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British Journal of Anaesthesia Sep 2021A study in this edition of the Journal has added to data showing that failures in communication in the operating room contribute to patient harm. These data support the...
A study in this edition of the Journal has added to data showing that failures in communication in the operating room contribute to patient harm. These data support the view that multidisciplinary teamwork and communication training should be part of the continuous professional development of all members of the perioperative team. Achieving change will require efforts to win the hearts and minds of all concerned, but these data also support an expectation that engagement in initiatives and techniques to enhance communication and teamwork should not be optional.
Topics: Anesthesia; Communication; Humans; Operating Rooms; Patient Care Team
PubMed: 34330413
DOI: 10.1016/j.bja.2021.06.033 -
British Journal of Anaesthesia May 2023Off-label use of medications in paediatric anaesthesia is common practice, owing to the relative paucity of evidence-based dosing regimens in children. Well-performed...
Off-label use of medications in paediatric anaesthesia is common practice, owing to the relative paucity of evidence-based dosing regimens in children. Well-performed dose-finding studies, especially in infants, are rare and urgently needed. Unanticipated effects can result when paediatric dosing is based on adult parameters or local traditions. A recent dose-finding study on ephedrine highlights the uniqueness of paediatric dosing in comparison with adult dosing. We discuss the problems of off-label medication use and the lack of evidence for various definitions of hypotension and associated treatment strategies in paediatric anaesthesia. What is the aim of treating hypotension associated with anaesthesia induction: restoring the MAP to awake baseline values or elevating it above a provisional hypotension threshold?
Topics: Adult; Infant; Humans; Child; Ephedrine; Vasoconstrictor Agents; Anesthesia, Spinal; Hypotension; Anesthesia, Obstetrical
PubMed: 36906461
DOI: 10.1016/j.bja.2023.02.007 -
PeerJ 2023Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia.
METHODS
The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023.
RESULTS
Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81-1.14]; = 0.65; I= 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [-0.54-8.16]; = 0.09; I= 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86-12.79]; < 0.0001; I= 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia.
CONCLUSIONS
Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.
Topics: Humans; Anesthesia, Local; Anesthetics, Local; Pain; Injections; Pain Measurement
PubMed: 37520252
DOI: 10.7717/peerj.15734 -
British Journal of Anaesthesia Apr 2022Anaesthesia exposure early in life potentially impairs neurobehavioural development. A recent study in the Journal investigated the possibility that progesterone...
Anaesthesia exposure early in life potentially impairs neurobehavioural development. A recent study in the Journal investigated the possibility that progesterone mitigates anaesthesia-induced developmental neurotoxicity in neonatal rats exposed to sevoflurane. The novel findings show that the steroid hormone progesterone protects against development of behavioural alterations caused by sevoflurane. The protective mechanism is proposed to relate to anti-inflammatory properties of progesterone, which brings up important questions regarding the role of inflammation in mediating the neurobehavioural alterations in anaesthesia-induced developmental neurotoxicity. We discuss this mechanism and encourage new research that may clarify the underlying mechanisms of progesterone-induced protection and extend these findings into a translational model.
Topics: Anesthesia; Animals; Humans; Inflammation; Neurotoxicity Syndromes; Rats; Sevoflurane
PubMed: 35115157
DOI: 10.1016/j.bja.2021.12.040 -
Anaesthesiology Intensive Therapy 2023Medication error has emerged as a significant problem in healthcare, especially in the past 2 decades. In anaesthesia, the paediatric age group is particularly at risk... (Review)
Review
Medication error has emerged as a significant problem in healthcare, especially in the past 2 decades. In anaesthesia, the paediatric age group is particularly at risk of such events because of complex age- and weight-based drug calculation, drug formulations, serial dilutions, and often limited staff experience in handling such patients. We searched PubMed, Cochrane, and Google Scholar for literature on medication errors in paediatric anaesthesia in children (< 18 years of age). Two authors searched for the articles independently, and a third author sorted any consensus differences. A total of 2979 articles were retrieved. We studied primary outcomes, the results, and conclusions of the various studies. A total of 21 relevant articles were selected finally. Following preventive strategies like colour coding, accurate dose calculations, verification by a second individual, and checking and encouraging self-reporting can improve perioperative safety in the paediatric population to a significant extent.
