Anaesthetics
Recent Submissions
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Beyond the pleura : bedside ultrasound evaluation of extravascular lung water in patients undergoing haemodialysisThis poster abstract from the British Thoracic Society Winter Meeting 2019 presents the results of a study into the use of bedside ultrasound evaluation of extravascular lung water in patients undergoing haemodialysis.
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The role of injection procedures in a multi-disciplinary chronic pain clinicThis e-poster abstract from the European Society of Regional Anesthesia presents results from data on the role of injection procedures in a multi-disciplinary chronic pain clinic.
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Insatiable thirst : is obstetric hyponatraemia under recognised?This Obstetric Anaesthetists' Association annual meeting case report abstract highlights the risk of obstetric hyponatraemia if women drink excessive water during labour.
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Current trends in the use of supraglottic airway device – a multicentre surveyThis European Airway Management Society (EAMS) conference abstract reports the results of a multicentre survey of current trends in the use of supraglottic airway devices.
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Prevalence of overt and covert regurgitation with supraglottic airway devices – a multicentre surveyThis European Airway Management Society (EAMS) conference abstract reports the results of a multicentre survey of the prevalence of overt and covert regurgitation with supraglottic airway devices.
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The patients' perspective : how communication from anaesthetists can induce relaxation before the drugsAbstract from the Trainee Conference 2021, 8‐9 July 2021, Newcastle, UK and hybrid conference discussing a survey of patient experiences with anaesthetists.
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Suprainguinal fascia iliaca with pericapsular nerve group block for fractured neck of femur vs. traditional approaches : a better way?Patients presenting with fractured neck of femur are predominantly elderly with often acutely deranged physiology, multiple comorbidities and limited physiological reserve. This places them at high risk of morbidity associated with surgery and emphasises the importance of optimum anaesthetic management. No clear evidence supports any single anaesthetic technique [1] and so considerable variation in peri-operative management exists. Peripheral nerve blockade reduces opioid requirements and total intravenous anaesthesia (TIVA) eliminates exposure to volatile anaesthetics that have been implicated in postoperative cognitive decline (POCD) and delirium [2]. For the purposes of this study, intervention refers to ultrasound-guided suprainguinal fascia iliaca (SIFI) and pericapsular nerve group (PENG) block with TIVA whereas control refers to all other anaesthetic techniques recorded. Methods An observational study was undertaken comparing patient outcome following emergency surgery for fractured neck of femur. Sixteen consecutive patients recruited prospectively to the intervention group from our scheduled trauma sessions from January to May 2019. Control patients were selected retrospectively from all trauma lists during the same period using online random number generation software to a total of 16. Patients were followed up manually by review of ward notes and drug charts. Results Group demographics were comparable in the control and intervention groups, with hemiarthroplasty being the most common operative procedure overall. Anaesthetic technique in the control group was predominantly spinal or volatile general anaesthesia with combinations of no block, fascia iliac and/or femoral nerve block. Total 24-h postoperative morphine administration was greater in the control group. In the control group, pain was an issue for five patients and three patients suffered from delirium. There were no documented issues in the intervention group. Discussion Our results suggest that ultrasound-guided regional anaesthesia targeting the lateral femoral cutaneous nerve of the thigh in combination with articular branches of the femoral and obturator nerves through the recently described PENG block has a place in combination with TIVA as an established protocol for anaesthetic in fractured neck of femur. Patients in this group required no intra-operative morphine and had greatly reduced analgesic requirements with no reported issues in the postoperative period.
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What are medical students’ perceptions of human factors in simulated learning events: a thematic analysisIntroduction Human factors, such as communication skills, are imperative to good patient care. In post-simulation debriefs we discuss these non-technical skills with medical students regularly, but do we have a good appreciation of what the terms mean to them, or what aspects of behaviour, good or bad, they focus on? Method Six human-factor sheets were developed to guide the students in their analysis of events in simulated scenarios. The sheets focused on one of: communication, teamwork, decision making, task management, situational awareness, or a final overview. A brief introduction to each factor was given as well as examples of good practice. The students were encouraged to record in writing what aspects of the scenario went well, and what could be improved, for a chosen skill. These sheets were then collected at the end of the session, with the students’ consent, for anonymous analysis. Data collection commenced last month and will run until December, with an estimated inclusion of about 100 students from two universities. The data will be analysed using thematic analysis performed by multiple researchers. Discussion If we can understand what aspects of these non-technical skills are considered important to our students early on in their career we can better tailor our teaching, both in simulation and in the clinical environment, to foster better performance throughout their training. By understanding what our students perceive, analyse, and internalise we can also reflect on our own practice and interactions to consider how we project as role models to our future colleagues.
