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Category: Pain

Posted in: ATOTW > Pain 2020 Language: english

This tutorial covers basic physiology and the principles of pain management including assessment, pharmacologic and regional analgesia techniques in elderly patients.

Posted in: ATOTW > Anaesthesia 2020 Language: english

Overview of traumatic rib fracture management including common mechanism of injury, associated complications and predictors of poorer outcomes. Appropriate work-up and clinical assessment including scoring systems used to guide ongoing management. Summary of key treatment modalities including pharmacological, non-pharmacologcial and regional anaesthetic techniques which may be appropriate.

Posted in: ATOTW > Paediatric Anaesthesia 2020 Language: english

Paediatric radiotherapy is an area of practice that possesses its own unique challenges. This tutorial details the various types of radiotherapy, in practical terms how they are delivered and the environmental and anaesthetic considerations that are required for safe anaesthetic practice.

Posted in: ATOTW > Anaesthesia 2020 Language: portuguese

A COVID-19 se tornou uma pandemia. Os anestesiologistas desempenham um papel significativo no tratamento dos pacientes, no controle da infecção e no período perioperatório e manejo de vias aéreas. Cuidar de pacientes com COVID-19 requer um esforço multidisciplinar. A transmissão da doença pode ser minimizada quando a terapia perioperatória é meticulosamente planejada.

Posted in: ATOTW > Basic Sciences 2020 Language: portuguese

Este tutorial investigará inicialmente a as propriedades farmacodinâmicas e farmacocinéticas da clonidina. Depois, o artigo vai abranger o uso clínico da clonidina na prática anestésica, incluindo seu uso na sedação, analgesia, adjuvante aos anestésicos locais em bloqueios regionais e outros usos relevantes.

Posted in: ATOTW > Anaesthesia 2020 Language: portuguese

Este tutorial resume os dados e controvérsias atuais acerca do uso do Índice Bispectral (BIS®; Medtronic, Minneapolis, MN, EUA) — um dos dispositivos de EEG processado mais comumente usados — e fornece recomendações sobre o uso apropriado dessa tecnologia na anestesia geral para prevenir o despertar.

Posted in: ATOTW > Regional Anaesthesia 2020 Language: english

Although nerve injuries associated with peripheral nerve blockade (PNB) are often temporary, the potential long-term consequences of nerve injury following PNB include sensory and motor deficits, neuropathic pain, and permanent disability, with an associated decrease in a patients’ quality of life. This article aims to explore the pathophysiology of nerve injury from PNB, suggest preventative strategies therein, and provide a common sense approach to their management.

Posted in: ATOTW > General Topics 2020 Language: english

COVID-19 has become a pandemic. Anaesthesiologists play significant role in patient care, infection control in the perioperative period and airway management. Caring for patients with COVID-19 requires multi-disciplinary effort. Disease transmission can be minimised when perioperative care is thoroughly planned.

Posted in: ATOTW > Intensive Care Medicine 2020 Language: english

Cocaine toxicity has a myriad of end organ complications, both in acute ingestion and chronic abuse. An appreciation for nuances of this presentation is required to provide excellent critical care.

Posted in: ATOTW > Regional Anaesthesia > Anaesthesia 2020 Language: portuguese

Este tutorial explorará a literatura atualmente publicada sobre bloqueios do plano do eretor da espinha e descobrirá sua versatilidade em anestesia regional

Posted in: UIA > Anaesthesia 2020 Language: english

• Implementation of the WHO surgical safety checklist in a West African teaching hospital: a quality improvement initiative • Postoperative pain management in Timor-Leste • Comprehensive review of laryngospasm • Perioperative myocardial ischaemia in non-cardiac surgery • Saddle Block • Erector spinae plane block • Tranexamic acid • Intrathecal tranexamic acid during spinal anaesthesia for caesarean delivery • Ketamine: Recent evidence and current uses • Complications associated with intraoperative use of irrigation fluid for endoscopic procedures • Case report: Posterior Reversible Encephalopathy Syndrome (PRES) • Letter: OxyContin - a tale of advertisement and addiction • Letter: Sphenopalatine ganglion block - management of PDPH after caesarean section

Posted in: Guidelines & Standards > Safety 2020 Language: english

Infographic produced by Dept of Anesthesia & Intensive Care, Prince of Wales, Hong Kong

Posted in: Guidelines & Standards > Safety 2020 Language: english

Infographic produced by Dept of Anesthesia & Intensive Care, Prince of Wales, Hong Kong

Posted in: ATOTW > Pain 2020 Language: english

Opioids are a cornerstone of anaesthetic practice. This tutorial will discuss a common opioid side effect - Opioid-induced Hyperalgesia (OIH). OIH is a phenomenon for which we have an increasing appreciation. We will discuss its proposed mechanism, clinical relevance and, lastly, evidence on its management strategies.

