ORCID Profile
0000-0001-6637-0029
Current Organisation
St Vincent's Hospital Melbourne
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Publisher: Wiley
Date: 26-10-2021
DOI: 10.1111/ANAE.15599
Abstract: Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol‐generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS‐CoV‐1 outbreak in 2003. There is no direct evidence to indicate whether facemask ventilation is a high‐risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation and facemask ventilation with an intentionally generated leak in anaesthetised patients. Recordings were made in ultraclean operating theatres and compared against the aerosol generated by tidal breathing and cough manoeuvres. Respiratory aerosol from tidal breathing in 11 patients was reliably detected above the very low background particle concentrations with median [IQR (range)] particle counts of 191 (77–486 [4–1313]) and 2 (1–5 [0–13]) particles.l ‐1 , respectively, p = 0.002. The median (IQR [range]) aerosol concentration detected during facemask ventilation without a leak (3 (0–9 [0–43]) particles.l ‐1 ) and with an intentional leak (11 (7–26 [1–62]) particles.l ‐1 ) was 64‐fold (p = 0.001) and 17‐fold (p = 0.002) lower than that of tidal breathing, respectively. Median (IQR [range]) peak particle concentration during facemask ventilation both without a leak (60 (0–60 [0–120]) particles.l ‐1 ) and with a leak (120 (60–180 [60–480]) particles.l ‐1 ) were 20‐fold (p = 0.002) and 10‐fold (0.001) lower than a cough (1260 (800–3242 [100–3682]) particles.l ‐1 ), respectively. This study demonstrates that facemask ventilation, even when performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, we argue facemask ventilation should not be considered an aerosol‐generating procedure.
Publisher: Wiley
Date: 2022
DOI: 10.1111/ANAE.15613
Abstract: Peri‐operative neurocognitive disorders are the most common complication experienced by older in iduals undergoing anaesthesia and surgery. Peri‐operative neurocognitive disorders, particularly postoperative delirium, result in long‐term poor outcomes including: death dementia loss of independence and poor cognitive and functional outcomes. Recent changes to the nomenclature of these disorders aims to align peri‐operative neurocognitive disorders with cognitive disorders in the community, with consistent definitions and clinical diagnosis. Possible mechanisms include: undiagnosed neurodegenerative disease inflammation and resulting neuroinflammation neuronal damage and comorbid systemic disease. Pre‐operative frailty represents a significant risk for poor postoperative outcomes it is associated with an increase in the incidence of cognitive decline at 3 and 12 months postoperatively. In addition to cognitive decline, frailty is associated with poor functional outcomes following elective non‐cardiac surgery. It was recently shown that 29% of frail patients died or experienced institutionalisation or new disability within 90 days of major elective surgery. Identification of vulnerable patients before undergoing surgery and anaesthesia is the key to preventing peri‐operative neurocognitive disorders. Current approaches include: pre‐operative delirium and cognitive screening blood biomarker analysis intra‐operative management that may reduce the incidence of postoperative delirium such as lighter anaesthesia using processed electroencephalography devices and introduction of guidelines which may reduce or prevent delirium and postoperative neurocognitive disorders. This review will address these issues and advocate for an approach to care for older peri‐operative patients which starts in the community and continues throughout the pre‐operative, intra‐operative, postoperative and post‐discharge phases of care management, involving multidisciplinary medical teams, as well as family and caregivers wherever possible.
Publisher: Elsevier BV
Date: 08-2023
Publisher: Cold Spring Harbor Laboratory
Date: 26-08-2021
DOI: 10.1101/2021.08.23.21262441
Abstract: Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol generating procedure. This designation is based on a single epidemiological study suggesting an association between facemask ventilation and transmission from the SARS 2003 outbreak. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation, and facemask ventilation with an intentionally generated leak, in anaesthetised patients with neuromuscular blockade. Recordings were made in ultraclean theatres and compared against the aerosol generated by the patient’s own tidal breathing and coughs. Respiratory aerosol from tidal breathing was reliably detected above the very low background particle concentrations (191 (77-486 [3.8-1313]) versus 2.1 (0.7-4.6 [0-12.9] particles.l -1 median(IQR)[range], n=11, p=0.002). The average aerosol concentration detected during facemask ventilation both without a leak (3.0 particles.l -1 (0 – 9 [0-43])) and with an intentional leak (11 particles.l -1 (7.0 – 26 [1-62])) was 64-fold and 17-fold lower than that of tidal breathing (p=0.001 and p=0.002 respectively). The peak particle concentration during facemask ventilation both without a leak (60 particles.l -1 (0 – 60 [0-120])) and with a leak (120 particles.l -1 (60 – 180 [60-480]) were respectively 20-fold and 10-fold lower than a cough (1260 particles (800 – 3242 [100-3682]), p=0.002 and p=0.001 respectively). This study demonstrates that facemask ventilation, even performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, facemask ventilation should not be considered an aerosol generating procedure.
No related grants have been discovered for David Scott.