Topics: Humans; Child; Anesthesia; Anesthesiology; Consensus; Medication Errors
PubMed: 37728452
DOI: 10.5114/ait.2023.130837 -
Anaesthesia, Critical Care & Pain... Oct 2019
Topics: Analgesics, Opioid; Anesthesia; Anesthesiology
PubMed: 31078798
DOI: 10.1016/j.accpm.2019.05.002 -
British Journal of Anaesthesia Sep 2020
Topics: Anesthesia, General; Anesthesiology; Biomarkers; Brain; Humans
PubMed: 32650952
DOI: 10.1016/j.bja.2020.05.036 -
Anaesthesia Jan 2022Traumatic brain injury is the alteration in brain function due to an external force. It is common and affects millions of people worldwide annually. The World Health... (Review)
Review
Traumatic brain injury is the alteration in brain function due to an external force. It is common and affects millions of people worldwide annually. The World Health Organization estimates that 90% of global deaths caused by injuries occur in low- and middle-income countries, with traumatic brain injury contributing up to half of these trauma-related deaths. Patients with traumatic brain injury in low- and middle-income countries have twice the odds of dying compared with their counterparts in high-income countries. Sedation is a key element of care in the management of traumatic brain injury, used for its neuroprotective effects and to prevent secondary brain injury. While sedatives have the potential to improve outcomes, they can be challenging to administer and have potentially dangerous complications. Sedation in low-resource settings should aim to be effective, safe, affordable and feasible. In this paper, we summarise the indications for sedation in traumatic brain injury, the choice of sedative drugs and the pragmatic management and monitoring of sedated traumatic brain injury patients in low-resource settings.
Topics: Anesthesia; Brain Injuries, Traumatic; Clinical Decision-Making; Health Resources; Humans; Hypnotics and Sedatives; Poverty
PubMed: 35001384
DOI: 10.1111/anae.15621 -
British Journal of Anaesthesia Dec 2023Cancer is a growing global burden; there were an estimated 18 million new cancer diagnoses worldwide in 2020. Excisional surgery remains one of the main treatments for... (Review)
Review
Cancer is a growing global burden; there were an estimated 18 million new cancer diagnoses worldwide in 2020. Excisional surgery remains one of the main treatments for solid organ tumours in cancer patients and is potentially curative. Cancer- and surgery-induced inflammatory processes can facilitate residual tumour cell survival, growth, and subsequent recurrence. However, it has been hypothesised that anaesthetic and analgesic techniques during surgery might influence the risk of cancer recurrence. This narrative review aims to provide an updated summary of recent observational studies and new randomised controlled clinical trials on whether certain specific anaesthetic and analgesic techniques or perioperative interventions during tumour resection surgery of curative intent materially affect long-term oncologic outcomes.
Topics: Humans; Neoplasm Recurrence, Local; Anesthesia; Anesthetics; Analgesics
PubMed: 37689540
DOI: 10.1016/j.bja.2023.07.027 -
JNMA; Journal of the Nepal Medical... Apr 2020Critical incidents related to peri-operative anesthesia carry a risk of unwanted patient outcomes. Studying those helps detect problems, which is crucial in minimizing...
INTRODUCTION
Critical incidents related to peri-operative anesthesia carry a risk of unwanted patient outcomes. Studying those helps detect problems, which is crucial in minimizing their recurrence. We aimed to identify the frequency of peri-anesthetic critical incidents.
METHODS
This is a hospital-based descriptive cross-sectional study of voluntarily reported incidents, which occurred during anesthesia or following 24 hours among patients subjected to non-cardiac surgery within the calendar year 2019. Patient characteristics, anesthesia, and surgery types, category, context, and outcome of incidents were recorded in an indigenously designed form. Incidents were assigned to attributable (patient, anesthesia or surgery) factor, and were analyzed for the system,equipment or human error contribution.
RESULTS
Altogether 464 reports were studied, which consisted of 524 incidents. Cardiovascular category comprised of 345 (65.8%) incidents. Incidents occurred in 433 (93%) otherwise healthy patients and during 258 (55.6%) spinal anesthetics. Obstetric surgery was involved in 179 (38.6%) incidents. Elective surgery and anesthesia maintenance phase included the context in 293 (63%)and 378 (72%) incidents respectively. Majority incidents 364 (69.5%) were anesthesia-attributable, with system and human error contribution in 196 (53.8%) and 152 (41.7%) cases respectively. All recovered fully except for 25 cases of mortality, which were mostly associated with patient factors, surgical urgency, and general anesthesia.
CONCLUSIONS
Critical incidents occur even in low-risk patients during anesthesia delivery. Patient factors and emergency surgery contribute to the most serious incidents.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia, General; Anesthetics; Child; Child, Preschool; Cross-Sectional Studies; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Infant; Intraoperative Period; Male; Middle Aged; Nepal; Postoperative Period; Risk Factors; Young Adult
PubMed: 32417861
DOI: 10.31729/jnma.4821