UHCW publication: Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario

Effect of palpable vs. impalpable cricothyroid membranes in a simulated emergency front-of-neck access scenario.
C. F. Pairaudeau, C. Mendonca, C. Hillermann, I. Qazi, P. A. Baker, R. E. Hodgson, S. Radhakrishna

Anaesthesia 2018 Jan 19. doi: 10.1111/anae.14218
Abstract
The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.


Full text PDF available at  http://onlinelibrary.wiley.com/doi/10.1111/anae.14218/epdf (UHCW Athens login required)

RCoA survey shows resources needed for vulnerable patients

More than half of anaesthetic doctors would feel uncomfortable with a relative or close friend with dementia being admitted to an NHS hospital this winter, a survey from the Royal College of Anaesthetists (RCoA) has revealed.

The survey, undertaken by the RCoA in collaboration with Alzheimer’s Society, found that 57 per cent of respondents would be uncomfortable with the possibility of a relative or close friend with a diagnosis of dementia receiving treatment in an NHS hospital.

NIHR Signal Lying on one’s side in labour with an epidural is safe and leads to more spontaneous births

Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.

This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.

From the NIHR Dissemination Centre

A report on the welfare, morale and experiences of anaesthetists in training: the need to listen

In a report released by the RCoA, anaesthetists in training are shown to be experiencing high levels of stress and fatigue due to system pressures, inflexible working patterns, and inadequate facilities for rest and catering. These issues are impacting on patient care and contributing to doctors of all specialties quitting the medical profession.

Survey of Dermatologists and Venereologists Shows Varying Approach to Penile Biopsies

J Clin Aesthet Dermatol. 2017;10(10):26–27

Objective. To determine frequency of use and safety of epinephrine containing local anesthesia among dermatologists in the United Kingdom and venereologists undertaking penile biopsy.

Conclusion. Use of epinephrine-containing local anesthesia is common among physicians in the United Kingdom undertaking penile biopsies. Despite this, no episodes of necrosis were observed. While further investigation is still required, it is likely that use of epinephrine-containing local anesthesia is safe for local penile injection.

UHCW Research: Aaron Wernham and Tang Ngee Shim

Winter service pressures and the role of anaesthetists in training

During last winter some anaesthetists in training were asked to work outside of their usual scope of practice due to unprecedented demands on clinical services. The AAGBI communicated its concerns to Health Education England and issued guidance. 

As winter approaches again, it may be timely for all anaesthetists to note the guidance which remains relevant.

Confirming removal or flushing of lines and cannulae after procedures

A patient safety alert from NHS Improvement on the need to confirm intravenous (IV) lines and cannulae have been effectively flushed or removed at the end of the procedure.

Health Services Research Centre seeks new clinical research fellows

The Health Services Research Centre (HSRC) is recruiting clinical fellows to work on high profile programmes in anaesthesia and perioperative medicine research.

The successful candidate/s will contribute to national research projects led by the Royal College of Anaesthetists and gain the opportunity to qualify for academic publication, present at conferences, and develop leadership and management skills.

The fellowships will begin in February 2018. The last possible start date for candidates is 1 August 2018.

SafeguardingPlus - new information for anaesthetists

The Royal College of Anaesthetists has launched SafeguardingPlus – a new resource of peer-reviewed education and information to provide advice for anaesthetists on how to identify, manage and prevent harm in patients and improve understanding of consent and ethical issues.

Handbook of Anaesthesia & Peri-operative Medicine

9781910079195. TFM Publishing Ltd. 2017

Edited by Chandrashekhar Vaidyanath, University Hospitals Coventry and Warwickshire NHS Trust

Major trauma in older people: implications for anaesthesia and intensive care medicine

Editorial in Anaesthesia. DOI: 10.1111/anae.14027

The Trauma Audit and Research Network (TARN ) is the independent monitor of trauma care in England and Wales. It produces reports for participating hospitals three times a year, and has also produced national reports on major trauma in children [1, 2]. It is the trauma equivalent of the Intensive Care National Audit and Research Centre (ICNARC) for Intensive Care Medicine. The latest themed report has just been published and is entitled ‘Major trauma in older people’ [3]. This first report on trauma in older people from TARN was written by a multidisciplinary group of healthcare professionals and we were privileged to be the representatives from anaesthesia.

UHCW Research: D. Surendra Kumar

Resources to support safe transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks

A resource alert has been issued by NHS Improvement to support providers to safely manage the transition from the Luer connector to NRFit™ for intrathecal and epidural procedures, and delivery of regional blocks.

Patient safety incidents are occurring due to the accidental administration of medication intended for intravenous use via a neuraxial device, and vice versa, resulting in the patient receiving drugs through the wrong delivery route, which in some cases has been fatal.

