“Compoundless Anaesthesia”, Controlled Administration, and Post-Operative Recovery Acceleration: Musings on Theoretical Nanomedicine Applications

Much research has been conducted on how patients may be served through new advances in perioperative anaesthetic care. However, adaptations of standardised care methodologies can only provide so many novel solutions for patients and caregivers alike. Similarly, unique methods such as nanoscopic liposomal package delivery for analgesics and affective numbing agents pose a similar issue—specifically that we are still left with the dilemma of patients for whom analgesics and numbing agents are ineffective or harmful. An examination of the potential gains that may result from the targeted development of nanorobotics for anaesthesia in perioperative care will be presented in this essay to help resolve this pending conflict for the research community. This examination should therefore serve as a “call to action” for such research and a “primer” for those for whom the method’s implementation would most directly impact.

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

ObjectivesStudies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study

Background Both wound infiltration (WI) with local anaesthetic and Erector Spinae Plane block (ESPB) have been described for post-operative analgesia after abdominal surgery. This study compared the efficacy of WI versus ESPB for post-operative analgesia after laparoscopic assisted colonic surgery. Methods Seventy-two patients between 18 and 85 years of age undergoing elective surgery were randomised to receive either WI or ESPB. In the WI group a 40 ml bolus of 0.5% Ropivacaine, infiltrated at the ports and minimally invasive wound at subcutaneous and fascia layers. In the ESPB group at T8 level, under ultrasound guidance, a 22-gauge nerve block needle was passed through the Erector Spinae muscle to reach its fascia. A dose up to 40 ml of 0.5% Ropivacaine, divided into two equal volumes, was injected at each side. Both groups had a multimodal analgesic regime, including regular Paracetamol, dexamethasone and patient-controlled analgesia (PCA) with Fentanyl. The primary end point was a post-operative pain score utilising a verbal Numerical Rating Score (NRS, 0–10) on rest and coughing in the post anaesthetic care unit (PACU) and in the first 24 h. Secondary outcomes measured were: opioid usage, length of stay and any clinical adverse events. Results There was no significant treatment difference in PACU NRS at rest and coughing (p-values 0. 382 and 0.595respectively). Similarly, there were no significant differences in first 24 h NRS at rest and coughing (p-values 0.285 and 0.431 respectively). There was no significant difference in Fentanyl use in PACU or in the first 24 h (p- values 0.900 and 0.783 respectively). Neither was there a significant difference found in mean total Fentanyl use between ESPB and WI groups (p-value 0.787). Conclusion Our observations found both interventions had an overall similar efficacy. Trial registration The study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN: 12619000113156).

Anaesthetic challenges and difficult airway in a child with Poland’s syndrome

: Poland’s syndrome is an uncommon clinical disorder with a typical musculoskeletal deformity of thorax and ipsilateral upper limb with a variable spectrum of associated anomalies. Although patients of this musculoskeletal disorder have several features with potential anaesthetic risks including malignant hyperthermia, previous reports about anaesthetic management of these patients are limited. : We report the successful anaesthetic management of a child of Poland’s syndrome posted for surgical correction of club foot who had an anticipated difficult airway alongwith unilateral chest wall defect with paradoxical breathing and ipsilateral syndactyly and hence, posing challenges in the insertion of endotracheal tube, ventilatory management, regional anaesthesia and prevention of any risk of development of malignant hyperthermia. Paramount in the anaesthetic care of such patients is a thorough preoperative evaluation and a cautious intraoperative anaesthetic management. Avoidance of halogenated inhalational agents and depolarising neuromuscular blocking drugs, and use of controlled ventilation and regional anaesthetic techniques are recommended. The possibility of a compromised airway should always be kept in mind while anaesthetising these patients.

