International Symposium of Intensive Care & Emergency Medicine, 2013

This is an excellent summary of the International Symposium of Intensive Care & Emergency Medicine, held in Brussels in March 2013.

In order to allow those who were unable to attend the meeting to gain a flavour of the topics covered by the speakers, Dr Ajay Raithatha has created a summary of the key points of the talks supplemented with additional references and reflections.

This is an excellent update for anyone who works in, or has on-call responsibilities for, critical care. For those of you who are predominately anaesthetists, the section on fluids is highly recommended in light numerous publications on the use of fluids (and particularly colloids) in the past 12 months.

The summary is in the form of a PowerPoint presentation which can be downloaded here: ICS_Brussels_2013

 

STH Consultant CPD Updates: Obstetrics

This is the summary of the PowerPoint presentation from the new consultant CPD teaching programme.

This month’s session provided an update on obstetric anaesthesia (for the non-obstetric anaesthetist) in line with the Royal College of Anaesthetists Matrix.

The following areas were covered by Dr Ian Wrench (Consultant Obstetric Anaesthetist, Sheffield Teaching Hospitals NHS Foundation Trust). Please click the link for a copy of the presentation. Obstetric Anaesthesia for Non-obstetric Anaesthetists

  • Assessment of the critically ill parturient (2B06)
  • Analgesia for labour (2B01)
  • Regional anaesthesia complications in the pregnant patient (2B04)
  • Regional & general anaesthesia for emergency & elective LSCS (2B02, 2B03)

AAGBI Core Topics Nottingham 2013: Key Points

I recently attended the Association of Anaesthetists Core Topics Meeting, September 2013.

In order to allow those who were unable to attend the meeting to gain a flavour of the topics covered by the speakers I have created a summary of the key points of each talk (in my opinion).

The RCOA Matrix Codes for each talk are shown, along with the details of the speaker.

Anaesthesia for emergency laparotomy (2A03, 2C03): Dr Craig Morris, Derby

  • If bowel perforation 50% of bacteria are resistant to cephalosporins. Give Tazocin 4.5g intraoperatively. No need to reduce dose even if patient has ARF.

Managing fluids in hip fracture patients (2A04, 2A05): Dr Iain Moppett, Nottingham

  • Check Hb in PACU and make a transfusion decision. Late blood transfusions on the ward delays rehab by up to 24 h.
  • Transfusion triggers: no evidence for transfusion preop; intraoperatively only if Hb very low. Postoperative transfusions make no difference to LOS or mortality with triggers 80 vs 100g/l
  • 40% of #NOF patients have significant intraoperative hypotension (SBP <60). Need a low threshold for invasive monitoring
  • Intraoperative fluid administration probably best with GDT (LiDCO or TOD): decreased LOS & postoperative complications but no decrease in mortality (for GA patients). The role of GDT with SAB is yet to be answered.
  • 10% Hb<10; 16% ARF. Mild hyponatraemia on presentation very common (usually due to diuretic dose) and can be ignored. 25% pats respond to fluid blouses in theatre.

Maintaining skills for the difficult airway (2A01): Dr Rob McCahon, Nottingham

  • Maintenance of airway skills. Skill fade an issue for anaesthetists. Needle cric/alternate DL (e.g. GlideScope, CMA etc) skills drop off at 1-12 months.
  • Airway skills. Anaesthetists often ignore anticipated airway difficulties with overreliance on direct laryngoscopy with reluctance to do AFOI

Analgesia for lower limb arthroplasty (2E01, 2G01): Dr Nigel Bedforth, Nottingham

  • Enhanced recovery for TKR/THR – whole package of care more important than anaesthetic and analgesic techniques.
  • Analgesia for THR. Local anaesthetic infiltration ineffective, providing oral multimodal analgesia used.
  • Analgesia for TKR. Local infiltration of LA effective for 26-32 h; this effect magnified by addition of compression bandage.
  • Analgesia for TKR. Obdurator & sciatic nerve blocks probably only of value for first 6 h postop. SAB+FNB alone probably best.
  • Analgesia for TKR. Pain worse than THR (up to 48h). FNB more effective than epidural after 4 h with lower SE.
  • THR postoperative pain scores only significant for 6 h postop. Lumbar plexus block better than FNB but neither as good as spinal morphine.
  • Analgesia for TKR/THR. Evolving evidence that regional techniques assoc with less surgical site infections.
  • Analgesia for TKR/THR. Perineural & epidural techniques superior to opiates at all time points (+less blood loss & VTE!)

Safety of spinal anaesthesia Domain (2B04, 2G04): Dr David Bogod, Nottingham

  • How safe is SAB? 65% of anaesthetists are higher up the spinal cord than they think (1-2 levels). Only 30% are correct!
  • Beware of chlorhexidine & SAB (severe arachnoiditis). Use only 0.5%, keep trolley covered, check gloves for contamination