Category Archives: Downloads

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.

Chlorhexidine Anaphylaxis

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.

From Helen;

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.

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,


Airway Articles

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.

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