743 Establishing COVID-Secure Surgery: Maintaining Urgent Elective Surgery During The COVID-19 Pandemic

Introduction The COVID-19 pandemic continues to impose significant direct burdens on secondary healthcare services in the UK and around the world. Maintaining timely and safe delivery of major urgent elective surgery throughout the pandemic is essential if we are to continue to treat cancer and other time-critical surgical conditions. Our Trust established a COVID-secure hospital within the Trust to deliver urgent elective surgical care. Method Basic demographics, operative interventions and 30-day outcomes of consecutive patients undergoing major surgery at our COVID-secure site were collected between June-November 2020. Major surgery was defined as patients requiring admission to the Post Anaesthetic care unit (PACU). PACU provides Level 2 care for 23 hours before discharging patients to the ward. Results 279 consecutive patients were included. PACU admission &gt;23 hours were associated with increased total length of stay (LOS) (p = 0.004), 30-day complications (p &lt; 0.0001), higher rate of transfer to a ‘COVID-hot’ hospital (p = 0.01) and nosocomial COVID-19 infection (p = 0.051). Compared to spinal anaesthesia, epidural anaesthesia was associated with PACU admission breach (p = 0.02), increased total LOS (p = 0.01), increased transfer to the ‘hot’ sites (p = 0.03) and 30-day complications (p = 0.06). Conclusions Establishing a COVID-secure site enabled continuation of major urgent elective surgery within a viral pandemic. Level 2 support is essential to ensure safe delivery of complex surgery at ‘cold’ sites. This study has identified clinically relevant advantage with the use of adjuvant spinal anaesthesia in preference to epidural. Enhancing critical care services is essential to minimise patient transfer to ‘hot sites’ and limit nosocomial COVID infection.

Parents’ experience of family-centred care in the post-anaesthetic care unit during non-clinical delays: A qualitative study

The qualitative exploratory descriptive study explored parents’ experience of family-centred care during delayed transfer from a paediatric post-anaesthetic care unit to an inpatient ward. Data were collected in a tertiary children’s hospital in Melbourne, Australia, using in-depth, semi-structured interviews. Participants ( n = 15) were parents of children ( n = 10, aged 6 months to 16 years) delayed in a Stage 1 post-anaesthetic care unit for longer than 30 min. Elements of the family-centred care framework guided thematic analysis, the core concepts of which are respect and dignity, information sharing, participation and collaboration. Respect and dignity was most often identified, expressed in three subthemes: (1) the caring behaviour of staff, (2) being present with their child and (3) a journey shared with other families. Information sharing was also common, illustrated through (1) being told information and (2) being heard. Participation, the third element of the framework, was infrequently identified by participants; however, parents of children under 6 years of age alluded to contributing to their child’s care. The final element, collaboration, was not identified in the study data. Only two of four elements of the family-centred care framework were common in parents’ experiences: respect and dignity, and information sharing. ‘Being with’ their child emerged as a central concern for parents’ perceptions of family-centred care.

Post operative nausea and vomiting, its causes, and the way of its prevention and treatment

Postoperative nausea and vomiting is still occurring in one third of the patient undergoing surgery under general anaesthesia even after following the guidelines and using multi modal approach for its prevention. Lots of studies have been done for its prevention but very few studies are done for its treatment in Post anaesthetic care unit after the failure of prophylaxis. The purpose of this article is to know about the risk factor, incidence of nausea and vomiting after surgery, its mechanism, available medication (pharmacological and nonpharmacological), reducing risk factor, and mainly to know about the method of using the antiemetic medication in PACU after the failure of the prophylactic medication.

Anaesthetic care of patients undergoing primary hip and knee arthroplasty: evolution of views

Operations of total hip arthroplasty (THA) and knee joints (TKA) are among the most frequently performed surgical interventions. At the same time, there is still no consensus regarding the choice of the optimal method of anesthesia for these operations. The review analyzes the approaches to the anesthetic provision of THA and TKA in different countries and different clinics of the same country. The tendencies of a gradual increase in the share of neuraxial anesthesia techniques in the structure of anesthesia for THA and TKA are presented. Based on a number of large population studies, an analysis of the effect of the anesthesia method on the early postoperative period and the results of surgical treatment in general is given. The positive role of epidural and spinal anesthesia, in comparison with general anesthesia, in the complex of anesthetic management of operations on the joints of the lower extremities has been shown.