ORCID Profile
0000-0002-3138-1091
Current Organisation
Women's and Children's Hospital
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Publisher: John Wiley & Sons, Ltd
Date: 05-10-2011
Publisher: SAGE Publications
Date: 07-2013
Publisher: SAGE Publications
Date: 06-1999
DOI: 10.1177/0310057X9902700309
Abstract: We aimed to explore the first 5000 incidents reported to the Australian Incident Monitoring Study (AIMS) involving anaesthesia for obstetric patients and found 203 such incidents. Analysis and classification identified seven main incident groups regional anaesthetic techniques (33%), anaesthetic equipment problems (13%), “wrong drug” errors (10%), other drug-related problems (16%), difficult/failed intubation (9%), problems with the endotracheal tube (9%) and other problems (10%). When compared to the incidents in the main database, obstetric cases were found to be over-represented with respect to accidental dural puncture, post dural puncture headache, failed intubation in emergency situations and the incidence of certain types of “wrong drug” error. The implications of these reports regarding safe practice of obstetric anaesthesia are discussed.
Publisher: Wiley
Date: 24-07-2018
Publisher: SAGE Publications
Date: 04-04-2018
Abstract: This research examined whether negative and positive arousal emotions modify the relationship between experience level and cue utilization among anesthetists. The capacity of a practitioner to form precise associations between clusters of features (e.g., symptoms) and events (e.g., diagnosis) and then act on them is known as cue utilization. A common assumption is that practice experience allows opportunities for cue acquisition and cue utilization. However, this relationship is often not borne out in research findings. This study investigates the role of emotional state in this relationship. An online tool (EXPERTise 2.0) was used to assess practitioner cue utilization for tasks relevant to anesthesia. The experience of positive and negative arousal emotions in the previous three days was measured, and emotion clusters were generated. Experience was measured as the composite of practice years and hours of practice experience. The moderating role of emotion on the relationship between experience and cue utilization was examined. Data on 125 anesthetists (36% female) were included in the analysis. The predicted interaction between arousal emotions and the experience level emerged. In particular, post hoc analyses revealed that anxiety-related emotions facilitated the likelihood of high cue utilization in less experienced practitioners. The findings suggest a role for emotions in cue use and suggest a functional role for normal range anxiety emotions in a simulated work-relevant task. This research illustrates the importance of understanding the potentially functional effects common negative arousal emotions may have on clinical performance, particularly for those with less experience.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.BJA.2017.12.037
Abstract: Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the perioperative period remain poorly defined. The Standardised Endpoints in Perioperative Medicine initiative was established to derive a set of standardised endpoints for use in perioperative clinical trials. We undertook a systematic review to identify measures of patient comfort used in the anaesthetic, surgical, and other perioperative literature. A multi-round Delphi consensus process that included up to 89 clinician researchers was then used to refine a recommended list of outcome measures. We identified 122 studies in a literature search, which were the basis for a preliminary list of 24 outcome measures and their definitions. The response rates for Delphi Rounds 1, 2, and 3 were 100% (n=22), 90% (n=79), and 100% (n=13), respectively. A final list of six defined endpoints was identified: pain intensity (at rest and during movement) at 24 h postoperatively, nausea and vomiting (0-6 h, 6-24 h, and overall), one of two quality-of-recovery (QoR) scales (QoR score or QoR-15), time to gastrointestinal recovery, time to mobilisation, and sleep quality. As standardised outcomes will support benchmarking and pooling (meta-analysis) of trials, one or more of these recommended endpoints should be considered for inclusion in clinical trials assessing patient comfort and pain after surgery.
Publisher: Wiley
Date: 28-01-2014
Publisher: Elsevier BV
Date: 08-2019
Publisher: Wiley
Date: 13-01-2015
DOI: 10.1111/PAN.12617
Abstract: Emergence agitation (EA) is a common behavioral disturbance after sevoflurane anesthesia in children. Propofol 1 mg · kg(-1) bolus at the end of sevoflurane anesthesia has had mixed results in reducing the incidence of EA, whereas propofol infusion throughout anesthesia maintenance seems effective but is more complex to administer. If a simple, short transition to propofol anesthesia was found to be effective in reducing EA, this could enhance the recovery of children following sevoflurane anesthesia. We therefore aimed to determine whether transition to propofol over 3 min at the end of sevoflurane anesthesia reduces the incidence of EA in children. In this prospective randomized controlled trial, 230 children aged 1-12 years, undergoing magnetic resonance imaging (MRI) scans under sevoflurane anesthesia were randomized to receive either propofol 3 mg · kg(-1) over 3 min (propofol group), or no propofol (control group), at the end of sevoflurane anesthesia. EA was assessed by a blinded assessor using the Pediatric Emergence Anesthesia Delirium (PAED) scale and the Watcha scale until 30 min after emergence. EA on the PAED scale was defined as a PAED score >12. EA on the Watcha scale was defined as a score ≥ 3. Times to emergence, postanesthesia care unit (PACU) discharge, and discharge home were also recorded. Data were analyzed for 218 children. The incidence of EA was lower in the propofol group on both PAED (29% vs 7% relative risk = 0.25 95% confidence interval 0.12-0.52 P < 0.001) and Watcha (39% vs 15% relative risk = 0.37 95% confidence interval 0.22-0.62 P < 0.001) scales. Duration and severity of EA were also reduced in the propofol group. Preplanned subgroup analyses for midazolam premedication, preexisting cognitive or behavioral disturbance, and age group did not alter our findings. Emergence time and time in PACU were both increased by a mean of 8 min in the propofol group (P < 0.001) with no difference in time to discharge home. Transition to propofol at the end of sevoflurane anesthesia reduces the incidence of EA and improves the quality of emergence. There is a small increase in recovery time, but no delay in discharge home.
Publisher: SAGE Publications
Date: 09-08-2019
Abstract: Research on the nocebo effect has shown that some words can hurt. Pain is defined as ‘unpleasant’ and ‘associated with actual or potential tissue damage’. So, a sensation described as ‘pain’ may function as a negative suggestion or nocebo communication. This can lead to pain being experienced or exacerbated where it would not have been otherwise. The nocebo effect has also been implicated as adversely affecting the pain experience during the assessment of pain postoperatively. Words that avoid this potential nocebo effect such as ‘comfort’ may represent a more satisfactory alternative. We therefore aimed to determine whether ‘comfort’ and ‘pain’ scores correlate when assessing patients postoperatively at the same timepoint. Patients were questioned before routine post-anaesthesia rounds to rate their pain and comfort levels, with the sequence of questions randomised. Patients were asked to rate pain and comfort on a 0–10 verbal numerical rating scale, where 0 represents ‘no pain’ or ‘no comfort’ and 10 ‘worst pain’ or ‘most comfort’ imaginable, respectively. To provide a clinically relevant correlation of approximately 0.7 between pain and inverted comfort scores, a s le size of 100 would provide adequate precision (95% confidence interval (CI) 0.58–0.79). A P-value of .05 was considered significant. We recruited 100 patients. A positive correlation of 0.62 was found between pain and inverted comfort scores (95% CI 0.47–0.72 P .0001). The question sequence of asking about pain or comfort did not affect either score. Comfort and pain scores are moderately correlated. This finding represents a first step in validating comfort scores and suggests that they could be considered a suitable alternative to pain scores when assessing patients postoperatively. As comfort is not an exact antonym to pain, caution is required when using these measures interchangeably.
Publisher: E.U. European Publishing
Date: 23-04-2020
DOI: 10.18332/EJM/120002
Publisher: John Wiley & Sons, Ltd
Date: 22-04-2003
Publisher: John Wiley & Sons, Ltd
Date: 20-10-2003
Publisher: SAGE Publications
Date: 02-2007
DOI: 10.1177/0310057X0703500109
Abstract: Recall and information sources regarding the risks of regional anaesthesia in women having lower segment caesarean section have not been adequately assessed previously. We aimed to survey women's recall of their pre-anaesthesia risk discussion and determine where women, presenting for lower segment caesarean section under regional anaesthesia, obtain risk information. Following a small pilot survey, women's responses were recorded for “spontaneous” or “prompted” recalled risks, the information source and its reliability. One-hundred and fifty women were surveyed following caesarean section. Seventy women (46.7%) had an elective procedure and 80 (53.3%) had an emergency procedure. Overall, 142 women (94.6%) recalled at least four risks (44.6% spontaneously 66% prompted). Of those women giving at least four spontaneous responses, 41 (58.6%) had elective and 26 (32.5%) had emergency lower segment caesarean section (P=0.001). The majority of women stated that anaesthetists were the main, and most reliable, source of their information regarding risks of regional anaesthesia for caesarean section. This report identifies the risks associated with regional anaesthesia for caesarean section that women most frequently recall, namely headache, paralysis, nerve damage and inadequate block.
