Monthly Archives: November 2016

CICO, Equipment, Safety

ANZCA Safety Updates

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Implementation of non-luer, non-interconnectable neuraxial connectors

The International Organization for Standardization (ISO) standard for device connectors used for neural applications has been published. The devices on which these connectors will be used are neuraxial, including spinal and epidural access, cerebral intraventricular drainage and access devices, peripheral nerve anaesthesia devices and associated equipment required such as syringes, infusion connectors (patient end) etc. See ISO 80369-6 Small bore connectors for liquids and gases in healthcare applications – Part 6: Connectors for neuraxial applications.

ANZCA’s position on CICO

ANZCA has clarified its position on can’t intubate, can’t oxygenate (CICO) front of neck access in response to the release of the Royal College of Anaesthetists’ (RCoA) statement “Anaesthetists and surgeons reach agreement on front of neck emergency techniques in life-threatening ‘CICO’ situations”, associated with a BJA editorial “Surgical intervention during a can’t intubate can’t oxygenate (CICO) event: emergency front of neck airway (FONA)?”. The College does not “mandate” one approach to FONA over the other for a number of reasons. For more information, please see here.

New airway assessment resource

A new resource, Airway Assessment, has been produced for use by ANZCA Fellows and trainees to improve understanding and to guide management of airway assessment and difficult airways. It is the first of a series of airway resources and complements the Transition to CICO resource document (and ANZCA professional document PS61).

Practice points: postoperative monitoring

Understanding the time periods of highest risk and individual patient risk factors for respiratory depression may assist in efficient resource allocation in postoperative patients. Drug-induced respiratory depression is associated with significant morbidity and mortality in the postoperative period and medical devices such as telemetry systems are a valuable resource often used for monitoring patients after surgery. Read the full article on the TGA website.

 

Articles

Early Anesthesia Exposure Linked to Minimal Academic Gap Later

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http://jamanetwork.com/journals/jamapediatrics/fullarticle/2580308

Observational study;

Results  Among 33 514 exposed children (22 484 male and 11 030 female) and 159 619 unexposed children (105 812 male and 53 807 female) in the primary study cohort, 1 exposure before age 4 years was associated with a mean difference of 0.41% (95% CI, 0.12%-0.70%) lower school grades and 0.97% (95% CI, 0.15%-1.78%) lower IQ test scores. The magnitude of the difference was the same after multiple exposures. There was no difference in school grades with 1 exposure before ages 6 months, 7 to 12 months, 13 to 24 months, or 25 to 36 months. The overall difference was markedly less than the differences associated with sex, maternal educational level, or month of birth during the same year.

Conclusions and Relevance  Exposure to anesthesia and surgery before age 4 years has a small association with later academic performance or cognitive performance in adolescence on a population level. While more vulnerable subgroups of children may exist, the low overall difference in academic performance after childhood exposure to surgery is reassuring. These findings should be interpreted in light of potential adverse effects of postponing surgery.

I wonder how much is due to disease e.g. middle ear infection vs the anaesthesiapoi160080