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British Journal of Anaesthesia Dec 2017The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the... (Review)
Review
The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the affected country is least able to respond. For this reason an international disaster response is often required. For many years this disaster response was not coordinated. The response consisted of what was available not what was needed and standards of care varied widely producing a healthcare lottery for the affected population. In recent years the World Health organisation has initiated the Emergency Medical Team programme to coordinate the response to disasters and set minimum standards for responding teams. Anaesthetists have a key role to play in Level 2 Surgical Field Hospitals. The disaster context produces a number of logistical challenges that directly impact on the anaesthetist requiring adaptation of anaesthetic techniques from their everyday practice. The context in which they will be working and the wider scope of practice that will be expected from them in the field mandates that deploying anaesthetists should be trained for disaster response. There have been significant improvements in recent years in the speed of response, equipment availability, coordination and training for disasters. Future challenges include increasing local disaster response capacity, agreeing international standards for training and improving data collection to allow for future research and improvement in disaster response. The goal of this review article is to provide an understanding of the disaster context and what logistical challenges it provides. There has been a move during the last decade from a globally uncoordinated, unregulated response, with no consensus on standards, to a globally coordinated response through the World Health Organisation (WHO). A classification system for responding Emergency Medical Teams (EMTs) and a set of agreed minimum standards has been defined. This review outlines the scope of the role of the anaesthetist in a Level 2 field hospital and some of the challenges that this scope and context present. It focuses mainly on natural disasters, but also outline some of the differences encountered in responding to other global disasters such as conflict and infectious outbreaks, and concludes with some of the challenges for the future.
Topics: Anesthesiology; Anesthetics; Disasters; Emergencies; Global Health; Humans; Internationality
PubMed: 29161394
DOI: 10.1093/bja/aex353 -
British Journal of Anaesthesia Jan 2023Over the 90 years since the first description of one-lung ventilation, the practice of thoracic surgery and anaesthesia continues to develop. Minimally invasive surgical...
Over the 90 years since the first description of one-lung ventilation, the practice of thoracic surgery and anaesthesia continues to develop. Minimally invasive surgical techniques are increasingly being used to minimise the surgical insult and facilitate improved outcomes. Challenging these outcomes, however, are parallel changes in patient characteristics with more older and sicker patients undergoing surgery. Thoracic anaesthesia as a speciality continues to respond to these challenges with evolution of practice and strong academic performance.
Topics: Humans; Anesthesia; Thoracic Surgical Procedures; Anesthesiology; One-Lung Ventilation; Anesthetics
PubMed: 36470744
DOI: 10.1016/j.bja.2022.10.034 -
Brazilian Journal of Anesthesiology... 2017Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to... (Review)
Review
Medication errors are the common causes of patient morbidity and mortality. It adds financial burden to the institution as well. Though the impact varies from no harm to serious adverse effects including death, it needs attention on priority basis since medication errors' are preventable. In today's world where people are aware and medical claims are on the hike, it is of utmost priority that we curb this issue. Individual effort to decrease medication error alone might not be successful until a change in the existing protocols and system is incorporated. Often drug errors that occur cannot be reversed. The best way to 'treat' drug errors is to prevent them. Wrong medication (due to syringe swap), overdose (due to misunderstanding or preconception of the dose, pump misuse and dilution error), incorrect administration route, under dosing and omission are common causes of medication error that occur perioperatively. Drug omission and calculation mistakes occur commonly in ICU. Medication errors can occur perioperatively either during preparation, administration or record keeping. Numerous human and system errors can be blamed for occurrence of medication errors. The need of the hour is to stop the blame - game, accept mistakes and develop a safe and 'just' culture in order to prevent medication errors. The newly devised systems like VEINROM, a fluid delivery system is a novel approach in preventing drug errors due to most commonly used medications in anesthesia. Similar developments along with vigilant doctors, safe workplace culture and organizational support all together can help prevent these errors.
Topics: Anesthesia; Anesthesiology; Anesthetics; Drug-Related Side Effects and Adverse Reactions; Humans; Intensive Care Units; Medication Errors; Quality Improvement
PubMed: 28236867
DOI: 10.1016/j.bjane.2015.09.006 -
Revista Brasileira de Anestesiologia 2009Although the absence of negative effects of prolonged exposure to anesthetic gases residue has been reported, controversies on the subject still linger. Contradictory... (Review)
Review
BACKGROUND AND OBJECTIVES
Although the absence of negative effects of prolonged exposure to anesthetic gases residue has been reported, controversies on the subject still linger. Contradictory data on the variability in individual response to different agents can be found in the literature. The objective of this report was to present a review of occupational exposure to anesthetic gases residue.