Publisher: John Wiley & Sons, Ltd
Date: 28-05-2005
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.IJOA.2017.10.004
Abstract: Perineural (Tarlov) cysts are cerebrospinal fluid-containing perineural sacs that are usually located in the sacral spine. While often asymptomatic, they can cause progressive neurological symptoms including pain, paraesthesia and weakness. We present a case of a 24-year-old patient who had uneventful spinal anaesthesia at the L3-4 level for an elective caesarean section. Prior to her procedure, she had reported a two-year history of intermittent back pain and lower-limb paraesthesia, secondary to an S1 segment perineural cyst. Recurrent cyst-related symptoms were managed using serial radiologically-guided injection and cerebrospinal fluid aspiration, rather than a more invasive neurosurgical approach. Successful neuraxial anaesthesia for caesarean section, in the context of Tarlov cysts, is described and the management options are discussed.
Publisher: John Wiley & Sons, Ltd
Date: 22-04-2003
Publisher: Elsevier BV
Date: 09-2019
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 05-10-2021
DOI: 10.1111/ANS.16348
Abstract: The tension between the ideal of informed consent and the reality of the process is under‐investigated in spine surgery. Guidelines around consent imply a logical, plain‐speaking process with a clear endpoint, agreement and signature yet surgeons' surveys and patient interviews suggest that surgeons' explanation is anecdotally variable and patient understanding remains poor. To obtain a more authentic reflection of practice, spine surgeons obtaining ‘informed consent’ for non‐instrumented spine surgery were studied via video recording and risk/benefit discussions were analysed. A prospective observational study was conducted at a single neurosurgical institution. Twelve video recordings involving six surgeons obtaining an informed consent for non‐instrumented spine surgery were transcribed verbatim and blindly analysed using descriptive quantification and linguistic ethnography. Ten (83%) consultations discussed surgical benefit but less than half (41%) quantified the likelihood of benefit from surgery. The most discussed risks were nerve damage or paralysis (92%), bleeding (92%), infection (92%), cerebrospinal fluid leak (83%) and bowel and bladder dysfunction (75%). Surgeons commonly used a quantitative statement of risk (58%) but only half of the risks were explained in words patients were likely to understand. This study highlights inconsistencies in the way spine surgeons explain risks and obtain informed consent for ‘simple’ spine procedures in a real‐world setting. There are wide disparities in the provision of informed consent, which may be encountered in other surgical fields. Direct observation and qualitative analysis can provide insights into the limitations of current informed consent practice and help guide future practice.
Publisher: Elsevier BV
Date: 10-2004
DOI: 10.1093/BJA/AEH225
Publisher: John Wiley & Sons, Ltd
Date: 14-06-2011
Publisher: Wiley
Date: 2003
Publisher: Wiley
Date: 11-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1093/BJA/AEX347
Publisher: Wiley
Date: 28-06-2008
Publisher: John Wiley & Sons, Ltd
Date: 15-02-2012
Publisher: Wiley
Date: 09-04-2020
Publisher: Wiley
Date: 08-12-2010
Publisher: Wiley
Date: 14-05-2022
DOI: 10.1111/ANAE.15758
Publisher: Informa UK Limited
Date: 03-07-2022
DOI: 10.1080/00207144.2022.2105147
Abstract: Chronic low back pain (CLBP) is a debilitating and burdensome condition, and new treatment strategies are needed. This study aimed to evaluate (1) the feasibility of undertaking a controlled clinical trial investigating a novel intervention for people with CLBP: hypnotically reinforced pain science education, and (2) the acceptability of the intervention as rated by participants.
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.003.0022
Abstract: Needle phobia describes an anticipatory fear of needle insertion, and is a well-recognized clinical entity of particular relevance to the anaesthetist. It may affect up to 10 % of the general population, is more common in the young, and can prevent patients from seeking medical care by avoiding immunizations, necessary blood tests or hospital procedures. The development of trust, a perception of control and an understanding of the conscious–subconscious aspects of the problem can help patients. In addition, patience, time and recognized communication skills are frequently needed if this distressing problem is to be managed effectively . Needle phobia is usually a learned response. Trust, control and perceptions rather than the pain itself are the key issues in needle phobia. Nevertheless pain reduction strategies such as EMLA, ice , premedication such as dexometomidine, stress-reducing medical devices and hypnosis, may have a role in management. Anaesthetists have traditionally used reassurance, EMLA and avoidance of needle insertion in the awake patient by giving inhalational inductions. However, this approach tends to reinforce the avoidance behaviour of both anaesthetist and patient! In addition, it wastes a valuable opportunity to educate patients in ways that can provide them with the necessary skills to manage future blood tests, drips and the like more easily. In some cases avoiding IV access prior to inducing anaesthesia—for ex le, at a Caesarean section — can put patients at increased risk of complications. Patients with needle phobia are like all patients only more so! At one level they function consciously and logically and are amenable to reason. However, in the context of hospital procedures such as blood tests and IV cannulation, subconscious responses take over. These patients often recognize that their behaviour is silly or even stupid, but find that they just can’t help themselves. They may describe their predicament as being in ‘two minds about it’ or ‘beside themselves’. This mind set illustrates, probably more clearly than any other, the conscious–subconscious basis of the problem.
Publisher: Wiley
Date: 03-2002
Publisher: Wiley
Date: 10-2017
DOI: 10.1111/IMJ.13545
Abstract: To determine the prevalence of psychological distress in Australian junior medical officers ( JMO ) and investigate the determinants associated with psychological distress over a 3‐year (2014–2016) period. JMO were surveyed using the 2014–2016 JMO Census ( n = 220, 399 and 466 each year response rate approximately 15%). Levels of psychological distress were assessed using the Kessler Psychological Distress Scale ( K10 ). A K10 ≥ 25 was chosen to indicate high psychological distress, and this determinant was compared to various demographic and work‐related factors. Australian JMO experience a high level of psychological distress (mean: 18.1, median 16.0). There were no differences in demographical variables, such as age, gender, marital status, dependants and between postgraduate years 1 and 2. Increasing hours worked per week was associated with a higher K10 , with every hour worked increasing odds by 3%. Attitudinal items, including feeling unwilling to study medicine again, feeling poorly trained and experiences of bullying, were related to high psychological distress. Coping strategies like exercise and spending time with friends correlated positively with lower distress, while time off work, frequent alcohol use, smoking and drug use were associated with increased distress levels. Of those with a high K10 , 54.5% indicated that they did not use any form of professional support 17.83% expressed that given their time again, they would not choose to study medicine. A focused approach to JMO support and education regarding significant risk factors identified is likely to assist health policies that aim to improve the mental well‐being of Australian JMO .
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1093/BJA/AET324
Publisher: BMJ
Date: 09-04-2021
Abstract: The Serious Harm and Morbidity “SHAM” grading system has previously been proposed to categorize the risks associated with the use of invasive placebos in peripheral nerve block research. SHAM grades range from 0 (no potential complications, eg, using standard analgesia techniques as a comparator) through to 4 (risk of major complications, eg, performing a sub-Tenon’s block and injecting normal saline). A study in 2011 found that 52% of studies of peripheral nerve blocks had SHAM grades of 3 or more. We repeated the original study by allocating SHAM grades to randomized controlled studies of peripheral nerve blocks published in English over a 22-month period. Documentation was made of the number of study participants, age, number of controls, body region, adverse events due to invasive placebos and any discussion regarding the ethics of using invasive placebos. We compared the proportion of studies with SHAM grades of 3 or more with the original study. In this current study, 114 studies fulfilled the inclusion criteria, 5 pediatric and 109 adult. The SHAM grade was ≥3 in 38 studies (33.3%), with 1494 patients in these control groups collectively. Several studies discussed their reasons for choosing a non-invasive placebo. No pediatric studies had a SHAM grade of ≥3. The use of invasive placebos that may be associated with serious risks in peripheral nerve block research has decreased in contemporary peripheral nerve block research.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1093/BJA/AES517
Abstract: The use of negative words, such as 'sting' and 'pain', can increase patient pain and anxiety. We aimed to determine how pain scores compare with comfort scores and how the technique of pain assessment affects patient perceptions and experiences after operation. After Caesarean section, 300 women were randomized before post-anaesthesia review. Group P women were asked to rate their pain on a 0-10-point verbal numerical rating scale (VNRS), where '0' was 'no pain' and '10' was 'worst pain imaginable'. Group C women were asked to rate comfort on a 0-10-point VNRS, where '0' was 'no comfort' and '10' was 'most comfortable'. All women were asked whether the Caesarean wound was bothersome, unpleasant, associated with tissue damage, and whether additional analgesia was desired. The median (inter-quartile range) VNRS pain scores was higher than inverted comfort scores at rest, 2 (1, 4) vs 2 (0.5, 3), P=0.001, and movement, 6 (4, 7) vs 4 (3, 5), P<0.001. Group P women were more likely to be bothered by their Caesarean section, had greater VNRS 'Bother' scores, 4 (2, 6) vs 1 (0, 3), P<0.001, perceived postoperative sensations as 'unpleasant' [relative risk (RR) 3.05, 95% confidence interval (CI) 2.20, 4.23], P<0.001, and related to tissue damage rather than healing and recovery (RR 2.03, 95% CI 1.30, 3.18), P=0.001. Group P women were also more likely to request additional analgesia (RR 4.33, 95% CI 1.84, 10.22), P<0.001. Asking about pain and pain scores after Caesarean section adversely affects patient reports of their postoperative experiences.
