More

Anaesth Intensive Care 2022 03;50(1-2):10-14

Adelaide Medical School, The University of Adelaide, Adelaide, Australia.

Anaesth Intensive Care 2022 05 14;50(3):255-257. Epub 2022 Mar 14.

Department of Anaesthesia, Austin Hospital, Heidelberg, Australia.

Anaesth Intensive Care 2022 Mar 14:310057X211039228. Epub 2022 Mar 14.

Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Australia.

Anaesth Intensive Care 2022 Mar 11:310057X211065048. Epub 2022 Mar 11.

Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia.

A 77-year-old lady with a laparoscopic adjustable gastric band (LAGB), implanted 12 years earlier for obesity, developed an unusual but almost fatal complication, characterised by dysphonia and stridor within minutes and a tensely swollen anterior neck. The condition mimicked haemorrhage into the subcutaneous tissues of the neck, and the airway was secured with an awake fibreoptic intubation. Subsequent computed tomography imaging of the abdomen and chest revealed megaoesophagus with dilatation up to 7 cm, proximal to the gastric band. Read More

Anaesth Intensive Care 2022 Mar 11:310057X211062614. Epub 2022 Mar 11.

Department of Anesthesia, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, USA.

SummaryThis retrospective study aimed to determine the incidence of and factors associated with peripheral intravenous extravasation in paediatric patients in the intraoperative setting. We conducted a retrospective study of 56,777 patients who underwent general anaesthesia and had peripheral intravenous catheter placement at Cincinnati Children's Hospital between 1 January 2015 and 1 January 2017. Data collected included age, American Society of Anesthesiologists Physical Status Classification, catheter site, number of cannulation attempts, ultrasound use for cannulation, surgery duration, and surgery class. Read More

Anaesth Intensive Care 2022 Mar 2;50(1-2):15-28. Epub 2022 Mar 2.

School of Languages and Cultures, and Institute for Teaching and Learning Innovation, The University of Queensland, Brisbane, Australia.

Over the last decades public discussion of opioids has changed radically. was once a word largely restricted to professional medical and pharmacological use for the treatment and management of pain. But propelled by the rapidly growing international wave of opioid use and overuse, it is now part of a much wider public discussion that covers more than pain medicine: dependency, addiction, over-prescription and oversupply, recreational drug use, and criminal drug trafficking. Read More

Anaesth Intensive Care 2022 Mar 21;50(1-2):52-67. Epub 2022 Feb 21.

Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, Australia.

Opioid-induced ventilatory impairment is the primary mechanism of harm from opioid use. Opioids suppress the activity of the central respiratory centres and are sedating, leading to impairment of alveolar ventilation.Respiratory physiological changes induced with acute opioid use include depression of the hypercapnic ventilatory response and hypoxic ventilatory response. Read More

Anaesth Intensive Care 2022 Mar 21;50(1-2):95-107. Epub 2022 Feb 21.

Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, Australia.

Opioid misuse is common, as is opioid agonist treatment of opioid dependence. Almost 3% of Australians and over 3.5% of those living in New Zealand report misuse of analgesics. Read More

Anaesth Intensive Care 2022 Mar 16;50(1-2):81-94. Epub 2022 Feb 16.

Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.

Opioids are integral to multimodal analgesic regimens in children with moderate to severe acute pain. Throughout normal childhood there are marked changes in physiology, and social and psychological development that influence the perception and expression of pain, the pharmacology of opioids, and how they are used. A multidimensional pain assessment is key to guiding appropriate opioid prescribing. Read More

Anaesth Intensive Care 2022 May 17;50(3):220-226. Epub 2022 Feb 17.

Department of Anaesthesia, Royal Brisbane and Women's Hospital, The University of Queensland, Herston, Australia.

