Helen Crilly is running another Anaphylaxis workshop at John Flynn Hospital. This workshop is approved by ANZCA as an Emergency Response Activity for CPD purposes.
- Venue: Auditorium, John Flynn Hospital
- Date and Time: Saturday 29th July
- Cost: Nil
- Workshop description: The format involves some pre-reading, then practically using the updated anaphylaxis box to complete 3 different case scenarios in pairs, followed by a small group discussion to debrief and time for questions at the end. It will take 90 minutes.
To register, please log in and submit the form on the Anaphylaxis page.
(Posted on behalf of Peter McLaren.)
- Date: Friday 28th July, 2017
- Time: 5.30 for 6.00pm
- Topic: Nerve Block Workshop
- Presenter: Stuart Greenway from Admedus
- Venue: Gold Coast Private Hospital
Due to conflicts with every other date we could come up with, Stuart Greenway from Admedus has offered to hold a nerve block workshop in the evening on Friday, 28th July and it’s at GCPH! There will be a couple of presenters, an u/s machine and the usual food and drink. The company felt that for a workshop with small numbers and a short time, it would be difficult applying to ANZCA for higher points.
Still, it is an opportunity for those who do blocks in particular to network with others and discuss any problems they be having with equipment, assistants or their working environment. GCPH is close to GCUH and I would hope that the change of venue may attract some anaesthetists who work at both hospitals and find the trip to Pindara for other meetings a little difficult. It is a Friday but it should be over by 7.30!
I am trying the occasional Wednesday and here is a new venue. Please make every effort to support these local meetings!
(Posted on behalf of Peter McLaren.)
- Date: Wednesday 19th July
- Time: 5.30 for 6.00pm
- Topic: Myasthenia gravis and anaesthesia – is it all now just a non-event?
- Presenter: Peter McLaren
- Venue: Pindara Boardroom.
The topic is a case presentation and review of the literature by me on ‘myasthenia gravis and anaesthesia – is it all now just a non-event?’ I would hope that others might also have contributions to the discussion. The venue is the boardroom, Pindara Hospital. Note that this is located in the main hospital at the end of the corridor leading from the main entrance in Allchurch St. 5.30 for 6. Food and drink supplied. Sponsored by Stephen Shields from MSD, the distributers of sugammadex, who will give a short presentation from 5.45. Surgeons interested in the topic are welcome to attend.
(Posted on behalf of Alison Herdman)
New ketamine ampoules at JFH – be careful not to confuse with Fentanyl!
Recommendations Following FDA Warnings about Tramadol Use in Children
- Tramadol can have a useful role as part of a multimodal analgesic regimen for managing acute pain in children.
- Tramadol dose should be limited for acute pain after tonsillectomy (e.g., maximum dose 1 mg/kg 6-8 h, max 400 mg/day). We suggest starting with a lower dose of 2 mg/kg daily in divided doses (e.g., 0.5 mg/kg 6-8 h). Tramadol overdose is a greater danger than CYP variants.
- Children with obstructive sleep apnoea who have undergone tonsillectomy should continue to be monitored in hospital overnight to assess both response and sensitivity to opioids before discharge. While evidence is lacking, it may be prudent to observe any child given opioids during a period of sleep before discharge.
- The use of any opioid in children after day-stay surgery should be done so with caution.
The full document can be downloaded here.
WHEN: 6.15pm – 9.00pm Thursday, 15 June 2017
WHERE: The Lakeside Terrace, The Arts Centre Gold Coast, 135 Bundall Rd, Surfers Paradise
- 6.15pm Registration & welcome drinks
- 6.40pm Dinner served
- 7.00pm Presentation#1 Dr Dan Robinson (ENT)
- 8.00pm Presentation#2 Dr James Reidy (Orthopaedics)
- 9.00pm Close
RSVP is essential.
I have checked with the college and you can claim 2 hours (4 credits) under “Practice Evaluation – Case Discussions/Conferencing”. Participation certificates are handed out on the night, please contact Kathryn O’Reilly at OReillyK@ramsayhealth.com.au for enquiries.
FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women
The Food and Drug Administration (FDA) is restricting the use of codeine and tramadol medicines in children. Codeine is approved to treat pain and cough, and tramadol is approved to treat pain. These medicines carry serious risks, including slowed or difficult breathing and death, which appear to be a greater risk in children younger than 12 years, and should not be used in these children. These medicines should also be limited in some older children. Single-ingredient codeine and all tramadol-containing products are FDA-approved only for use in adults. We are also recommending against the use of codeine and tramadol medicines in breastfeeding mothers due to possible harm to their infants.
As a result, we are requiring several changes to the labels of all prescription medicines containing these drugs. These new actions further limit the use of these medicines beyond our 2013 restriction of codeine use in children younger than 18 years to treat pain after surgery to remove the tonsils and/or adenoids. We are now adding:
- FDA’s strongest warning, called a Contraindication, to the drug labels of codeine and tramadol alerting that codeine should not be used to treat pain or cough and tramadol should not be used to treat pain in children younger than 12 years.
- A new Contraindication to the tramadol label warning against its use in children younger than 18 years to treat pain after surgery to remove the tonsils and/or adenoids.
- A new Warning to the drug labels of codeine and tramadol to recommend against their use in adolescents between 12 and 18 years who are obese or have conditions such as obstructive sleep apnea or severe lung disease, which may increase the risk of serious breathing problems.
- A strengthened Warning to mothers that breastfeeding is not recommended when taking codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants. These can include excess sleepiness, difficulty breastfeeding, or serious breathing problems that could result in death.
More information available from the FDA website.
(posted on behalf of Alison Herdman)
The next Ansafe Meeting will be held on the Friday after Easter which is April 21st.
The meeting will be held as usual at the Southport Anaesthetic Services HQ at Minnie St and will start at 6pm promptly.
If you have any agenda items for Pindara, GCPH, GCSH or any issue which is bothering you please email me directly, or;
- For Pindara James Derrick
- For GCPH Adrian Skidmore or Stuart Green
- For the GCSH Phil Lo
- JFH have their own Anaesthetic Meetings which are chaired by Di Sapwell but very often Pindara issues are Ramsay issues so items overlap. Andrew Cairncross is the Anaesthetic MAC representative at JFH
You can also submit agenda items online from the GCAPE AnSafe page.
At a recent clinical meeting, our local allergy guru Helen Crilly spoke about the growing and potentially lethal problem of chlorhexidine allergy. Helen has graciously provided the source documents for the chlorhexidine allergy kits that have recently been added to the red anaphylaxis boxes.
Please find attached docs from the Friday night meeting as promised. Other than the ANZCA Docs these aids are not endorsed – just what I use to manage chlorhexidine free when I have a case. We are going to develop this and ultimately get it up on ANZAAG website.
The documents are mostly in word format so that they can be customised according to local needs.
- Drug infusion guidelines for JFH
- Docs for chlorhex free management including ANZCA docs
- Chlorhex stickers – Wipes sticker is meant to be placed near all injection points to prevent wiping of IV line access points. The Chlorhexidine anaphylaxis label can be used on cover of chart or other documents that you want to highlight chlorhex allergy, on patient wrist bands (or patient forehead if necessary!) These should be printed on 14 sticker (7×2) Avery template L7163FP – available from Officeworks in a variety of colours (I prefer the fluoro pink).
- Chlorhex signs – sent as word docs in case anyone wants to customise. Best if they are laminated.
I have uploaded a new colour coded CICO flowchart and equipment pack PDF, reflecting the move from the Enk to Rapid-O2 device. You can download a copy from the CICO page.