Publisher: Informa UK Limited
Date: 28-06-2019
DOI: 10.1080/00207144.2019.1612669
Abstract: This article describes two common hypnotic communication techniques that can be used in anesthesiology and more generally for a variety of medical applications. First, the LAURS (listening, acceptance, utilization, reframing, suggestion) hypnotic communication structure is detailed. This technique allows clinicians to rapidly build patient rapport and maximize the chance of a suggestion being realized. Second, the "Lived in Imagination
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2005
Publisher: Wiley
Date: 04-08-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2005
Publisher: Elsevier BV
Date: 10-2005
Publisher: Wiley
Date: 18-10-2006
Publisher: Wiley
Date: 07-2020
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Publisher: Wiley
Date: 05-2004
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2006
Publisher: SAGE Publications
Date: 2008
DOI: 10.1177/0310057X0803600117
Abstract: Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. Following dural puncture, 265 respondents (64%) indicated that they “would usually remove the Tuohy needle and resite”. The most common reason for this decision was concern regarding the safety of intrathecal catheters (ITC) (n=236, 89%), in particular, the risk of misuse (n=182, 70%). The most frequently reported reason for “usually inserting an ITC” was that this reduced the incidence (n=120, 84%) and severity (n=110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
Publisher: Elsevier BV
Date: 11-2017
Publisher: John Wiley & Sons, Ltd
Date: 22-07-2002
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.003.0017
Abstract: The obstetric anaesthetist’s clinical practice is concerned with the safety of not one, but two intricately interwoven in iduals, and much of this takes place in the presence of a third party—partner, friend or relative. Pregnancy and birth are natural and normal processes in the lives of most people. In this context, communication might be expected to be a matter of common sense and somewhat intuitive. How we communicate with women is a pivotal factor in determining their experience and, although recognized as such by many within the midwifery community , this is perhaps less so by doctors. Advances in medicine and changes in society over the last 100 years have resulted in a safer but, socially and technologically, a more complex experience for both women and their babies. Communication in childbirth originally occurred between women caring for each other, but this subsequently became dominated by an authoritarian medical machine, which has left some women feeling vulnerable and ‘processed’. Recognition of the importance and value of patient rights and satisfaction has been responsible for a cultural shift in many maternity units. However, the medicalization of childbirth continues to take over even when labour is proceeding normally. Anaesthetists are perfectly positioned as providers of analgesia and anaesthesia, within a multidisciplinary team, to communicate with women in a way that empowers them and supports their autonomy. Women become highly focused on the pregnancy and labour as the evidence looms ever larger in front of them. Pregnancy and childbirth usually represent a challenging psychological and physiological experience. This focus of attention on the pregnancy makes women highly suggestible to subconscious communications. For this reason, messages received can function as powerful determinants of how women perceive their pregnancy, and respond during childbirth. Central nervous system (CNS) changes occur that reduce anaesthesia requirements during pregnancy and increase hypnotizability, dissociation, daydreaming and an ability to use imagery to experience labour in a fulfilling way. There is a range of emotional responses to pregnancy. For some, there is joy and excitement, while for others there is no excitement—just fear and anxiety. Overlaying this, there may be pre-existing generalized anxiety, social concerns, obstetric problems and other complications.
Publisher: Wiley
Date: 29-09-2015
DOI: 10.1111/PAN.12759
Abstract: The impact of communication within the perioperative period is an area of increasing research interest. Suggestions are phrases or actions that can lead to subconscious nonvolitional changes in patient perception, mood, and/or behavior. Statements functioning as suggestions may induce positive or negative perceptual responses and experiences. Children and anxious patients are particularly responsive to the effects of suggestion. We aimed to identify positively and negatively worded statements used during the provision of preoperative information by nursing staff in a tertiary referral center for pediatric care. Audio recordings of preoperative consultations between nurses, children, and their parents were made between February and May 2014. Two researchers independently reviewed the transcripts and identified positively and negatively worded suggestions. Ex les of negative suggestions were, 'he is going to be sore for a week or two' or 'normal to feel a bit sick....', and a positive suggestion was 'so she will be feeling quite comfortable...'. There were 51 consultations transcribed and analyzed. Of the 130 suggestions independently agreed by both researchers to be either positive or negative, 40 were identified as positive (31%) and 90 negative (69%). Commonly occurring negative suggestions described: pain in 21 consultations (41%) nausea and sickness in 19 (37%) and irritability or agitation in nine (18%). Positive suggestions included a description of a return of normal activities such as eating and drinking in 14 (28%), comfort in nine (18%), and well-being in nine (18%). Twelve consultations (24%) contained only negative suggestions, while four (8%) had only positive suggestions. This is the first prospective observational study investigating the language used by nurses during the preoperative child-parent encounter. Suggestions for negative perceptual experiences were frequently used during the preoperative nurse consultations. Education of nurses regarding awareness and understanding of negative suggestions and their potential adverse effects is recommended.
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.003.0018
Abstract: Anaesthetists usually develop their communication skills through experience over many years of trial and error. Much angst can be avoided by learning some simple techniques that can facilitate interactions during the delivery of anaesthesia care. Caring for children from newborn to adolescence provides the anaesthetist with unique opportunities to use communication to improve anaesthesia care. To a parent, the matter of handing over control and protection of their child to the anaesthetist is invariably difficult, emotional and can lead to significant distress. This is irrespective of whether the surgical intervention is major or not. For their child to attend the hospital for a procedure, families have frequently made unspoken and intricate arrangements in their schedule. Making these arrangements adds to the other stresses of coming in for surgery. Being mindful of this can help the anaesthetist communicate in a way that recognizes the possible complexity for some families of even attending the hospital on time. In recent years the increasing popularity of day-surgery admission has meant that many parents meet their child’s anaesthetist for the first time only minutes before the procedure. However, much can be done to enhance patient and parent rapport even when only a short time is available. Flexibility in approach is paramount. The age of the child determines how the ‘LAURS’ of communication can be implemented to facilitate patient rapport, trust and engagement during anaesthesia care. Communicating with children is similar to, yet differs from, communicating with adults. Children live in a subconscious world of play and make-believe. They are highly responsive to suggestion, and the use of subconscious language and non-verbal cues is frequently more effective than the usual adult logical communication most doctors are familiar with. Because of this, children often do not appear to be paying attention and instead frequently behave spontaneously, subconsciously or contrary to what is being asked of them. Adults when stressed will often do this too. As with adults, the aim of communicating effectively with children is to promote autonomy and a sense of control.