Posted in: UIA > Obstetric Anaesthesia 2020 Language: english

The National Committee on Confidential Enquiries into Maternal Deaths recently received notification of a death in South Africa caused by inadvertent intrathecal administration of tranexamic acid (TXA). TXA is increasingly used during caesarean delivery following updated recommendations from the World Health Organization in 2017. However, its greater availability has led to an international rise in drug errors during obstetric spinal anaesthesia. This case highlights a growing clinical risk, of which all operating theatre staff should be aware. Review of existing operating theatre drug handling practices is required in order to decrease this risk. Recommendations are made that aim to minimise drug errors associated with the use of this potentially life-saving intervention.

Posted in: UIA > Basic Sciences 2020 Language: english

Tranexamic acid significantly reduces peri-operative blood loss in a wide variety of surgical specialties and improves survival in haemorrhage from trauma and birth. In cardiac patients it carries a risk of seizures, especially with higher doses, and theoretically may predispose to thromboembolic disease but clinically relatively few side effects are observed. It is highly cost-effective and requires minimal training to administer. As such the World Health Organisation now include it on the essential medicines list. Future research to clarify dosing regimens, especially in the cardiac and paediatric populations, as well as usage in other surgical disciplines and intracranial haemorrhage is expected.

Posted in: UIA > Obstetric Anaesthesia 2020 Language: english

The sphenopalatine ganglion is a parasympathetic ganglion and has been blocked for various types of headaches and facial pain. We have reported a patient with severe post-dural puncture headache after cesarean section who showed rapid symptomatic improvement after a single sphenopalatine ganglion block.

Posted in: UIA > Regional Anaesthesia 2020 Language: english

Saddle block is a spinal anaesthetic restricted to the perineal area, or that part of the body in touch with a saddle. It is achieved by using a small dose of hyperbaric solution of local anaesthetic and maintaining the patient in a seated position after injection. One of the major advantages is avoiding hypotension. It also allows rapid mobilization of the patient for the surgical procedure. Certain surgical procedures have an increased risk of urinary retention when performed under saddle block.

Posted in: UIA > Cerebral Challenge 2020 Language: english

Posterior Reversible Encephalopathy Syndrome (PRES) is a clinico-radiological syndrome of heterogeneous etiologies that are grouped together because of similar findings on neuro-imaging studies. It was first described by Hinchey et al. in 1996 based on 15 cases1 This condition has been known by various names previously (reversible posterior leukoencephalopathy syndrome, reversible posterior cerebral edema syndrome and reversible occipital parietal encephalopathy). PRES is now the widely accepted term.2 This clinical syndrome is increasingly recognized commonly because of improvement and availability of brain imaging.

Posted in: UIA > Pain 2020 Language: english

After decades of turmoil Timor-Leste is re-building its healthcare system. Resource limitations are severe. Opiates are unavailable on the wards and used sparingly in theatres. Minimal staff training, inadequate medication supply and cultural acceptance result in poor pain management. This audit examines post-operative pain management in 85 patients thought reasonably to require post-operative analgesia. Despite medication being charted 20 patients (24%) received no post-operative analgesia, (before review). This group had a mean verbal numeric pain score of 5.8+/-2.2, median 6, range 2-9. Thirty-four patients (41%) received some of their charted analgesics. This group had a mean pain score of 5.1+/-2.2, median 5, range 1-9. The remaining 31 patients received their analgesics as charted and, unsurprisingly, had the lowest pain scores, mean 4.3+/-2.3, median 4, range 1-8. No patient received prn analgesia. More than 40% of patients reported pain scores greater than 5, with 15% reporting pain scores of 8 or 9. Forty-seven patients (55%) were unsatisfied with their pain relief. Fifty-one patients (60%) received additional analgesia as a result of review. Despite cultural expectations Timorese patients would welcome additional post-operative analgesia. To achieve this there are significant hurdles to overcome in training, drug availability and attitudes towards pain relief.

