Category Archives: Clinical

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?

Clinical Meeting, Friday 13th February.


(Posted on belaf of Peter McLaren)


The topic of this meeting is “Algorithms for Difficult Airway Scenarios”. Adrian Skidmore has offered to kick off the discussion with a presentation of the algorithms used in the RBH airway management workshops. I hope we will then continue on looking at some of these questions:

In the known difficult intubation patient with a full stomach, should we switch to awake fibreoptic intubation or is the use of a videolaryngoscope ‘good enough’?

  • Is the morbidly obese patient any different?
  • What should we do post bariatric surgery?
  • What about the scleroderma patient or post-oesophagectomy patient where the amount of reflux can be uncontrollable?
  • What is the current surgical approach to Ludwigs angina?
  • Anything new with the trauma patient in a collar?
  • How about a post-thyroidectomy bleed?

If you have ideas, protocols, experience or strong feelings on any of these scenarios, please feel free to hijack them and present them yourself.

Same format: 5.30 for 6, Boardroom, first floor, Pindara Professional Centre, 8 Carrara St, Benowa, opposite the laneway to Pindy Day, food and drink supplied, please RSVP for catering purposes, further notice in the week prior.


Peter McLaren


Stop before you block!

(Posted on behalf of Paul Slocombe)

Thank you for your time and effort completing the recent computer survey on survey monkey regarding safety checklists prior to regional anaesthesia.

The survey was sent to all Anaesthetists and trainees at Gold Coast University Hospital and Private Anaesthetists via GCape. The purpose of the survey was to gauge how common wrong sided blocks are (given they are believed to be under reported) and also to gauge opinion around the introduction of the “Stop before you block” checklist.

There were 54 responses, the majority of which were consultants (38 or 70%), with 4 fellows, 6 advanced trainees and 6 basic trainees. There was a variety of level of experience with blocks with the majority reporting they perform blocks weekly.


There were 7 respondents that reported they had performed a wrong sided block (13% of respondents). The wrong sided blocks were a range of different types (eye blocks, shoulder, paravertebral, femoral and ankle blocks).


There was no real relationship with wrong-sided blocks and being awake (2), sedated (3) or asleep (2). This is similar to other surveys with a survey from the UK reporting that 40% of wrong-sided blocks were performed on patients that were awake, so having an awake patient does not prevent against wrong-sided block.

There were also 7 respondents that reported “near misses” where they had been stopped from performing a wrong-sided block, 6 by the anaesthetic nurse. The majority of anaesthetists never mark the site of their block (66%).


To the question of should a site check be performed the majority (94%) said yes, with 92% in favour of one just prior to needle insertion.

Of the replies, the majority (96%) preferred a quick verbal check and 64% would document it in the anaesthetic record.


So in summary the survey had a good response from consultants with varying experience with blocks. 7 had performed a wrong-sided block with a further 7 near misses. The majority were in favour of performing a site check, with a quick verbal check preferred.


Stop Before You Block has been introduced to Gold Coast University and Robina Hospitals. Simon Pattullo has provided the following references should you wish to institute Stop Before You Block in your hospital;


Anaphylaxis Workshop Saturday 1st Nov 2014

Note: The November workshop is now full, however you can register your interest for workshops in 2015.

Dr Helen Crilly will be running a College recognised Anaphylaxis Workshop at John Flynn on Saturday morning 1st November 2014. Helen, the ANZAAG Coordinator, ran a workshop at the recent ASA NSC however it was quickly booked out. To satisfy demand for an encore, Helen has graciously agreed to repeat the workshop, giving local Anaesthetists the opportunity to attend at no cost.

You are able to claim this course as an “Emergency Response” activity in your college CPD. If you were on your toes and attended the CICO activity earlier this year you could attend Helen’s workshop and satisfy all your emergency response requirements for the triennium before the end of the first year, all for free!

Registration is now open at the GCAPE Anaphylaxis page.

  • Venue: VMO Lounge, First Floor, John Flynn Medical Centre, John Flynn Hospital
  • Time: 830am and 1030am (time for attendance advised by Dr Crilly once booked)
  • NB: A further opportunity to do the workshop will be available in 2015 with date TBA. If you are interested in this workshop please advise by registering and indicating you would like to attend in 2015 in the comments section
  • Cost: Nil
  • Workshop description: This 90 minute interactive workshop utilises case discussion and the anaphylaxis box to develop skill with using the ANZAAG/ANZCA Anaphylaxis management guidelines in the event of anaphylaxis emergency. Although paper-based, each participant will be required to consider their own approach to all questions. There is pre-reading required which can be found on line in the management section of the ANZAAG website – Resources.aspx
  • Registration: You can register at the GCAPE Anaphylaxis page.

(Please note that this activity has been recognised as suitable to be claimed in the emergency responses category of the ANZCA CPD program. The course content has not been assessed and this recognition does not represent endorsement by ANZCA.)

Updated Guidelines


Updated Consensus Guidelines for PONV were published in Anesthesia and Analgesia in January. You can download the article below.

Download PONV Guidelines

Also hot off the press are the 2014 ACC/AHA Guidelines on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. You can download the 100+ pages of the full article and the executive summary below.

Download ACC AHA Guidelines

Download ACC AHA Summary