Author(s): Doherty C.; Bowler M.; Perkins R.; Neal R.; English C.; Cooke J.; Wyatt M.; Atkinson D.; Moore J.; McGrath B.A.; Bates L.; Monks S.; Bruce I.A.; Bateman N.; Russell J.
Source: Anaesthesia; Nov 2018; vol. 73 (no. 11); p. 1400-1417
Publication Date: Nov 2018
Publication Type(s): Article
Available  at Anaesthesia -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Temporary and permanent tracheostomies are required in children to manage actual or anticipated long-term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.Copyright © 2018 Association of Anaesthetists
Database: EMBASE

​Author(s): Waqar-Uddin H.; Wilson J.; Habgood M.
Source: Anaesthesia; Jul 2018; vol. 73 ; p. 121
Publication Date: Jul 2018
Publication Type(s): Conference Abstract
Abstract:Around 160,000 hip and knee replacements are performed every year in the UK [1]. Numerous studies across surgical specialties have shown that pre-operative anaemia is associated with longer length of stay (LoS) in hospital and higher mortality [2]. It has been recommended that patients who present for elective surgery and are found to be anaemic pre-operatively, their operation should be postponed until the anaemia has been investigated and treated adequately. A cut-off of 130 g.l-1 has been suggested [3]. At the same time, the UK Blood Transfusion service has introduced the 'two sample rule' so patients who require transfusion need two blood samples. Our aim was to assess whether our service was functioning well in identifying patients with anaemia and optimising them prior to surgery. 

Author(s): Hajibandeh, S; Antoniou, S A; Torella, F; Antoniou, G A

Source: British journal of anaesthesia; Jan 2017; vol. 118 (no. 1); p. 11-21

Publication Date: Jan 2017

Publication Type(s): Journal Article
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Abstract:To investigate the role of perioperative beta-blocker use in vascular and endovascular surgery.   We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (registration number:CRD42016038111). We searched electronic databases to identify all randomized controlled trials and observational studies investigating outcomes of patients undergoing vascular and endovascular surgery with or without perioperative beta blockade. We used the Cochrane tool and the Newcastle-Ottawa scale to assess the risk of bias of trials and observational studies, respectively. Random-effects models were applied to calculate pooled outcome data. We identified three randomized trials, five retrospective cohort studies, and three prospective cohort studies, enrolling a total of 32,602 patients. Our analyses indicated that perioperative use of beta-blockers did not reduce the risk of all-cause mortality [odds ratio (OR) 1.10, 95% confidence interval (CI) 0.59-2.04, P = 0.77], cardiac mortality (OR 2.62, 95% CI 0.86-8.05, P = 0.09), myocardial infarction (OR 0.89, 95% CI 0.59-1.35, P = 0.58), unstable angina (OR 1.34, 95% CI 0.41- 4.38, P = 0.63), stroke (OR 2.45, 95% CI 0.89-6.75, P = 0.08), arrhythmias (OR 0.76, 95% CI 0.41-1.43, P = 0.40), congestive heart failure (OR 1.12, 95% CI 0.77-1.63, P = 0.56), renal failure (OR 1.48, 95% CI 0.90-2.45, P = 0.13), composite cardiovascular events (OR 0.88, 95% CI 0.55-1.40, P = 0.58), rehospitalisation (OR 0.86, 95% CI 0.48-1.52, P = 0.60), and reoperation (OR 1.17, 95% CI 0.42-3.27, P = 0.77) in vascular surgery. Beta-blockers do not improve perioperative outcomes in vascular and endovascular surgery.           © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.Database: Medline

Source: Journal of clinical anesthesia; Nov 2016; vol. 34 ; p. 270-271

Publication Type(s): Journal Article

Author(s): Tran, Steven; Krige, Anton
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Abstract:The benefits of cardiopulmonary exercise testing have been well established. Certain patient groups present challenges for conducting such a test. We were presented with a patient with a permanent tracheostomy at the preoperative assessment clinic. We describe our technique in overcoming the problem of connecting him to the testing machine, as this is normally done with the aid of a tight-fitting face mask. We used a cuffed tracheostomy tube together with some widely available tubing from theaters to connect the patient to the gas analyzer. The test was only stopped because of excessive secretions from the patient, and we had already established enough data to tell us that the patient was fit enough to proceed to surgery. As more patients present with tracheostomies, we feel that this case would be a useful reference in managing and assessing such patients.