Posted in: UIA > Anaesthesia 2020 Language: english

Purdue Pharma is under scrutiny for its role in North America’s opioid crisis with its widely marketed narcotic OxyContin. Released in 1995, the same year as the American Pain Society announced their Pain is the Fifth Vital Sign campaign, OxyContin quickly became a blockbuster drug through aggressive advertisement. Purdue Pharma sponsored tens of thousands of pain management education programs, funded influential organizations, and marketed directly to physicians. They publicized research that downplayed the risk of addiction, suppressed early reports of drug abuse, and led physicians to believe that iatrogenic narcotic addiction was rare. By 2004, OxyContin had become the most prevalent prescription opioid abused in the USA. Purdue Pharma has since acknowledged misleading regulators, doctors and patients about OxyContin’s risk of addiction and abuse. The company recently filed for bankruptcy, as thousands of jurisdictions are now seeking to recover costs associated with the opioid crisis. This story demonstrates how vulnerable physicians are to marketing and misinformation, and the importance of critical appraisal when new drugs, technologies, and practice patterns are introduced to our practice.

Posted in: UIA > General Topics > Comorbid Disease 2020 Language: english

Perioperative myocardial ischaemia is an important entity with prognostic implications. Preoperatively, patients should have their perioperative risk clarified, and be optimised where time permits. • Intraoperative management consists of appropriate monitoring and anaesthetic technique, preventing myocardial oxygen supply-demand imbalances and identifying and treating intraoperative myocardial ischaemia. Postoperative considerations will depend on intraoperative events and the risk category of the patient, but may involve intensive monitoring and cardiology review.

Posted in: UIA > General Topics > Anaesthetic Emergencies 2020 Language: english

Laryngospasm is a well-known entity occurring during the perioperative period, most commonly during intubation or extubation. Clinical signs are the consequence of patient effort to breath against a closed glottis. Risk factors can be related to patient, surgery or anesthesia. They should be managed pre-operatively in order to prevent this occurrence, together with preventative drugs such as iv (intravenous) lidocaine and magnesium sulphate, iv propofol induction instead of the inhalational route in children and laryngeal aspiration before extubation. Prompt diagnosis and management is the key to success and includes Continuous Positive Airway Pressure (CPAP) with 100% oxygen, manual maneuvers (subluxation of the temporomandibular joint and Larson’s maneuver), increasing depth of anesthesia and muscle relaxation. If these measures do not succeed, forced orotracheal intubation or even cricothyroidectomy/tracheostomy are the emergency steps

Posted in: UIA > Basic Sciences > Pharmacology 2020 Language: english

Ketamine is a versatile drug with a unique profile that allows it to be successfully used for a multitude of situations worldwide. Its variable dosing means it can be used both as an induction agent with a good haemodynamic profile or in lower doses as a reliable sedative or analgesic drug. It has a vital role in prehospital and emergency medicine. As an adjunct during routine anaesthesia it can help reduce opioid requirements postoperatively. Its use in critical care includes sedation and management of refractory asthma; however, further research is required to elucidate its role in trauma and head injury patients. In the developing world, it is a vital and highly valued drug that allows performance of interventions and operations that may otherwise prove impossible, especially when resources are limited. Ketamine still suffers from traditional stigma from doctors and the public alike and it is often neglected due to concerns about psychological side effects. Increased availability of preparations of pure S-(þ)-isomer ketamine may help increase its popularity.

With greater understanding of the complications of irrigation fluids and the correlated pathophysiology, anaesthesiologists should be better able to stratify risk and improve the quality of perioperative care. Irrigation fluid–associated complications, including TURP syndrome, may present subtly, necessitating a low threshold to initiate focused physical examination and investigations. Supportive treatment is the mainstay of initial intervention.

About the Library

WFSA's virtual library is a resource hub made up of our own publications and other open source material that we recommend for anaesthesia providers around the world. It contains a variety of media and can be searched according to keyword, publication and specialist category ensuring that the user finds the most relevant resource for their needs.

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The WFSA Virtual Library is for use by qualified anaesthesia providers and those pursuing a qualification in anaesthesia. Its content is supplementary to more formal education and is offered for informational purposes only. Whilst the WFSA has taken every care to ensure that content is accurate we can not be held responsible for any loss, damage or inconvenience caused as a result of any error or inaccuracy within the library.

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