Anaesthesia In Theatre Research Articles

Five-year audit of adherence to an anaesthesia pre-induction checklist.

SummaryAlthough patient safety related to airway management has improved substantially over the last few decades, life‐threatening events still occur. Technical skills, clinical expertise and human factors contribute to successful airway management. Checklists aim to improve safety by providing a structured approach to equipment, personnel and decision‐making. This audit investigates adherence to our institution's airway checklist from 1 June 2016 to 31 May 2021. Inclusion criteria were procedures requiring airway management and we excluded all procedures performed solely under regional anaesthesia, sedation without airway management or paediatric and cardiovascular surgery. The primary outcome was the proportion of wholly performed pre‐induction checklists. Secondary outcomes were the pattern of adherence over the 5 years well as details of airway management, including: airway management difficulties; time and location of induction; anaesthesia teams in operating theatres (including teams for different surgical specialities); non‐operating theatre and emergency procedures; type of anaesthesia (general or combined); and urgency of the procedure. In total, 95,946 procedures were included. In 57.3%, anaesthesia pre‐induction checklists were completed. Over the 5 years after implementation, adherence improved from 48.3% to 66.7% (p < 0.001). Anticipated and unanticipated airway management difficulties (e.g. facemask ventilation, supraglottic airway device or intubation) defined by the handling anaesthetist were encountered in 4.2% of all procedures. Completion of the checklist differed depending on the time of day (61.3% during the day vs. 35.0% during the night, p < 0.001). Completion also differed depending on location (66.8% in operating theatres vs. 41.0% for non‐operating theatre anaesthesia, p < 0.001) and urgency of procedure (65.4% in non‐emergencies vs. 35.4% in emergencies, p < 0.001). A mixed‐effect model indicated that urgency of procedure is a strong predictor for adherence, with emergency cases having lower adherence (OR 0.58, 95%CI 0.49–0.68, p < 0.001). In conclusion, over 5 years, a significant increase in adherence to an anaesthesia pre‐induction checklist was found, and areas for further improvement (e.g. emergencies, non‐operating room procedures, night‐time procedures) were identified.

Isolated upper vaginal wall laceration in an underage: a need to re-examine child sexual abuse in South-South Nigeria.

&lt;p&gt;Child sexual abuse includes any sexual act between a minor and an adult, or between two minors, when one exerts power over the other. It involves forcing, coercing or persuading a child to engage in any type of sexual act. It also involves non-contact acts such as exhibitionism, exposure to pornography, voyeurism, and communicating in a sexual manner by phone or internet. An eight-year-old girl was rushed to the gynaecological emergency unit of the Federal medical centre, Yenagoa with complaints of a three-hour history of sudden onset vaginal bleeding following a fall astride in their house. There was no injury to the vulva and the child and her relatives denied any form of sexual abuse by anyone within or outside their home. She had examination under anaesthesia in theatre and a 3 cm laceration was identified at the proximal one-third of the left lateral wall of the vagina, covered with a blood clot; not bleeding actively. Repair was done and she was subsequently discharged home on the fourth post-operative day after counselling of mother and child. Child sexual abuse is common in our environment. Education and bonding with children, education of the public via outreaches, social media campaigns and other means possible, and improvement in the socio-economic situation of people will help reduce the incidence of child sexual abuse and encourage reporting and early disclosure where they occur.&lt;/p&gt;

Self-harm by Sharp Foreign Body Ingestion.

Ingestion of sharp foreign bodies is a less frequently encountered method of selfharm. This study aims to follow up patients presenting with foreign body (FB) ingestion requiring urgent endoscopic intervention under general anaesthetic in theatre, characterise each patient and establish whether admission or removal of the FB promotes further self-harm. Eleven adult patients, totalling 38 presentations over a 28-month period were identified. Each was followed up from an initial presentation requiring endoscopy. 9/11 (81.9%) where transferred either from prison or psychiatric care with an extensive history of multimodal and usually violent self-harm. Of these 8/9 (88.9%) had a formal psychiatric diagnosis linked to their previous self-harm. Objects retrieved included pens, razor blades, cutlery, wiring, batteries, a metal screw and a TV aerial. The median time between presentations with self-harm was 11 days. Those discharged from the emergency department re-presented after a median of 7.5 days. This was longer, at 14 days, if admitted to hospital; with those having endoscopic procedures re-presenting after a median of 11 days. Inpatient endoscopic removal of the FB was not associated with an earlier presentation with further self-harm when compared with discharge straight form A+E, but was frequently repeated, often in a characterised manner.