CONTENTS
The results of the main articles on the subject, as well as the causes of contamination of the surgical environment, ventilation, exhaust system, monitoring, and dosage of anesthetic gases residues are discussed. Recommendations to minimize the supposed effects of inhalational agents are emphasized.
CONCLUSIONS
Even in task-forces studies of renowned international regulating institutions, there are some controversies on the risks of occupational exposure to anesthetic gases residue. Minimal values for occupational exposure are stipulated, but acknowledging the lack of epidemiological evidence of any type of damage caused by said exposure in places where standard measures of ventilation and exhaust systems and the use of anesthetic equipment are observed. In our country, most of the time those measures are not implemented and, when they are, they are not supervised properly. Besides, differences in techniques and working conditions have to be considered. Taking into consideration the multifactorial nature of the exposure of health care professionals, measures should be undertaken to minimize occupational exposure to agents with known or probable toxic potential. The demand for better equipped operating rooms, with adequate ventilation and exhaust systems as well as their maintenance should be stimulated.
Topics: Anesthesia; Anesthesiology; Anesthetics, Inhalation; Humans; Occupational Exposure; Operating Rooms
PubMed: 19374222
DOI: 10.1590/s0034-70942009000100014 -
Journal of Neurosurgical Anesthesiology Oct 2014The results of several retrospective clinical studies suggest that exposure to anesthetic agents early in life is correlated with subsequent learning and behavioral... (Review)
Review
The results of several retrospective clinical studies suggest that exposure to anesthetic agents early in life is correlated with subsequent learning and behavioral disorders. Although ongoing prospective clinical trials may help to clarify this association, they remain confounded by numerous factors. Thus, some of the most compelling data supporting the hypothesis that a relatively short anesthetic exposure can lead to a long-lasting change in brain function are derived from animal models. The mechanism by which such changes could occur remains incompletely understood. Early studies identified anesthetic-induced neuronal apoptosis as a possible mechanism of injury, and more recent work suggests that anesthetics may interfere with several critical processes in brain development. The function of the mature brain requires the presence of circuits, established during development, which perform the computations underlying learning and cognition. In this review, we examine the mechanisms by which anesthetics could disrupt brain circuit formation, including effects on neuronal survival and neurogenesis, neurite growth and guidance, formation of synapses, and function of supporting cells. There is evidence that anesthetics can disrupt aspects of all of these processes, and further research is required to elucidate which are most relevant to pediatric anesthetic neurotoxicity.
Topics: Anesthesia; Anesthesiology; Anesthetics; Brain; Child; Humans; Neurotoxicity Syndromes
PubMed: 25144504
DOI: 10.1097/ANA.0000000000000118 -
Minerva Anestesiologica Mar 2021Anesthetic records facilitate information transmission to the next healthcare professional and should contain all relevant information of perioperative care. While most...
BACKGROUND
Anesthetic records facilitate information transmission to the next healthcare professional and should contain all relevant information of perioperative care. While most anesthesia societies provide guidelines for record content, important topics like hemotherapy and hemostatic therapy are not well represented. We considered the quality of anesthetic records with regard to the documentation options for hemotherapy and hemostatic therapy. A secondary objective was to examine guidelines for appropriate recommendations.
METHODS
Anesthetic records of international anesthesiology departments were evaluated for the presence of 20 defined fields associated with hemotherapy, hemostatic and fluid therapy as well as intraoperative diagnostics and monitoring. International guidelines were reviewed for appropriate recommendations.
RESULTS
A total of 98 anesthetic records from eight countries and guidelines of six anesthesia societies were analyzed. Data fields for red blood cell transfusion have been found in 29.3% (95% CI 0.20 to 0.38), ABO-testing in 6.1% (95% CI 0.01 to 0.11) and indication for transfusion in 2.0% (CI 0.00 to 0.05) of records. Most records contain fields for blood loss (94.4%; 95% CI 0.91 to 0.99) and diuresis (87.9%; 95% CI 0.81 to 0.94). International guidelines that were analyzed do not cover the topic of transfusion, but most give recommendations on basic monitoring, blood loss and fluid management documentation.
CONCLUSIONS
Most of the evaluated anesthetic records did not contain fields for relevant aspects of perioperative hemotherapy, hemostatic therapy and diagnostics. Guidelines and protocols for anesthetic documentation should include these topics to ensure information transfer and patient safety.
Topics: Anesthesia; Anesthesiology; Anesthetics; Blood Transfusion; Documentation; Humans
PubMed: 33319948
DOI: 10.23736/S0375-9393.20.14828-4 -
Anaesthesiology Intensive Therapy 2022I have attentively read the article "Minute Zero: an essential assessment in peri-operative ultrasound for anaesthesia" by Elena Segura-Grau et al. [1]. The authors have...
