This category contains 27 posts

EuSOS study published – and it’s not pretty!

46,539 patients from all over Europe were recruited to the The European Surgical Outcomes Study over 7 days in April 2011 (read here). Day cases, cardiac and neurosurgical patients were excluded. The overall mortality rate was 4% (nearly 1 in 20 patients). 8% of patients were admitted to ICU or HDU at some stage – … Continue reading

Tuesday Meetings September

Tuesday 8 a.m. Meetings Venue: ICU conference room September 4th Anesthesia for Vascular surgery Dr L Kevin 11th Obstetric anaesthesia Dr J Costello 18th Fluid therapy Dr P Neligan 25th Paediatric anaesthesia Dr Gerry Coughlan

Hydroxy Ethyl Starches – are we nearing the end of the road?

When the VISEP study was published in 2008,1 proponents of colloid based resuscitation (myself included) argued that, since the study was conducted using old generation pentastarches, the data were not generalizable to all hydroxyl-ethyl fluids.2 Indeed there was an emerging body of evidence supporting the safety of newer, lower molecular weight starches; particularly those composed … Continue reading

Recovery from neuromuscular blockade

residual blockade Lesson unlearned

The value of pre oxygenation

Apnoea and preoxygenation Click the link above for the BJA CEACCP review on physiology of apnea and the value of pre oxygenation

Ultrasound for central venous access

The ASA has published its guidelines for central venous access (see link below).  I am regularly amused by the slavish credence given by trainees to use of ultrasound as ‘mandatory’ for central  venous access.  Why I ask?  That ‘s what the NICE guideline says, they reply.  Do you work in the NHS I ask? Yes … Continue reading

Hyperoxia and Surgical Site Infections: is oxygen beneficial?

Using high inspired concentrations of oxygen in the perioperative period may reduce the risk of surgical site infections for patients undergoing colo-rectal surgery. It does not appear to confer benefit for other patient groups. We live side by side with an element that both feeds us and damages us simultaneously: oxygen. Reactive oxygen species cause … Continue reading

Visit the Ether Dome

I hope our recent Anaesthesia History session inspired some interest in the noble (and not so noble!) origins of our speciality.  The ‘Ether Dome’, where WTG Morton first demonstrated ether anesthesia to an audience of doctors and medical students is a real place, is essentially unchanged since October 16th 1846, and is a must-see for … Continue reading

NAP4 report on airway catastrophes

Have you had a highly challenging airway situation in the ICU or the emergency department?  Did it lead to a major adverse event?  If so you are not alone, as the NAP4 report demonstrates: http://www.rcoa.ac.uk/index.asp?PageID=1089 Although there is no denominator, and a direct comparison with operating theatre events was not a purpose of the report, … Continue reading

Acute Respiratory Distress in the Recovery Room (tutorial)

Clinical Scenario: A 57 year old male undergoes upper abdominal surgery. He refused an epidural. The intraoperative course was uneventful. He was given 2mg hydromorphone in the OR. He was extubated, breathing 360 ml tidal volumes; arousable. Shortly after arrival to the recovery room, the patient develops acute respiratory distress. His respiratory rate increases to … Continue reading