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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: 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.

Posted in: UIA > Regional Anaesthesia 2020 Language: english

From the evidencewe have available, the ESP block should be considered an alternative analgesic option for patients with acute or chornic pain of the trunk Most of the favourable data for the ESP block relies on its use as part of a multimodal analgesic package, and this should be considered when planning a patient’s care. Further research needs to be conducted to determine its true effectiveness compared with other regional techniques as well as optimal dosing regimens.

Posted in: UIA > General Topics 2020 Language: english

Editor's note for UIA35

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Update in Anaesthesia #34 Obstetrics Special

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Update in Anaesthesia #34 Obstetrics Special

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Postpartum hemorrhage remains the leading cause of maternal mortality and morbidity. Oxytocic drugs are the main stay in prevention as well as treatment. Oxytocin remains the drug of choice

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Deaths of babies in the first 28 days of life in resource-limited countries can be significantly reduced with a small number of low-tech interventions. This article summarises the core equipment and skills needed for the resuscitation of newborns where equipment is limited and skilled paediatric support is not available.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Physiological changes in the parturient occur due to the needs of the developing foetus. Understanding these changes is important when administering anaesthesia to the obstetric patient. Additionally, understanding the physiological effects in the foetus allows for appropriate intrauterine monitoring and expedient delivery if there are signs of foetal hypoxia.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Sepsis remains one of the four main causes of maternal mortality. Common causes of severe sepsis & septic shock during pregnancy include pyelonephritis, infection during labour and peurpurium & respiratory infection.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Trauma during pregnancy is the leading non-obstetrical cause of maternal death and remains the most common cause of foetal demise. Trauma management needs multidisciplinary team of emergency physician, obstetrician, anesthesiologist & surgeons. Major trauma causes obstetric & fetal complications & may end by maternal death.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Obesity is one of the greatest public health challenges of the 21st century. Obesity during pregnancy puts the mother, fetus and neonate at higher risk of morbidity and mortality during the antenatal, intrapartum and postnatal periods.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

The anaesthesiologist’s expertise in treatment of the parturient and massive haemorrhage resuscitation is a valuable component of the multidisciplinary care team’s capacity to reduce maternal and perinatal morbidity and mortality. This article reviews recent updates in the diagnosis and management of placental pathology and will present challenges facing today’s obstetric anesthesiologist.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

Pre-eclampsia causes significant morbidity and mortality to both mother and foetus worldwide, the major causes being delayed diagnosis and poor management. Identifying the parturient at risk of developing pre-eclampsia is paramount and optimising this patient cohort is key. Early management of pre-eclampsia favours a better outcome with magnesium sulphate and anti-hypertensive medications being the mainstay of treatment.

Posted in: UIA > Obstetric Anaesthesia 2019 Language: english

The cause of maternal collapse and cardiorespiratory arrest is not always immediately apparent. A generic approach based on Basic and Advanced Adult Life Support is recommended. Key modifications to these algorithms are required in pregnancy. These include early intubation and the use of lateral tilt or uterine displacement.

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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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