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.003.0015
Abstract: The perioperative period can be a life-changing event for many patients, the effects of which can be lifelong for better or worse. The anaesthetist’s communication at this time can have a profound impact on the care of their patients in the matter of both short-term cooperation and long-term perceptions of their hospital experience. Induction of anaesthesia is a stressful time for many patients, young and old. There is an inevitable loss of control when the patient hands this over temporarily to the anaesthetist. In order to enhance cooperation, anaesthetists will reap unexpected benefits by avoiding the use of negative language. Well-meaning staff may, however, sabotage an otherwise smooth induction by telling patients, ‘There is nothing to worry about’ with the implicit suggestion that there is ‘something to worry about’. Unfortunately such well-meaning statements, even when directed at children, tend to yield the opposite effect of what is intended. Patient stress at this time increases suggestibility such that comments frequently function as inadvertent suggestions—be they positive or negative. This can be utilized to enhance the anaesthetist’s ability to provide a smooth, safe and stress-free induction. A typical series of pre-induction communications may go something like, … ‘Don’t worry we won’t drop you’. As the patient is transferred from a trolley to the operating table. ‘The blood pressure cuff gets really tight and may hurt and try not to move while it’s pumping up’. ‘That noise over there is just the nurse checking the drill!’… Explaining what is happening in simple straightforward non-technical language, and at the same time communicating in a positive way, is invariably the more useful approach. For ex le, …‘Welcome to the operating room Mr P ’. ‘You can relax as we move you to this other bed—you are quite safe’. ‘We will place some monitoring leads on so we can keep you safe and comfortable. A pulse monitor gently placed on your finger, an ECG on your chest and a blood pressure cuff on your arm. As the blood pressure cuff tightens and we take its reading this often allows patients to relax knowing how closely we are looking after them’. …
Publisher: Wiley
Date: 06-1997
DOI: 10.1111/J.1365-2222.1997.131-AZ0127.X
Abstract: This controlled, randomised, double-blind study compared whether glossopharyngeal nerve block and intravenous morphine administered peri-operatively, decreased pain following elective adult tonsillectomy and uvulopalatoplasty more than morphine alone. Sixteen of 30 patients undergoing uvulopalatoplasty and 38 of 78 patients having tonsillectomy received bilateral glossopharyngeal nerve blocks, using bupivacaine 0.5% and adrenaline 1:200,000, or no intervention. There were no differences in postoperative analgesic consumption between the two groups. Visual analogue pain scores measured during swallowing in the recovery room and on the ward postoperatively were significantly less overall in uvulopalatoplasty patients who had received a block (p = 0.004). This difference was not found for tonsillectomy. We found no significant differences between groups, in pain scores recorded during the first 5 days at home. We conclude that glossopharyngeal block does not improve analgesia following tonsillectomy although there is short-lived benefit following uvulopalatoplasty.
Publisher: Wiley
Date: 17-10-2012
Publisher: Elsevier BV
Date: 08-2007
Publisher: SAGE Publications
Date: 08-2006
DOI: 10.1177/0310057X0603400402
Abstract: In our institution we have used antenatal training in self-hypnosis for over three years as a tool to provide relaxation, anxiolysis and analgesia for women in labour. To assess the effects of hypnotherapy, we prospectively collected data related to the use of hypnosis in preparation for childbirth, and compared the birth outcomes of women experiencing antenatal hypnosis with parity and gestational age matched controls. Methods: Prospective data about women taught self-hypnosis in preparation for childbirth were collected between August 2002 and August 2004. Birth outcome data of women using hypnosis were compared with routinely collected retrospective data from parity and gestational age matched women delivering after 37 weeks gestation during 2003. Results: Seventy-seven antenatal women consecutively taught self-hypnosis in preparation for childbirth were compared with 3,249 parity and gestational age matched controls. Of the women taught antenatal self-hypnosis, nulliparous parturients used fewer epidurals: 36% (18/50) compared with 53% (765/1436) of controls (RR 0.68 [95% CI 0.47–0.98]) and required less augmentation: 18% (9/50) vs 36% (523/1436) (RR 0.48 [95%CI 0.27–0.90]). Conclusions: Our clinical findings are consistent with recent meta-analyses showing beneficial outcomes associated with the use of hypnosis in childbirth. Adequately powered, randomized trials are required to further elucidate the effects of hypnosis preparation for childbirth.
Publisher: John Wiley & Sons, Ltd
Date: 18-07-2007
Publisher: Elsevier BV
Date: 05-2020
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.BJA.2018.03.020
Abstract: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, given the current equipoise in the existing literature, prospective, randomised, controlled trials are necessary to test this hypothesis. As such, a cancer subgroup was formed to derive endpoints related to research in onco-anaesthesia based on a current evidence base, international consensus and expert guidance. We undertook a systematic review to identify measures of oncological outcome used in the oncological, surgical, and wider literature. A multiround Delphi consensus process that included up to 89 clinician-researchers was then used to refine a recommended list of endpoints. We identified 90 studies in a literature search, which were the basis for a preliminary list of nine outcome measures and their definitions. A further two were added during the Delphi process. Response rates for Delphi rounds one, two, and three were 88% (n=9), 82% (n=73), and 100% (n=10), respectively. A final list of 10 defined endpoints was refined and developed, of which six secured approval by ≥70% of the group: cancer health related quality of life, days alive and out of hospital at 90 days, time to tumour progression, disease-free survival, cancer-specific survival, and overall survival (and 5-yr overall survival). Standardised endpoints in clinical outcomes studies will support benchmarking and pooling (meta-analysis) of trials. It is therefore recommended that one or more of these consensus-derived endpoints should be considered for inclusion in clinical trials evaluating a causal effect of anaesthesia-analgesia technique on oncological outcomes.
Publisher: Elsevier BV
Date: 02-2021
DOI: 10.1016/J.IJOA.2020.10.009
Abstract: In 2017, a South Australia Perinatal Practice Guideline was introduced state-wide for the use of subcutaneous fentanyl for labour analgesia as a replacement for intramuscular pethidine. We retrospectively reviewed the implementation of this practice change in our institution. A retrospective review of maternal and neonatal case notes for the first 100 women administered subcutaneous fentanyl in labour at a single tertiary referral centre for maternity care, between February and June 2017. Of the 102 women administered subcutaneous fentanyl, the majority (55%) were primipara, with an average maternal age of 29 years and body mass index of 27 kg/m Subcutaneous fentanyl for labour analgesia appears effective and has a low incidence of adverse events.
Publisher: Wiley
Date: 08-2007
DOI: 10.1111/J.1460-9592.2007.02224.X
Abstract: We present a case of severe needle phobia in a 5-year-old boy who learned to utilize a self-hypnosis technique to facilitate intravenous (i.v.) cannula placement. He was diagnosed with Bruton's disease at 5 months of age and required monthly intravenous infusions. The boy had received inhalational general anesthesia for i.v. cannulation on 58 occasions. Initially, this was because of difficult venous access but more recently because of severe distress and agitation when approached with a cannula. Oral premedication with midazolam or ketamine proved unsatisfactory and hypnotherapy was therefore considered. Following a 10-min conversational hypnotic induction, he was able to use switch--wire imagery to dissociate sensation and movement in all four limbs in turn. Two days later the boy experienced painless venepuncture without the use of topical local anesthetic cream. There was no movement in the 'switched-off' arm during i.v. cannula placement. This report adds to the increasing body of evidence that hypnosis represents a useful, additional tool that anesthetists may find valuable in everyday practice.
Publisher: Wiley
Date: 13-02-2012
DOI: 10.1111/J.1365-2044.2011.06998.X
Abstract: The SHAM (Serious Harm and Morbidity) scale was developed to categorise the severity of potential complications of placebo control interventions in the context of local anaesthesia research. A convenience s le of 43 anaesthetists used the SHAM scale to grade ten published randomised controlled trials investigating local anaesthesia nerve blocks. The Fleiss κ statistic assessed agreement between these anaesthetists and probability of random agreement (Pr(e)) when using the SHAM scale a κ > 0 shows concordance between assessors above random agreement. Overall κ was 0.50 (95% CI 0.49-0.51, p < 0.001), Pr(e) = 0.21. There was moderate agreement between assessors in determining whether studies were low-risk (SHAM score 0-2) or high-risk (SHAM score 3-4) (κ 0.60 (95% CI 0.58-0.62), Pr(e) = 0.51). Compared with anaesthetists given clinical ex les of interventions when applying the SHAM score, anaesthetists who were not given ex les showed significantly less inter-in idual agreement (κ 0.76 (95% CI 0.72-0.81), Pr(e) = 0.5 vs 0.45 (95% CI 0.41-0.49), Pr(e) = 0.52, p < 0.0001). These results suggest that the SHAM score can be successfully used to grade the severity of potential complications of placebo-controlled interventions in local anaesthesia research and represent a first step towards the score's validation.