Sugammadex has been used for more than ten years in Australia and New Zealand and has been implicated as an effective treatment, and in some cases a potential cause, of a critical incident. We aimed to identify and analyse critical incidents involving sugammadex reported to webAIRS, a de-identified voluntary online critical incident reporting system in Australia and New Zealand. We identified 116 incidents where the reporter implicated sugammadex as either a cause (23 cases) or a treatment (93 cases) during anaesthesia. Read More

Anaesth Intensive Care 2022 Mar 16;50(1-2):108-126. Epub 2022 Feb 16.

Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Fitzroy, Australia.

Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. As a result, these patients are potentially exposed to high opioid doses for prolonged periods, increasing the risk of adverse effects. Read More

Anaesth Intensive Care 2022 Mar 16;50(1-2):141-145. Epub 2022 Feb 16.

Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Canada.

Effective pain control after major surgery in neonates presents many challenges. Parenteral opioids (and co-analgesics) are often used but inadequate analgesia and oversedation are not uncommon. Although continuous thoracic epidural analgesia is highly effective and opioid-sparing, its associated risks and the need for staff with specialised skills and/or neonatal intensive care unit staff buy-in may preclude this option even in many academic centres. Read More

Anaesth Intensive Care 2022 May 16;50(3):159-168. Epub 2022 Feb 16.

Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Australia.

The most appropriate method to predict postoperative outcomes in patients with severe obesity undergoing elective non-bariatric surgery is not known. We conducted a single-centre prospective cohort study in patients with a body mass index of at least 35 kg/m undergoing non-bariatric, non-cardiac surgery. Patients completed the six-minute walk test prior to surgery. Read More

Anaesth Intensive Care 2022 Feb 16:310057X211055755. Epub 2022 Feb 16.

Department of Anaesthesia, Wellington Hospital, Wellington, New Zealand.

Anaesth Intensive Care 2022 Mar 16;50(1-2):44-51. Epub 2022 Feb 16.

Brian Dwyer Department of Anaesthesia, St Vincent's Hospital, Sydney, Australia.

Excellent resources are now available that distil the best evidence around opioid prescribing in the perioperative period, including the list of recommendations provided by the international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. While some of the recommendations have been widely accepted as an essential part of postoperative practice, others have had slow and variable adoption. This article focuses on the items where theory and practice still diverge and suggests how best to close that gap. Read More

Anaesth Intensive Care 2022 03 16;50(1-2):4-7. Epub 2022 Feb 16.

John V Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK.

Anaesth Intensive Care 2022 Feb 16:310057X211060850. Epub 2022 Feb 16.

Department of Anaesthesia, 95317Western Health, Pain and Perioperative Medicine, Western Health, Melbourne, Australia.

Anaesth Intensive Care 2022 Mar 3;50(1-2):68-80. Epub 2022 Feb 3.

Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, Australia.

Misuse of prescription opioids forced an inevitable response from authorities to intervene with consequences felt by all.In the Australian community one person will die for approximately every 3600 adults prescribed opioids, while in the hospital setting a postoperative patient managed primarily with opioids, as opposed to epidural analgesia, has an additional risk of death as high as between one in 56 to 477.Opioids maintain a valid role in acute pain management when use is reasoned and with full awareness of the harms and how they are to be avoided, such as in those at risk of ongoing use, the opioid naïve, and when opioid-induced ventilatory impairment may occur. Read More

Anaesth Intensive Care 2022 Mar 3;50(1-2):127-140. Epub 2022 Feb 3.

Discipline of Physiology, University of Adelaide, Adelaide, Australia.

Opioids remain the major drug class for the treatment of acute, chronic and cancer pain, but have major harmful effects such as dependence and opioid-induced ventilatory impairment. Although no new typical opioids have come onto the market in the past almost 50 years, a plethora of new innovative formulations has been developed to meet the clinical need. This review is intended to shed light on new understanding of the molecular pharmacology of opioids, which has arisen largely due to the genomic revolution, and what new drugs may become available in the coming years. Read More