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Transferring critically ill Covid-19 patients in ITU - A multidisciplinary training exerciseIntroduction During Covid-19 many staff members were redeployed to the Intensive Care Unit (ICU) with little opportunity to train in the new skills they would require. One such skill was the transfer of a critically ill, and contagious, patient from ICU; a risky and complicated procedure which requires planning, preparation, risk assessment, situational awareness and, ideally, experience. To assist our colleagues in this skill an existing ICU transfer course has been adapted to cover the Covid-19 situation, or any similar contagious pandemic, in patient transfer. Methods An in-situ simulation method was chosen as the most realistic method of immersing our participants into the environment of ICU and to highlight real-life complexities and issues they may face. A multidisciplinary training session was devised so that novice anaesthetists, ACCPs and nurses could learn together, reflective of the usual team. Human factors such as communication, team leadership, task management and situational awareness are the focus of the post-simulation debrief, and human factors sheets have been created to guide the participants in analysing these skills. Pre- and post-simulation confidence, knowledge and attitudes will be assessed using validated appraisal tools and questionnaires to gather both quantitative and qualitative data about the experience. Discussion Multidisciplinary training is often difficult to arrange, due to the different requirements, processes, and procedures each department demands. A hidden blessing of Covid-19 is the realisation that this barrier can be broken, for the benefit of our patients and colleagues alike, and training sessions like this implemented.
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Post resuscitation care: are intensive care units adhering to Resuscitation Council (UK) guidelines?Conference abstract 000758 for ESICM LIVES 2019 investigating whether intensive care units were adhering to current Resuscitation Council (UK) guidelines.
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Post cardiac arrest managementPoster abstract P186 for the 39th International Symposium on Intensive Care and Emergency Medicine (Brussels, Belgium, 19-22 March 2019) on Trust compliance with European Resuscitation Council guidelines for management of patients post cardiac arrest.
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Point of care lung ultrasound and focused echocardiography findings in a cohort of patients with severe COVID‑19.Conference abstract concerning point of care lung ultrasound and focused echocardiography findings in a cohort of patients with severe COVID‑19.
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Best practice in radiofrequency denervation of the lumbar facet joints: a consensus techniqueBackground: Radiofrequency denervation is used to treat selected people with low back pain. Recent trials have been criticised for using a sub-optimal intervention technique. Objectives: To achieve consensus on a best practice technique for administering radiofrequency denervation of the lumbar facet joints to selected people with low back pain. Study design: A consensus of expert professionals in the area of radiofrequency denervation of the lumbar facet joints. Methods: We invited a clinical member from the 30 most active UK departments in radiofrequency pain procedures and two overseas clinicians with specific expertise to a 1 day consensus meeting. Drawing on the known anatomy of the medial branch, the theoretical basis of radiofrequency procedures, a survey of current practice and collective expertise, delegates were facilitated to reach consensus on the best practice technique. Results: The day was attended by 24 UK and international clinical experts. Attendees agreed a best practice technique for the conduct of radiofrequency denervation of the lumbar facet joints. Limitations: This consensus was based on a 1 day meeting of 24 clinical experts who attended and took part in the discussions. The agreed technique has not been subject to input from a wider community of experts. Conclusions: Current best practice for radiofrequency denervation has been agreed for use in a UK trial. Group members intend immediate implementation in their respective trusts. We propose using this in a planned Randomised Controlled Trial (RCT) of radiofrequency denervation for selected people with low back pain. Keywords: Low back pain; facet rhizolysis; lumbar facet joints; lumbar zygapophyseal joints; medial branch block; medial branch of the dorsal ramus; radiofrequency denervation.