Publisher: SAGE Publications
Date: 09-2017
DOI: 10.1177/0310057X1704500514
Abstract: Drug errors amongst anaesthetists are common. Although there has been previous work on the system factors involved with drug error, there has been little research on the sequelae of a drug error from the anaesthetist's perspective. To clarify this issue, we surveyed anaesthetists regarding their most memorable drug error to identify associated factors and personal sequelae regarding their professional practice after the event. An online survey was sent anonymously to 989 Australian and New Zealand College of Anaesthetists (ANZCA) Fellows in March 2016 and the results were collected over the following two months. There were 295 completed surveys (29.8% response). The majority of respondents were male consultants, aged over 45 years. Reported drug errors occurred most frequently during normal working hours, and the most common drugs involved were non-depolarising muscle relaxants. In 34% of the errors, another anaesthetist was present, and their presence was felt to have contributed in 40.7% of these cases. About 20% of respondents reported that they did not receive adequate support after the event. Sleep patterns were affected in 14.4% of respondents, although very few found that the error had affected their capacity to function at work. These findings suggest that memorable drug errors can be significant enough to have adverse sequelae to anaesthetists, even if no patient harm occurs.
Publisher: BMJ
Date: 27-06-1998
DOI: 10.1136/BMJ.316.7149.1944
Abstract: The aim of our study was to evaluate the curative effect and safety of stereotactic body radiation therapy (SBRT) in treating hepatocellular carcinoma (HCC) patients with inferior vena cava (IVCTT) and right atrial tumor thrombus (RATT). This retrospective study included fifteen advanced HCC patients with IVCTT and RATT who were treated with SBRT between 2013 and 2020. The prescribed dose delivered to the tumor was 45-50 Gy/7-10 fx. We report their treatment responses according to survival time and toxicities. For these patients, the median follow-up time was 15 months (2-52 months). Local tumor control rates of the treated area were 80% at the time of death or at the last follow-up. The 6-month, 12-month, 18-month and 24-month OS rates were 80.0%, 60.0%, 33.3% and 26.7%, respectively. None of these patients died from the toxicity outcomes and complications of SBRT. SBRT is an effective option for advanced HCC patients with IVCTT and RATT.
Publisher: BMJ
Date: 13-05-2000
Publisher: SAGE Publications
Date: 02-2003
DOI: 10.1177/0310057X0303100108
Abstract: Inadvertent administration of non-epidural medications into the epidural space has the potential for serious morbidity and mortality. The aim of this study was to collate reported incidents of this type, describe the potential mechanisms of occurrence and identify possible solutions. We searched medical databases and reviewed reference lists of papers retrieved, covering a period of 35 years, regarding this type of medication incident. The 31 reports of 37 cases found is likely to represent a gross underestimation of the actual number of incidents that occur. “Syringe swap”, “ oule error”, and epidural/intravenous line confusion were the main sources of error in 36/37 cases (97%). Given that no effective treatment for such errors has been identified, prevention should be the main defence strategy. Despite all the precautions that are currently undertaken, accidents will inevitably occur. We have identified areas for system-wide change that may prevent these types of incidents from occurring in future.
Publisher: Wiley
Date: 14-05-2002
DOI: 10.1046/J.1365-2044.2002.02509_3.X
Abstract: We performed a postal survey of Fellows of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric practice, about their beliefs regarding aseptic precautions for insertion of an epidural catheter in the labour ward. Of the 435 consultant anaesthetists surveyed, 367 responded (84%), revealing a wide variation in practice. It was not thought to be essential practice to remove a watch before washing hands by 51 respondents (14%), to wear a facemask by 105 (29%) or to wear a sterile gown by 45 (12%). Three anaesthetists (1%) did not believe sterile gloves were essential. However, all respondents indicated that an antiseptic skin preparation was essential. Our results raise questions regarding an acceptable standard of aseptic practice for the insertion of an epidural catheter in labour and we propose a minimal standard of essential precautions.
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.003.0008
Abstract: Anaesthetic culture tends to view patients as physiological specimens to which pharmacological and technical procedures are applied and utilized to optimize various measurable parameters. However, this aspect is only one small part of a patient’s anaesthetic care. The medical model to which many anaesthetists still cling is very much a paternalistic one. Although terms such as ‘patient autonomy’ and ‘choice’ are frequently used, achieving these laudable aims in clinical practice remains elusive. Promoting patient autonomy and fostering a therapeutic relationship are areas of practice that have traditionally not been of direct concern to anaesthetists. The communication skills required to achieve this are centred on listening to what patients are really saying, and accepting the patients’ alternative, but sometimes radically different, view of the world. In addition, anaesthetists can use their understanding of this alternative view to communicate in a way that is likely to engender cooperation and trust. Language affects our patients, our colleagues and our own perceptions. This has profound implications in the practice of anaesthesia. Dissecting the anatomy of communication begins with a message between two or more people. This message can take many forms—for ex le, as a request for assistance or information, a command, advice, clarification, addressing a concern or the provision of reassurance. The message, superficially, is contained only in words. However, the meaning of the communication carried in the message is invariably far more complex. Spoken words are inevitably accompanied by pitch, volume and intonation, a facial expression and body posture. For ex le, take the six words ‘He anaesthetized that patient last Tuesday’. Box 2.1 shows six different meanings of this sentence. Each one is dependent on just one change in emphasis on how the words are said. The ex le demonstrates that with just one small change of emphasis in one word the entire meaning of the phrase can change. One can begin to imagine how many hundreds of pieces of information—probably thousands—are being passed on implicitly during any particular interpersonal interaction or communication. It is, of course, impossible to dissect every last nuance, but we can begin to understand some aspects of language and non-verbal cues in a way that will facilitate the accuracy of our communications.
Publisher: Elsevier BV
Date: 10-2005
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.003.0009
Abstract: Suggestions are statements that evoke an image in the listener’s mind. They may be positive, evoking an image of peace and hope or a desirable mood and behaviour, or they may be negative, eliciting thoughts of pain and doom. Once mentioned, the suggestion is front and centre: ‘You probably even didn’t think of an endotracheal tube before we mentioned it right now—even if we had instructed you not to do so or just reminded you that there is absolutely no need to think of it right now ’. When anaesthetists tell patients that a procedure such as intravenous or arterial line placement ‘will hurt’, the communication itself increases the likelihood of this possibility, and the perception referred to becomes more likely to be experienced as pain. Fortunately, suggestibility can also be used in a positive way — for ex le, telling patients that there are ways to improve their comfort such as coughing during IV cannulation or that breathing exercises after abdominal surgery can make things more comfortable. Also just not mentioning words with negative connotations significantly reduces pain and anxiety associated with potentially painful stimuli such as injection of local anaesthetic. Remaining factual ‘I will give you the local anaesthetic now’ or ‘the numbing medicine’ as some prefer, will suffice. In times of stress, patients assume a focus of attention that leads to a hypnotic frame of mind that is highly suggestible to communications from the anaesthetist, whether the communications are negative or positive. Hence an important step is to avoid wording with negative connotations. Often, however, even well-meaning comments are misunderstood. Many words have double meanings, and in this setting patients will cling to the more pessimistic interpretation. ‘I will put you to sleep’ may conjure images of the veterinarian euthanizing a pet. Also interpretations are highly in idual. We (EL) had one patient who objected to being made ‘numb’ since ‘numb’ meant ‘dumb’ for him. The effects of suggestion become all too evident when considering the widely recognized phenomenon of placebo.
Publisher: Wiley
Date: 10-1998
Publisher: SAGE Publications
Date: 12-1996
DOI: 10.1518/001872096778827206
Abstract: To elicit components of task complexity in emergency medical care, a study was conducted to contrast one medical procedure with two levels of task urgency in trauma patient resuscitation. Videotapes of actual resuscitation were reviewed to extract task characteristics of the procedure. Two levels of urgency were compared in the following areas: patient status, technical difficulty of tasks, the amount of available patient monitoring information, and the pace of work. Four components of task complexity in emergency medical care were identified: multiple and concurrent tasks, uncertainty, changing plans, and compressed work procedures and high workload. These components of task complexity pose challenges to team functions and can lead to problems in team coordination, such as conflicts in goals, tasks, and access to the patient. Training to increase explicit communications and improvements in the design of work procedures are necessary in order to meet the challenges of task complexity.