Outside the Operating Theatre Anaesthesia

Modern hospital practice has seen the role of the anaesthesiogist expand beyond the operating theatre complex. While the operating theatres have experienced staff, adequate equipment and monitors, providing anaesthesian outside this complex is challenging and requires expertise and skill. Journal of Bangladesh Society of Anaesthesiologists 2015; 28(1): 32-38

INTRANASAL KETAMINE FOR PROCEDURAL SEDATION

Objectives &amp; BackgroundThe safety of intravenous ketamine in procedural sedation is well described.1 2Guidelines produced by NICE3and the College of Emergency Medicine4are used by Emergency Departments (ED) nationwide. To avoid cannulation, opioids are frequently administered to children intranasally5, avoiding first-pass metabolism.6Intranasal ketamine (INK) is an effective analgesic in children7and has been successfully utilised in prehospital and military settings.8 9However, a recent survey revealed that INK is not currently in use in UK paediatric EDs.10To determine the current level of evidence of the use of INK in procedural sedation in children we developed a clinical scenario and three part question.A 4 year old child presents with a lip laceration. Options for closure are under procedural sedation in the ED or general anaesthetic in theatre. You feel he would be suitable for procedural sedation. Your department's policy is intravenous ketamine. However the child is very upset and you feel the trauma of cannulation will adversely affect quality of sedation. Would INK be an alternative?MethodsIn [children undergoing procedural sedation] does [intranasal ketamine] result in [rapid onset, safe, effective sedation without prolonged recovery]?Using the search strategy outlined in table 1, seven relevant papers were identified.11–18ResultsEfficacyINK can be successfully used to sedate children for dental procedures at 3–6 mg/kg.11–135 mg/kg facilitates cannulation prior to induction of anaesthesia.14–16An ED based double-blinded RCT compared sedation with 3,6 and 9mg/kg INK17. The study was small and was terminated early due to high sedation failures.SafetyAll studies demonstrated 3–9 mg/kg INK is safe, with no serious adverse events.EfficiencyAt 3–9mg/kg, time to onset ranged from 3.6–9.4 minutes with recovery time between 30–69 minutes.11–17ConclusionAn ideal agent for procedural sedation in the Paediatric ED is safe, easily delivered with rapid onset and recovery. The limited but growing evidence supports the use of INK to achieve this, although ideal dose is still unclear. All published studies to date have varying flaws with strict protocols defining adequate sedation and a lack of validated dissociative sedation scale potentially limiting reported success. More studies are emerging with a recent proposal presented to the PERUKI group. INK may still make its way into Paediatric EDs in the not too distant future.

Continuing need for and provision of a service for non-standard implant removal

Background and methodologyInformation is presented on the management of women referred to a sexual health service during a 1-year period for management of a non-palpable contraceptive implant or of a...

The cost of microwave endometrial ablation under different anaesthetic and clinical settings

To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting. The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting. Department of Gynaecology, Aberdeen Royal Infirmary, Scotland. One hundred and twenty-seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic. Health and non-health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting. Health and non-health service costs. There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non-health cost of microwave endometrial ablation was 440 pounds and 120 pounds, respectively, under general anaesthetic and 428 pounds and 125 pounds per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be 432 pounds per treatment; however, this varied from 389 pounds to 491 pounds in the sensitivity analysis. There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re-admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model.

