ORCID Profile
0000-0002-8711-4590
Current Organisations
Monash University
,
Alfred Health
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Publisher: SAGE Publications
Date: 22-06-2021
Abstract: Airway Management is the key for anaesthetists dealing with patients undergoing diagnostic procedures and surgical interventions. The present coronavirus pandemic underpins even more how important safe airway management is. It also highlights the need to apply stringent precautions to avoid infection and ongoing transmission to patients, anaesthetists and other healthcare workers (HCWs). In light of this extraordinary global situation the aim of this article is to update the reader on the varied aspects of the ever-changing tasks anaesthetists are involved in and highlight the equipment, devices and techniques that have evolved in response to changing technology and unique patient and surgical requirements.
Publisher: SAGE Publications
Date: 19-06-2022
DOI: 10.1177/0310057X221082664
Abstract: The Australian and New Zealand College of Anaesthetists (ANZCA) recently reviewed and updated the guideline on equipment to manage a difficult airway. An ANZCA-established document development group, which included representatives from the Australasian College for Emergency Medicine and the College of Intensive Care Medicine of Australia and New Zealand, performed the review, which is based on expert consensus, an extensive literature review, and bi-nationwide consultation. The guideline (PG56(A) 2021, www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PS56-Guideline-on-equipment-to-manage-difficult-airways ) is accompanied by a detailed background paper (PG56(A)BP 2021, www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PG56(A)BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper ), from which the current recommendations are reproduced on behalf of, and with the permission of, ANZCA. The updated 2021 guideline replaces the 2012 version and aims to provide an updated, objective, informed, transparent, and evidence-based review of equipment to manage difficult airways.
Publisher: AMPCo
Date: 17-05-2021
DOI: 10.5694/MJA2.51086
Publisher: SAGE Publications
Date: 07-2012
DOI: 10.1177/0310057X1204000407
Abstract: Due to the large number of videolaryngoscopes now available, it might be difficult for novice users to assess the various devices or use them optimally. We have collated the experiences of several airway management experts to assist in the assessment and optimal use of seven commonly used videolaryngoscopes. While all videolaryngoscopes have unique features, they can be broadly ided into those inserted via a midline approach over the tongue and those inserted laterally along the floor of the mouth. Videolaryngoscopes that are placed on the floor of the mouth displace the tongue antero-laterally and flatten the submandibular tissues. They generally require a conventional shaped bougie for tracheal intubation. Videolaryngoscopes that use the midline approach may have an in-built airway conduit for the tracheal tube or may require a ‘J-shaped’ stylet in the tracheal tube to negotiate the upper airway. This may cause difficulty when the tracheal tube is inserted through the glottis and the tip abuts the anterior wall of the subglottic space. Knowledge of the mechanism used by videolaryngoscopes to achieve laryngoscopy is essential for safe and successful tracheal intubation when using these devices.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: Wiley
Date: 03-08-2021
DOI: 10.1002/JMRS.533
Abstract: Peripherally inserted central catheters (PICCs) offer a convenient long‐term intravenous access option. Different methods exist for insertion including the use of continuous fluoroscopy for guidance, or bedside insertion techniques. The blind pushing technique is a bedside approach which involves advancing a PICC through the access sheath without imaging guidance, before taking a mobile chest radiograph to confirm tip position. Obtaining optimal position is a critical aim of PICC placement as malpositioned lines have been associated with higher complications including death. We aimed to assess the accuracy of PICC placement by comparing the tip position and complications for lines placed under fluoroscopic guidance to those placed without fluoroscopic guidance. The Radiology Information System was used to identify 100 continuous PICC insertions in each group (fluoroscopic and blind pushing) between 1 January and 12 May 2019. Patients were excluded if there was a known history of central venous occlusion/stenosis. In the fluoroscopic‐guided group, 0% of the lines were malpositioned compared with 60% of the lines placed using the blind pushing technique, P 0.001. Fluoroscopic‐guided PICC insertions were in place for a total of 2446 days and demonstrated 6 complications (2.45 complications per 1000 catheter days). This compared with blind pushing technique PICC insertions which were in place for a total of 1521 days and demonstrated 18 complications (11.83 complications per 1000 catheter days), P = 0.004. The use of fluoroscopy for PICC placement leads to significant improvements in tip accuracy than for PICCs placed using the blind pushing technique. While the use of these imaging resources incurs cost and time, these factors should be balanced in order to offer patients the safest and most accurate method of line insertion.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 14-12-2019
