TP9.2.14A novel 'one stop' service for Gallstone (GS) disease utilizing Emergency General Surgery (EGS) ambulatory clinic (AC) and dedicated expedited theater lists for early Cholecystectomy

Introduction GS related disease account for almost 1/3rd admissions and referrals in EGS 1. Rate of early cholecystectomy, as mandated by NICE guidelines, in a recent RCS annual report was only 0-30% of eligible patients.2 Aims The aim was to determine if an improved rate of acute cholecystectomy (AC) had been achieved by; increasing elective capacity for emergency general surgeons (EGS), ring fencing hot lists for AC, increased use of NCEPOD list and campaign of awareness among theatre and anaesthetic staff. Material and Methods A retrospective study of rates of AC before and after implementation of changes in working practice was conducted using hospital episode data. All patients eligible for early cholecystectomy were included. AC rate, Intra and post -operative complications, length of stay and number of referrals to the elective upper gastrointestinal (UGI) service were determined. Results Conclusion Acute cholecystectomy during acute admission by emergency surgical had been significantly improved. It is safe and does not increase post-operative LOS.

A randomised crossover study to compare the user seal check and quantitative fit test between two types of duckbill N95 particulate respirator masks: The Halyard Fluidshield® N95 and the BSN Medical ProShield® N-95 particulate respirator masks

N95 particulate respirator masks are currently recommended for all healthcare workers who care for patients with suspected or confirmed coronavirus disease (COVID-19) when performing aerosol-generating procedures. The protection provided by N95 particulate respirator masks is dependent on the filter’s efficiency and seal quality. In this prospective randomised crossover study, we conducted the user seal check and the quantitative fit test on two readily available duckbill models of N95 masks, the Halyard Fluidshield® N95 (Halyard, Alpharetta, GA, USA) and the BSN Medical ProShield® N-95 (BSN Medical, Mount Waverley, Victoria) particulate respirator masks. We recruited a total of 96 anaesthetic staff, of whom 26% were of South-East Asian ethnicity. We found that both types of masks provided reasonably high fit test pass rates among our participants and there was no significant difference between the two brands (77% for the Fluidshield and 65% for the ProShield, P = 0.916). Ninety-two percent of the participants could find at least one well-fitted mask among these two types of masks. We also demonstrated that the user seal check had low accuracy and low concordance (kappa coefficient of 0.16 for the Fluidshield and 0.08 for the ProShield) when compared to the quantitative fit test, and hence was not a reliable method to test seal quality.

Role of playback videolaryngoscope footage in improved patient care

Despite the frequency of videolaryngoscope use, to the authors’ knowledge, there are no publications exploring the role of playback video recording in real time to improve patient care. We present a patient with a difficult airway complicated by trauma during GlideScope® (Verathon Inc., Bothell, WA, USA) intubation. The injury was not recognised by any of the anaesthetic staff observing the intubation, and was only identified when playback video footage was viewed. This provided the opportunity for early ear, nose and throat surgical review prior to extubation. Airway trauma can be missed by the anaesthetist. Reviewing video playback footage at an appropriate time during the case may enable more timely recognition of airway injuries and, ultimately, improved patient care.

Intrapartum management of twin gestations

The intrapartum management of the twin pregnancy has remained a controversial and challenging issue in obstetrics. Development of a management plan for delivery of a twin gestation necessitates consideration of multiple factors including fetal presentations, gestational age, estimated fetal weights, the presence of maternal or fetal complications, and the experience of the attending obstetrician, anaesthetic staff and neonatologists. In twin gestations in which a trial of labour is possible, the major factor determining the intrapartum course is the relative presentations of twin A and twin B on admission to the delivery suite.