I have uploaded a PDF of Steven Steele’s presentation from the recent AnSafe meeting. The link is on the APS Page.
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.
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.
(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.
If you are interested in trialling the ClearSight non-invasive haemodynamic monitor please contact Adrian Skidmore.
ANZAAG have updated their anaphylaxis management guidelines, along with the supporting crisis management package.
These updates can be accessed from the ANZCA or ANZAAG websites.
Hugh Stephens has graciously supplied the following articles on airway management;
- Airway risk assessment – a review of current evidence to aid clinical decision-making Download
- Airway management roundtable – six international airway experts offer their opinions on various airway matters Download
- Submental tracheal intubation for a patient with multiple facial fractures – let me know if you plan to do one of these and I’ll come and watch Download
If you come across any interesting articles that you think are worth sharing, please contact me and I’ll post details on GCAPE.
The NAP5 report has been released. There have already been sensationalised reports in the popular media, so expect questions from patients! Registered users can download the report and a summary from Anaesthesia below.
Download full NAP5 report
Download Anaesthesia NAP5 summary
ACC/AHA & PONV
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