I have attentively read the article "Minute Zero: an essential assessment in peri-operative ultrasound for anaesthesia" by Elena Segura-Grau et al. [1]. The authors have suggested using point-of-care ultrasonography (POCUS) as part of a comprehensive anaesthetic assessment in the perioperative period. Such an extension of the standard perioperative examination aimed at searching for pathologies that may affect the intra- and postoperative course performed by an anaes-thesiologist seems fully justified and may have a significant impact on treatment outcomes [2]. In the "Minute Zero" model, the authors have suggested that POCUS assessment of anaesthetised patients should be carried out twice - on admission to the operating theatre and before transfer to the postoperative ward. The described scheme is based on the well-known eFAST, FATE and BLUE protocols (assessment to determine the presence of free fluid in the body cavities, basic cardiac assessment, including IVC, and lung ultrasound assessment). The examination conducted in the manner specified by the authors provides a general but holistic picture of the patient, focused at detecting life-threatening pathologies. It is right to include a preoperative assessment of the filling of the stomach in the protocol, as the surface area of the pylorus found on ultrasound scans indicates the risk of aspiration during the induction of general anaesthesia [3, 4]. This may be of particular importance in patients undergoing emergency procedures, with gastrointestinal obstruction or in those with difficult contact (mainly children and the elderly). In the algorithm described, the assessment of bladder filling in the postoperative period has been emphasised. This is a huge asset, which is often overlooked and, as the authors rightly point out, can cause postoperative delirium, especially in the elderly. The authors have developed an examination card that enables to document the examination in a simple and transparent manner based on markings of the appropriate blanks, which makes the protocol very friendly. The additional pros of the publication are the attached sample ultrasound images, which perfectly illustrate the ease of diagnosis of basic pathologies.
Topics: Aged; Anesthesia, General; Anesthesiology; Anesthetics; Child; Humans; Point-of-Care Systems; Ultrasonography
PubMed: 35193330
DOI: 10.5114/ait.2022.113490 -
British Journal of Anaesthesia Nov 2021This editorial highlights the findings of the Balanced Anaesthesia Delirium study, a 515-patient substudy of the 6644 patient Balanced Anaesthesia trial, which found...
This editorial highlights the findings of the Balanced Anaesthesia Delirium study, a 515-patient substudy of the 6644 patient Balanced Anaesthesia trial, which found that targeting deep anaesthesia in patients undergoing major noncardiac surgery was not associated with significantly increased postoperative death or major morbidity. The substudy found that using bispectral index (BIS) guidance with the intention of deliberately achieving deep volatile agent-based anaesthesia (target BIS reading 35 vs 50) significantly increased delirium incidence (28% vs 19%), although not subsyndromal delirium incidence (45% vs 49%). We discuss the implications of these findings for anaesthetic practice, and address whether the BIS should be used as a guide to deliver precision anaesthesia for delirium prevention. We posit that subpopulation-based differences within this multicentre substudy could have affected delirium occurrence, since the findings appeared to rest on outcomes in patients from East Asia. We conclude that questions of whether and for whom deep anaesthesia is deliriogenic remain unanswered.
Topics: Anesthesia, General; Anesthesiology; Anesthetics; Delirium; Humans
PubMed: 34503835
DOI: 10.1016/j.bja.2021.08.003 -
Anaesthesia May 2022
Topics: Anesthesiology; Anesthetics; Humans; Pandemics
PubMed: 35064569
DOI: 10.1111/anae.15642 -
European Journal of Medical Research Mar 2024Big data technologies have proliferated since the dawn of the cloud-computing era. Traditional data storage, extraction, transformation, and analysis technologies have... (Review)
Review
Big data technologies have proliferated since the dawn of the cloud-computing era. Traditional data storage, extraction, transformation, and analysis technologies have thus become unsuitable for the large volume, diversity, high processing speed, and low value density of big data in medical strategies, which require the development of novel big data application technologies. In this regard, we investigated the most recent big data platform breakthroughs in anesthesiology and designed an anesthesia decision model based on a cloud system for storing and analyzing massive amounts of data from anesthetic records. The presented Anesthesia Decision Analysis Platform performs distributed computing on medical records via several programming tools, and provides services such as keyword search, data filtering, and basic statistics to reduce inaccurate and subjective judgments by decision-makers. Importantly, it can potentially to improve anesthetic strategy and create individualized anesthesia decisions, lowering the likelihood of perioperative complications.
Topics: Humans; Big Data; Anesthesiology; Cloud Computing; Anesthesia; Anesthetics; Decision Support Techniques
PubMed: 38528564
DOI: 10.1186/s40001-024-01764-0