Category Archives: Clinical

Detection of Euglycaemic Ketoacidosis preoperatively

(Posted on behalf of Alison Herdman)

Pindara Admissions now finger prick test every preoperative patient on dapagliflozin (Forxiga), empagliflozin (Jardiance) or a combination with metformin (Xigduo, Jardiamet) with a ketone reagent strip.

They write the result on the Preop Check List.

If it is > 0.6mmol/l you will be notified by phone.

The Australian Diabetic Society (ADS) recommends that strong consideration to postponing non urgent surgery be given if SGLT2 inhibitors have not been stopped preoperatively and either the blood ketones are > 0.6 mol/l or the HbA1c is >9% .

Download ADS Alert and Recommendations here… ADS Alert and Recommendations

SPANZA Advisory on Tramadol

Recommendations Following FDA Warnings about Tramadol Use in Children
  1. Tramadol can have a useful role as part of a multimodal analgesic regimen for managing acute pain in children.
  2. 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.
  3. 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.
  4. The use of any opioid in children after day-stay surgery should be done so with caution.

The full document can be downloaded here.

Healthscope – blood transfusion prescriptions

(Posted on behalf of Julie Hopf, Anaesthetic/PARU Educator Gold Coast Private Hospital)

Healthscope have introduced the attached form for use with blood & blood products ‘Blood and Blood Products Prescription and Transfusion Record’ This is being used across all Healthscope sites. The blood product is prescribed on this form instead of the IV Fluids order form. The form includes the indications, pre-transfusion checks, information on observations, reactions & blood products all in the one place.

Download form here.


Kind Regards,


Time to dump Maxolon?

Latest advice from the TGA;

Health professionals are advised of the risk of neurological adverse events, including extrapyramidal disorders and tardive dyskinesia, associated with the use of metoclopramide. A risk of rare cardiac conduction disorders has also been identified.

In response to these identified risks, the following changes have been made to the PI for prescription metoclopramide:

  • it is contraindicated for children aged under one year
  • for young adults (aged under 20 years) and children over one year of age, it is only indicated as second-line therapy
  • the total daily dosage, especially for children and young adults, should not normally exceed 0.5 mg/kg bodyweight, with a maximum of 30 mg daily
  • the maximum dose for adults is 10 mg three times daily
  • the maximum recommended treatment duration is now five days in all age groups.

Dubious clinical efficacy urging higher doses from the British Journal of Anaesthesia83 (5): 761–71 (1999).

Should we just forget about it?