DOI: 10.1111/ANAE.14543
Publisher: Wiley
Date: 11-07-2017
DOI: 10.1111/ANAE.13994
Publisher: SAGE Publications
Date: 07-2021
DOI: 10.1177/0310057X211024691
Abstract: The use of high flow nasal oxygen in the care of COVID-19-positive adult patients remains an area of contention. Early guidelines have discouraged the use of high flow nasal oxygen therapy in this setting due to the risk of viral spread to healthcare workers. However, there is the need to balance the relative risks of increased aerosol generation and virus transmission to healthcare workers against the role high flow nasal oxygen has in reducing hypoxaemia when managing the airway in high-risk patients during intubation or sedation procedures. The authors of this article undertook a narrative review to present results from several recent papers. Surrogate outcome studies suggest that the risk of high flow nasal oxygen in dispersing aerosol-sized particles is probably not as great as first perceived. Smoke laser-visualisation experiments and particle counter studies suggest that the generation and dispersion of bio-aerosols via high flow nasal oxygen with flow rates up to 60 l/min is similar to standard oxygen therapies. The risk appears to be similar to oxygen supplementation via a Hudson mask at 15 l/min and significantly less than low flow nasal prong oxygen 1–5 l/min, nasal continuous positive airway pressure with ill-fitting masks, bilevel positive airway pressure, or from a coughing patient. However, given the limited safety data, we recommend a cautious approach. For intubation in the COVID-positive or suspected COVID-positive patient we support the use of high flow nasal oxygen to extend time to desaturation in the at-risk groups, which include the morbidly obese, those with predicted difficult airways and patients with significant hypoxaemia, ensuring well-fitted high flow nasal oxygen prongs with staff wearing full personal protective equipment. For sedation cases, we support the use of high flow nasal oxygen when there is an elevated risk of hypoxaemia (e.g. bariatric endoscopy or prone-positioned procedures), but recommend securing the airway with a cuffed endotracheal tube for the longer duration procedures when theatre staff remain in close proximity to the upper airway, or considering the use of a surgical mask to reduce the risk of exhaled particle dispersion.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2022
Publisher: Elsevier BV
Date: 06-2017
DOI: 10.1093/BJA/AEX101
Publisher: Cambridge University Press (CUP)
Date: 14-07-2022
DOI: 10.1017/ICE.2022.169
Abstract: To compare the accuracy of monitoring personal protective equipment (PPE) donning and doffing process between an artificial intelligent (AI) machine collaborated with remote human buddy support system and an onsite buddy, and to determine the degree of AI autonomy at the current development stage. We conducted a pilot simulation study with 30 procedural scenarios (15 donning and 15 doffing, performed by one in idual) incorporating random errors in 55 steps. In total, 195 steps were assessed. The human–AI machine system and the onsite buddy assessed the procedures independently. The human–AI machine system performed the assessment via a tablet device, which was positioned to allow full-body visualization of the donning and doffing person. The overall accuracy of PPE monitoring using the human–AI machine system was 100% and the overall accuracy of the onsite buddy was 99%. There was a very good agreement between the 2 methods (κ coefficient, 0.97). The current version of the AI technology was able to perform autonomously, without the remote human buddy’s rectification in 173 (89%) of 195 steps. It identified 67.3% of all the errors independently. This study provides preliminary evidence suggesting that a human–AI machine system may be able to serve as a substitute or enhancement to an onsite buddy performing the PPE monitoring task. It provides practical assistance using a combination of a computer mirror, visual prompts, and verbal commands. However, further studies are required to examine its clinical efficacy with a erse range of in iduals performing the donning and doffing procedures.
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 07-2013
DOI: 10.3171/2013.4.SPINE12876
Abstract: The treatment of morbidly obese in iduals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese in iduals, and to illustrate practical solutions. Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management. Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues. Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for in idual cases.
Publisher: Wiley
Date: 13-06-2016
DOI: 10.1111/ANAE.13507
No related grants have been discovered for William Bradley.