Publisher: Wiley
Date: 07-10-2009
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.IJOA.2012.03.002
Abstract: Detecting inadvertent dural puncture during labour epidural insertion can be difficult when using a loss of resistance to saline technique. Testing fluid for glucose that leaks from a Tuohy needle may confirm the presence of cerebrospinal fluid and infer inadvertent dural puncture. This study compared the glucose content of intrathecal fluid obtained during spinal anaesthesia for elective caesarean delivery with that of fluid from a Tuohy needle or epidural catheter when establishing epidural analgesia for labour. Women aged ≥18 years undergoing elective caesarean delivery and labouring parturients who requested epidural analgesia were recruited prospectively in a tertiary referral centre over a three-month period. Fluid was collected into a sterile container either during spinal anaesthesia or from a labour epidural needle. Glucose content was evaluated using a bedside blood glucometer and laboratory colorimetric analyzer. Of the 118 women approached, 115 participated. All 40 women having spinal anaesthesia and 2/75 (2.7%) women having epidural analgesia, in whom inadvertent dural puncture was subsequently confirmed, had fluid s les testing positive for glucose. Median [range] laboratory glucose readings were 2.9 [1.3-5.1] mmol/L for cerebrospinal fluid and <0.3 mmol/L in fluid that leaked from a Tuohy needle (P=0.0001). When using a loss of resistance to saline technique for epidural catheter placement, bedside glucometer testing of fluid leaking from the epidural needle may be of value in the early detection of inadvertent dural puncture.
Publisher: Wiley
Date: 03-2006
DOI: 10.1111/J.1365-2044.2005.04508.X
Abstract: We report the case of a 15-year-old girl with a near fatal obstructive tracheal lesion following tracheal intubation. The patient developed stridor and acute respiratory distress 29 h following tracheal extubation, after 35 h intubation in the intensive care unit. The failure of conventional management of stridor, including re-intubation, to provide a satisfactory airway prompted an urgent bronchoscopy, which revealed a tracheal mucosal flap causing 80% obstruction of the subglottic trachea. The fibreoptic bronchoscope allowed careful placement of a tracheal tube distal to the obstruction. The patient eventually made a full recovery. The low incidence of similar lesions and the lack of distinguishing clinical features from other causes of post-extubation stridor make diagnosis and appropriate management of this life-threatening condition difficult. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome.
Publisher: Wiley
Date: 21-05-2018
Publisher: Elsevier BV
Date: 10-2017
Publisher: Elsevier BV
Date: 10-2018
Publisher: Wiley
Date: 13-05-2011
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.MIDW.2018.04.024
Abstract: The language structures used by antenatal educators have not been previously researched in the context of antenatal childbirth classes. Epidural analgesia for labour is a common, and a frequently asked about, component of antenatal education for parents in hospitals providing maternity care. We aimed to identify the way information is described and presented by childbirth educators to assess content and determine which language structures such as metaphor, suggestion, information and storytelling are utilized. This observational study of antenatal education was conducted at a single tertiary referral center for maternity care in Western Sydney, Australia. All three childbirth educators agreed to be video recorded whilst providing information to parents during antenatal classes. Audio data was subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. For the purposes of the current study, data concerning a single topic was used for the analysis-'epidural analgesia for labour'. Language structures used were highly variable between educators, as was the content and time taken for the information being provided. Our findings represent a first attempt to identify baseline information used in the clinical setting of antenatal education in order to categories communication structures used. This study has identified areas for further improvements and consistency in the way educators provide information to parents and has important implications for future midwifery practice, education and research.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Wiley
Date: 03-10-2011
Publisher: Wiley
Date: 12-10-2012
DOI: 10.1111/ANAE.12034
Abstract: We investigated block heights that anaesthetists considered adequate for caesarean section to proceed under spinal anaesthesia. During 3 months, 15 obstetric anaesthetists recorded block height to touch, pinprick or cold when spinal anaesthesia was considered satisfactory for caesarean section to proceed. Median (IQR [range]) block height for touch, pinprick, first cold and icy were: T10 (T7-T12 [T3-L1]) T5 (T4-T6 [C7-L1]) T5 (T4-T6 [C7-L1]) and T3 (T2-T4 [C7-L1]), respectively. Modalities were significantly correlated for: touch and cold, p = 0.0001 touch and icy, p = 0.0007 touch and pinprick, p = 0.0018 cold and icy, p < 0.0001 cold and pinprick, p = 0.0001 icy and pinprick, p < 0.0001. Pairwise comparisons showed differences between all modalities (p < 0.001) apart from pinprick and first cold (p = 0.94). All women had satisfactory anaesthesia despite 76 (81%) having a block to touch below T6. Single modality assessment of block height, particularly using touch, may erroneously indicate inadequate anaesthesia for caesarean section.
Publisher: Wiley
Date: 17-11-2005
Publisher: Wiley
Date: 11-1997
DOI: 10.1111/J.1365-2044.1997.215-AZ0356.X
Abstract: We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previously fit young man. Following induction of general anaesthesia, and prior to surgery, the patient received bilateral glossopharyngeal nerve blocks with 0.5% bupivacaine and adrenaline 1:200,000. The initial recovery was uneventful but persistent throat and neck pain developed at home which was diagnosed as a throat infection and possible hyperextension injury of the neck. It is impossible to say how much the dissection of chronically infected tonsils or the infiltration of local anaesthetic into or near a potentially infected area contributed to the development of cervical osteomyelitis. The absence of any other symptoms and signs, a normal blood count and cervical spine X-ray, and the rarity of cervical osteomyelitis, all contributed to a delay in diagnosis.
Publisher: Wiley
Date: 19-05-2016
Publisher: Wiley
Date: 10-10-2019
Publisher: Wiley
Date: 22-02-1993
Publisher: John Wiley & Sons, Ltd
Date: 14-11-2012
Publisher: Wiley
Date: 12-06-2017
DOI: 10.1111/ANAE.13927
Publisher: Wiley
Date: 02-2009
DOI: 10.1111/J.1365-2044.2008.05734.X
Abstract: Words with negative emotional content such as pain or itch may enhance perception of these symptoms. We assessed open and direct questioning for symptoms in 100 women following Caesarean section. Of the 65 women reporting pain, 25 (39%) did so only when questioned specifically. Similarly, three women with bothersome pain (5%), and two requesting analgesia (3%), failed to disclose pain until questioned specifically. None of the 46 women with pain scores or= 6, while those with scores < 6 are unlikely to request additional analgesia.
Publisher: Wiley
Date: 02-08-2022
DOI: 10.1111/ANAE.15824
Abstract: Recent evidence suggests that how anaesthesia information is presented may influence patient treatment outcomes. We conducted an observational study of anaesthetic‐based patient information leaflets across NHS Trusts in England for their nocebo terms vs. therapeutic terms, and how adverse effects were presented. In this study, ‘nocebo’ is wording that may predispose the patient to expect adverse events such as pain or nausea. Data were extracted and analysed for word frequency, weighted proportion and thematic analysis. In total, 42 patient information leaflets from 61 NHS Trusts were analysed. ‘Pain’ was the second most common word across the leaflets, median (IQR [range]) 0.82 (0.50–1.0 [0.12–1.47]) per 100 words, second only to ‘anaesthesia’. In comparison, ‘safe’ was the most common positively valanced word which featured eight times less frequently than ‘pain’ 0.10 (0.07–0.18 [0.0–0.84]) and ‘comfort’ featured 16.5 times less than ‘pain’ 0.02 (0.0–0.05 [0.0–0.13]). Multiple ex les of phrasing that could have potential nocebo effects included, ‘you will need strong painkillers’ suggesting ‘strong pain’ and the need for ‘painkillers’ rather than using therapeutic terms focusing on ‘comfort’, ‘healing’ and ‘recovery’. Our results suggest a dominance of phrases with negative content in the presentation of anaesthesia information provided to patients. Clinicians need to be aware of inadvertent generation of nocebo‐weighted vs. comfort‐weighted communication with patients. Our study findings suggest an opportunity for more emphasis to be placed on therapeutic outcomes and effective mitigation strategies of anaesthesia risks to avoid potential unintended nocebo effects of anaesthesia information leaflets or websites.