To prevent these errors a new dedicated connector for neuraxial and regional block devices – NRFitTM (ISO 80369-6:2016) has been developed and is now being introduced to the NHS. Devices with this connector are not compatible with Luer connectors, preventing the risk of drugs being delivered through the wrong route. Industry has now adopted this new ISO standard for use throughout the UK and NRFitTM is now the dedicated connector for neuraxial devices. The Surety® devices introduced as an interim safety measure while the new ISO standard was being developed will now be discontinued.

RCoA/NIHR Research Awards 2017

The RCoA is pleased to announce three joint awards in conjunction with the National Institute for Health Research (NIHR) Clinical Research Network (CRN). The awards are designed to recognise NHS clinicians (consultants and trainees) who are making outstanding contributions to clinical research, particularly in relation to NIHR CRN portfolio research studies.

Applicants must be NHS clinicians (clinical academics are not eligible) and must be a fellow or member of the RCoA. Clinicians can enter under one of three categories: consultant (including SAS), trainee (individual) and a new trainee network category.

Each award carries a £1,000 prize. Complete this short application form to apply. The deadline for applications is midnight on Friday 3 November 2017.

Anaesthetic management of a patient with multiple pterygium syndrome for elective caesarean section

International Journal of Obstetric Anesthesia , Volume 31 , 96 - 100 

We report a case of a pregnant woman with multiple pterygium syndrome who presented for elective caesarean section. Neuraxial anaesthesia failed and the backup plan of awake intubation was extremely difficult.

UHCW Research: V. Daga, C. Mendonca, F. Choksey, J. Elton and S. Radhakrishna

A pragmatic randomised controlled trial comparing the efficacy of a femoral nerve block and periarticular infiltration for early pain relief following total knee arthroplasty

Bone Joint J. 2017 Jul;99-B(7):904-911. doi: 10.1302/0301-620X.99B7.BJJ-2016-0767.R2. Epub 2017 Jun 29.

The aim of this study was to compare the effectiveness of a femoral nerve block and a periarticular infiltration in the management of early post-operative pain after total knee arthroplasty (TKA).

Periarticular infiltration is a viable and safe alternative to femoral nerve block for the early post-operative relief of pain following TKA. Cite this article: Bone Joint J 2017;99-B:904-11.

UHCW Research: Wall, P. D. H., Balasubramanian S. and Thompson P.

SAS Anaesthetists – Securing our Workforce

The SAS Anaesthetists – Securing Our Workforce report on the outcomes of the RCoA’s 2016 SAS survey is now available after being released today at the College’s annual Summer Symposium meeting.

Launch of Core Standards for Pain Medicine Services (CSPMS) Gap Analysis Questionnaire

Following feedback received since the launch of thje RCoA's Faculty of Pain Medicine's Core Standards for Pain Medicine Services, a need for a Gap Analysis Questionnaire was recognised and this tool is now available. This is aimed at allowing clinicians/ pain units to assess how closely their institution adheres to the Core Standards published in CSPMS.

BMA and FPM guidance produced on analgesic prescribing and end of life pain management

The British Medical Association has released two guidance documents around the use of analgesics.

Chronic pain: supporting safer prescribing of analgesics
Improving analgesic use to support pain management at the end of life

GPAS 2017 updates

The Royal College of Anaesthetists has updated its Guidelines for the Provision of Anaesthesia Services (GPAS).

The 2017 edition includes a further five chapters that have been developed using the College’s NICE-accredited process for chapter development. These are:

• Guidelines for the Provision of Paediatric Anaesthesia Services
• Guidelines for the Provision of Anaesthesia Services for an Obstetric Population
• Guidelines for the Provision of Ophthalmic Anaesthesia Services
• Guidelines for the Provision of Anaesthesia Services for Burn and Plastics Surgery 
• Guidelines for the Provision of Anaesthesia Services for Intra-operative Care

Almost all patients satisfied with their anaesthetic care

New research has discovered that almost all UK patients were very satisfied with the care they received from anaesthetists.

The HSRC SNAP-1 study, carried out by the RCoA funded Health Services Research Centre (HSRC) and the University College London Hospitals NIHR Biomedical Research Centre, and surveying 15,040 patients, looked into adult patient satisfaction and experience after undergoing non-obstetric surgery requiring anaesthesia care, in order to identify targets for research and quality improvement.

99% of respondents stated that they would recommend their hospital’s anaesthesia service to their friends and family. Anxiety was most frequently cited as being the worst element of having an operation – reported by 34% of women and 26% of men and a third (35%) of patients reported discomfort after anaesthesia.

However, surprisingly the study found that women are up to three times more likely to experience discomfort than men. The study found that compared to men, women were also:

• almost three times (2.77 times) more likely to experience severe cold or nausea and vomiting
• almost twice as likely to experience severe pain (1.73 times) and drowsiness (1.7) after surgery requiring anaesthesia care
• more likely to experience severe thirst (1.32 times) and sore throat (1.52 times).