The cost of microwave endometrial ablation under different anaesthetic and clinical settings

Objective To compare the costs of microwave endometrial ablation under local anaesthetic and general anaesthetic in an operating theatre and to estimate the cost of performing treatment under local anaesthetic in a dedicated clinic setting. Design The costing study was undertaken alongside a randomised controlled trial comparing the acceptability of microwave endometrial ablation using local versus general anaesthetic in a theatre setting. Setting Department of Gynaecology, Aberdeen Royal Infirmary, Scotland. Sample One hundred and twenty-seven women undergoing microwave endometrial ablation who had been randomly allocated to general or local anaesthetic. Methods Health and non-health service resource use was recorded prospectively. Data on resource use were combined with unit costs estimated using standardised methods to determine the cost per patient for microwave endometrial ablation under local or general anaesthetic in theatre. A model was developed to estimate the health service cost of microwave endometrial ablation under local anaesthetic in a clinic setting. Main outcome measures Health and non-health service costs. Results There was little difference in cost when treatments were performed under local or general anaesthetic in theatre. The median health and non-health cost of microwave endometrial ablation was £440 and £120, respectively, under general anaesthetic and £428 and £125 per women under local anaesthetic. The health service cost of microwave endometrial ablation using local anaesthetic in a clinic setting was estimated to be £432 per treatment; however, this varied from £389 to £491 in the sensitivity analysis. Conclusion There are minimal cost savings to the patient or health service from using local rather than general anaesthetic for microwave endometrial ablation in a theatre setting. Cost modelling suggests that in a clinic setting microwave endometrial ablation has a similar cost to theatre based treatment once re-admissions for treatment under general anaesthetic are considered. Sensitivity analysis indicated that these findings were sensitive to assumptions in the model.

The implications of HIV for the anaesthetist and the intensivist.

The acquired immune deficiency syndrome has reached pandemic proportions. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed, symptomatic and asymptomatic, human immunodeficiency virus-infected patients in the fields of intensive therapy, operating theatre anaesthesia, obstetrics and pain management. With recent advances, important insights have been gained into the pathogenesis of human immunodeficiency virus. Molecular techniques allow quantification of viral burden, and together with CD4 T-lymphocyte count, prognosis and response to therapy can be evaluated. New drugs and therapeutic regimens have improved prognosis for those who are infected with the virus and vertical transmission of infection from mother to infant can be minimised. Should accidental occupational exposure to the virus occur, a prophylactic regimen of antiretroviral drugs can be administered in an attempt to prevent subsequent human immunodeficiency virus infection.

Endometrial assessment procedures: an audit of current practice in Scotland.

The objective was to determine, in relation to endometrial assessment procedures, the extent to which the current practice of gynaecologists in Scotland (as assessed both by questionnaire survey of clinicians and review of hospital records) accords with recommendations in recent evidence-based guidelines. All 132 consultant gynaecologists in Scotland were surveyed and 123 (93%) responded. In addition, the case records of 1199 consecutive women undergoing endometrial assessment procedures in 12 representative hospitals were reviewed. Over two thirds of consultants agreed that endometrial assessment procedures are seldom indicated in women aged under 40 years and over 80% agreed that when such procedures are indicated, outpatient endometrial biopsy represents the method of choice. However, the review of case records showed that 23% of the women who underwent endometrial assessment were aged under 40 years and only 44% of the procedures undertaken were out-patient endometrial biopsies. We conclude that some Scottish women may be undergoing endometrial assessment procedures unnecessarily and that, in some centres, traditional dilatation and curettage is being replaced by hysteroscopy under general anaesthetic in theatre although there is no evidence that this procedure provides more clinically useful information than out-patient endometrial biopsy.

AIDS and anaesthesia.

The Acquired Immune Deficiency Syndrome (AIDS) is a group of conditions which is reaching epidemic proportions. It is caused by a virus new to man, with an as yet poorly understood natural history, ominous prognosis and no known cure. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed AIDS patients and asymptomatic carriers in the fields of resuscitation, intensive therapy and theatre anaesthesia. The misunderstanding of AIDS is as extensive as the literature on the subject and a review of the current knowledge of the disease relevant to the anaesthetist is pertinent.