Publisher: SAGE Publications
Date: 12-1993
DOI: 10.1177/0310057X9302100615
Abstract: The Flying Obstetric and Gynaecology (FOG) service visits 27 outback towns scattered over approximately one million square kilometres of western Queensland. The role and workload of an anaesthetist attached to the FOG Service and a prospective audit of 760 consecutive anaesthetics over a ten-month period are reported. Flying anaesthetists are in an ideal position to review standards of equipment, staffing levels, anaesthetic assistance in theatre as well as participate in both medical and nursing rural training programs. This ensures that deficiencies in anaesthetic related areas are identified and appropriate action taken. The challenge to rural practitioners must be to provide a service, of at least an equivalent standard to that of their metropolitan counterparts.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2012
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2012
Publisher: Wiley
Date: 10-1998
Publisher: Wiley
Date: 02-1990
DOI: 10.1111/J.1365-2044.1990.TB14281.X
Abstract: We report a case of profound hypotension, after induction of general anaesthesia, that resulted from unexpected cardiac t onade. The differential diagnosis was complicated by the absence of any evidence to indicate that there was significant direct chest injury. Many of the recognised clinical signs of cardiac t onade were absent, in particular, there was no compensatory tachycardia, and heart rate remained stable despite severe hypotension before surgical drainage of the pericardium. The possible aetiology and pathophysiology is discussed. It is suggested that after major trauma, cardiac t onade should be considered as a possibility even in the absence of significantly abnormal cardiovascular signs, evidence of direct chest injury, or an abnormal chest X ray.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-1996
Publisher: Wiley
Date: 20-05-2010
DOI: 10.1111/J.1460-9592.2010.03328.X
Abstract: Emergence delirium (ED) is of increasing interest since the introduction of short-acting volatiles such as sevoflurane. We compared the Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales for assessing the presence of ED in 117 of 118 consecutive children or =10 detected ED in 37 children (32%), while the Watcha detected 30 (26%) and Cravero 41 (35%). Twenty-five patients (21%) fulfilled criteria for ED in all three scales as did all eight patients assessed by the experienced pediatric anesthetist observer. Median PAED scores (interquartile ranges) for patients assessed as having ED or not respectively were for Watcha, 12 (11,14), 7 (4,8) for Cravero, 11 (9,13), 7 (4,8) and for the experienced anesthetist observer, 14.5 (13.5,16.5), 7 (6,10). All three scales correlated reasonably well with each other but have in idual limitations in their potential to assess whether ED is present. In the absence of developing an improved research tool to assess ED, a PAED score >12 appears to provide greater sensitivity and specificity than a PAED score > or =10. However, the Watcha scale is a simpler tool to use in clinical practice and may have a higher overall sensitivity and specificity than the other scales.
Publisher: SAGE Publications
Date: 08-2004
DOI: 10.1177/0310057X0403200406
Abstract: A retrospective casenote review was performed to identify anaesthetic challenges relevant to the opioid-dependent obstetric population. Medical records showed that of the 7,449 deliveries during a 24 month period, 85 women (1.1%) were taking regular opioids such as methadone and/or heroin. Of these 67 (79%) received anaesthetic services, ten of whom (11.7%) were referred antenatally. Forty opioid-dependent women (47%) received epidural analgesia in labour compared with the overall hospital rate of 38%. Twenty-three women (27%) delivered by caesarean section: five received general anaesthesia, five combined spinal anaesthesia, five spinal anaesthesia and eight epidural anaesthesia. Twenty opioid-dependent women (23.5%) had documented problems related to labour analgesia and 17 (74%) had problems with analgesia after caesarean section. A variety of postoperative analgesia methods were administered in addition to maintenance methadone. Fourteen patients (16.5%) had difficult intravenous access and seven “arrest” calls were documented. One anaesthetist was exposed to hepatitis C. This review demonstrates the demands placed on obstetric anaesthetic services by opioid-dependent women. Early antenatal referral for anaesthetic review is recommended.
Publisher: Wiley
Date: 03-2002
Publisher: Wiley
Date: 03-07-2013
Abstract: To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Randomised controlled clinical trial, conducted from December 2005 to December 2010. The largest tertiary referral centre for maternity care in South Australia. A cohort of 448 women at >34 weeks of gestation, with a singleton pregnancy and cephalic presentation, planning a vaginal birth. Exclusions were: the need for an interpreter pre-existing pain psychiatric illness younger than 18 years and previous experience of hypnosis for childbirth. All participants received usual care. The group of women termed Hypnosis + CD (hypnotherapist guided) were offered three antenatal live hypnosis sessions plus each session's corresponding audio CD for further practise, as well as a final fourth CD to listen to during labour. The group of women termed CD only (nurse administered) were played the same antenatal hypnosis CDs as group 1, but did not receive live hypnosis training. The control group participants were given no additional intervention or CDs. Use of pharmacological analgesia during labour and childbirth. No difference in the use of pharmacological analgesia during labour and childbirth was found comparing hypnosis + CD with control (81.2 versus 76.2% relative risk, RR 1.07 95% confidence interval, 95% CI 0.95-1.20), or comparing CD only with control (76.9 versus 76.2%, RR 1.01, 95% CI 0.89-1.15). Antenatal group hypnosis using the Hypnosis Antenatal Training for Childbirth (HATCh) intervention in late pregnancy does not reduce the use of pharmacological analgesia during labour and childbirth.
Publisher: SAGE Publications
Date: 02-2019
DOI: 10.1177/0310057X9902700112
Abstract: We report a parturient delivering vaginally at term with symptomatic congenital hypertrophic obstructive cardiomyopathy. Epidural analgesia was used during labour and delivery and is likely to have made a useful contribution to the successful outcome. Although controversial, reported use of epidural analgesia during labour for hypertrophic obstructive cardiomyopathy parturients has been generally positive. A multi-disciplinary team approach, early anaesthetic assessment and a carefully managed epidural catheter inserted in early labour can optimize analgesia and minimize the stresses of labour and vaginal delivery provided the risks of reduced preload and after load are minimized.
Publisher: Elsevier BV
Date: 12-2007
DOI: 10.1093/BJA/AEM308
Abstract: Clinicians frequently warn patients of discomfort before potentially painful procedures, despite the lack of evidence that such communications are helpful. We aimed to compare two communications (one with, and the other without, a warning of a 'sting') immediately before i.v. cannulation in order to measure differences in perceived pain by patients during the procedure. Randomly assigned patients awaiting elective surgery received a communication immediately before i.v. cannulation consisting of either 'I am going to apply the tourniquet and insert the needle in a few moments. It's a sharp scratch and it may sting a little' (Group S) or 'I am going to apply the tourniquet on the arm. As I do this many people find the arm becomes heavy, numb and tingly. This allows the drip to be placed more comfortably' (Group NS). Cannulation pain was measured by a 0-10 verbal numerical rating score (VNRS) and five-point Likert scale. Of 101 participants, 49 were allocated to Group S and 52 to Group NS. Median VNRS pain scores with inter-quartile ranges (IQR) were 1 and 2, respectively, for both groups. Median Likert scores were 3 in Group S and 2 in Group NS with an IQR of 1 for both groups (P = 0.13). Six participants vocalized pain in Group S and none in Group NS (P = 0.01). Three participants withdrew their arm spontaneously in Group S and none in Group NS (P = 0.11). Warning patients of a 'sting' before i.v. cannulation may not be helpful.
Publisher: SAGE Publications
Date: 03-2020
Abstract: Anaesthetists are key members of teams caring for burn-injured children in almost every aspect of their management. Their role can involve initial resuscitation, intensive care, analgesia, and anaesthesia for multiple procedures both acutely and subsequently for scar management. As key members of burns management teams, effective communication with patients and their families as well as other members of the burn care team is vital. There is little guidance, however, addressing how the anaesthetist might communicate and optimise anaesthetic burns care of children pre-, intra-, and postoperatively. Advances in the understanding of the neurobiology of communication suggests that we need to consider positive (placebo) or negative (nocebo) subconscious processes. Learnable language structures GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion) can facilitate any patient or family interaction ensuring children and their parents feel they are being heard and understood. Talking about finishing rather than starting when about to perform a potentially painful procedure can also facilitate burns care with children. Other strategies include the avoidance of nocebo communications or apologising before a painful procedure and, instead, focusing on therapeutic (placebo) alternatives. Children do not view pain in the same way as adults do, and techniques such as play therapy and hypnosis can be valuable adjuncts to traditional analgesia administration in burns care, with the added benefit of minimising side-effects. The use of regular time-outs during prolonged burns surgeries is a helpful communication strategy between the anaesthetist and other members of the burns team that can optimise patient safety. Communication is a core clinical skill in the practice of anaesthesia during paediatric burns care and is an area for future research.
Publisher: SAGE Publications
Date: 05-2015
DOI: 10.1177/0310057X1504300307
Abstract: There is a wide range of practice amongst obstetric anaesthetists when obtaining consent for women requesting labour epidural analgesia. This is the first prospective observational study recording the number and types of risks mentioned and whether the risk was quantified. Statements of benefits and alternatives to the procedure were also noted. Fourteen anaesthetists, each consulting a single patient, were recorded during the process of obtaining consent and inserting the epidural. The most commonly mentioned risks (median 7) were headache/dural puncture, failure/difficulty with insertion, nerve damage, bleeding/haematoma and infection/epidural abscess. There was no difference between consultants and trainees, although consultants showed greater variance. It was uncommon for anaesthetists to state a benefit (21%) or mention an alternative option (21%), but there was usually a quantitative statement of risk (71%). Data showed a deviation from the Australian and New Zealand College of Anaesthetists guidelines and these findings may encourage anaesthetists to reflect on their own practice and guide future research.
Publisher: Wiley
Date: 05-01-2015
Abstract: To compare the efficacy of fentanyl administered via the subcutaneous (s.c.) or intranasal (i.n.) route with intramuscular (i.m.) pethidine in labouring women requesting analgesia. A randomised controlled trial three-armed, parallel-design. A regional hospital and the largest tertiary maternity centre in South Australia. One hundred and fifty-six healthy parturients birthing at term. Women were randomised to receive s.c. fentanyl (n = 53), i.n. fentanyl (n = 52), or i.m. pethidine (n = 51). The outcomes were analysed by intention-to-treat. Pain scores measured before and 30 minutes after opioid administration. All groups reported clinically significant reductions in pain scores (mean range 1.2-1.6 P < 0.001), with no significant differences between groups. Significantly more women in the fentanyl groups reported satisfaction with using the study drug again, compared with women receiving i.m. pethidine (82.9% i.n. fentanyl, 80.6% s.c. fentanyl, and 44.0% i.m. pethidine P < 0.01). Women in the fentanyl groups experienced less sedation (i.n. fentanyl 7.3%, s.c. fentanyl 2.9%, i.m. pethidine 44% P ≤ 0.03), shorter labours by at least 2 hours (P < 0.05), and fewer difficulties establishing breastfeeding (78.8% i.m. pethidine, 39.4% i.n. fentanyl, and 44.0% s.c. fentanyl P < 0.01). Neonates in the pethidine group were more likely to require nursery admission (P < 0.02). Fentanyl administered by s.c. and i.n. routes is as efficacious in relieving labour pain as i.m. pethidine, but resulted in greater satisfaction, less sedation, shorter labour, fewer nursery admissions, and fewer difficulties in establishing breastfeeding. Fentanyl appears to be a suitable alternative to pethidine when providing parenteral pain relief to labouring women.
Publisher: SAGE Publications
Date: 03-2008
DOI: 10.1177/0310057X0803600207
Abstract: We aimed to identify and categorise advanced communication skills used by experienced consultant paediatric anaesthetists to facilitate the induction of paediatric anaesthesia. The communication techniques were both verbal and non-verbal. Communications with potentially negative effects were also noted. Eighty-three inductions were observed over a three-month period. The 12 anaesthetists observed were all senior consultants at a tertiary referral paediatric centre. The mean age of patients was 6.1 years SD±4.8. There were 53 males (63.9%) and 30 females (36.1%). A first anaesthetic was administered to 43 patients (56%) and sedative premedication to six (8%). Inhalational inductions were observed in 59 patients (71%). The remainder received an intravenous induction. Anaesthesia was induced in the operating room on 68 occasions (82%), in the induction room on 11 (13%) and in the radiology department on 4(5%). The most common communication techniques used were: voice change in 60 (72%) distraction in 49 (59%) direct commands in 39 (47%) repetition in 34 (41%) imagery in 21 (25%) and focused attention 21 (25%). Other techniques used were seeding of ideas, utilisation, non-verbal cues, double-binds, story-telling, indirect suggestion, dissociation and reversed effect. Sabotage by parents or staff, such as inadvertent negative suggestions, was observed on 14 occasions (17%). Paediatric anaesthetists utilise a wide range of communication techniques in a highly flexible manner when inducing anaesthesia in children. Many of these communications can be characterised as hypnotherapeutic. Our observations suggest that formal structured training in communication skills and further research is warranted.
Publisher: Informa UK Limited
Date: 07-2009
DOI: 10.1080/00029157.2009.10401688
Abstract: Hypnosis during pregnancy and childbirth has been shown to reduce labor analgesia use and other medical interventions. We aimed to investigate whether there was a difference in hypnotizability in pregnant and nonpregnant women. Study participants had hypnotizability measured by the Creative Imagination Scale (CIS) in the third trimester of pregnancy and subsequently between 14 and 28 months postpartum and when not pregnant. The 37 participants who completed the study gave birth in the largest maternity unit in South Australia between January 2006 and March 2007. CIS scores were increased in women when pregnant (Mean 23.5, SD 6.9) compared to when they were not pregnant (Mean 18.7, SD 6.6), p < 0.001. The mean effect size was 0.84 suggesting that the hypnotizability change was both statistically significant and clinically meaningful. Our study findings support previous evidence showing that women are more hypnotizable when pregnant than when not pregnant.
Publisher: SAGE Publications
Date: 03-2010
DOI: 10.1177/0310057X1003800218
Abstract: Communication between patients and anaesthetists is being recognised as an increasingly important aspect of clinical care. Patients need to understand the nature and consequences of any proposed procedure prior to giving informed consent. In this regard, anaesthetists have a responsibility to provide adequate information about anaesthesia and related procedures in a form that patients are likely to understand. We investigated whether patients understood the technical terms used by the anaesthetist. We observed 68 obstetric and gynaecological pre-anaesthesia consultations at two tertiary hospitals in South Australia. These pre-anaesthesia consultations were conducted by consultant anaesthetists on 46 occasions (68%) and by anaesthesia trainees (nine registrars and one resident medical officer) on 22 occasions (32%). Approximately half of the patients participating in the study (45%) failed to understand one or more of the terms used during their consultation. Of the technical terms used more than once, “reflux” was the most poorly understood, with seven of 36 patients (19%) having either poor or no understanding. The next five most commonly misunderstood technical terms were “aspiration”, “allergy”, “anaphylaxis, “local anaesthetic” and “sedation”. We have identified many technical terms that may not be understood by patients presenting for anaesthesia care. An awareness of commonly misunderstood words may facilitate better transfer of information during pre-anaesthesia consultations. Our study findings should remind doctors that patients frequently fail to understand or take in what we tell them.
Publisher: Wiley
Date: 02-1990
Publisher: John Wiley & Sons, Ltd
Date: 18-04-2007
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.BJA.2018.02.007
Abstract: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials. From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions) (ii) pneumonia (12 definitions) and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition. A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.
Publisher: SAGE Publications
Date: 2014
Publisher: BMJ
Date: 14-02-1987
Abstract: Vocational trainees in the West Midlands who were in their general practice year were sent a postal questionnaire to find out whether there were important differences between the criteria for training of the 1986 West Midland postgraduate education committee (based on national recommendations) and the perceptions of the trainees of their current trainers and practices. The response rate was 86.2% (75 out of 87). Sixty four per cent (48) of trainees reported that they received on average less than the recommended minimum of three hours of teaching time a week. They felt that experience was inadequate in paediatric surveillance (62.7%) and preventive medical care (37.3%). Most trainers gave topic teaching (90.7%), and few used role play (5%). Most of the trainees (52%) had not signed a contract, a third did not get help with recommended allowances, and 37% thought that their progress had not been reviewed. Several trainees commented on the excellence of their training practices, and most of the practices appeared to be keeping to the spirit of the recommendations. There are, however, discrepancies between what some trainees feel they receive and what is recommended.
Publisher: Wiley
Date: 23-12-2012
DOI: 10.1111/J.1460-9592.2011.03770.X
Abstract: Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. A convenience s le of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed. Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%) sore throat (35%) allergy (29%) hypoxia (25%) and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P < 0.05, when the consultation was performed by a trainee rather than a consultant anesthetist and when the patient had previous anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025. The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk.
Publisher: SAGE Publications
Date: 2013
Publisher: Springer International Publishing
Date: 2017
Publisher: Springer International Publishing
Date: 2017
Publisher: Springer Science and Business Media LLC
Date: 05-03-2006
Publisher: Springer International Publishing
Date: 2017
Publisher: SAGE Publications
Date: 2011
DOI: 10.1177/0310057X1103900117
Abstract: Negative or harsh words such as ‘pain’ and ‘sting’ used to describe sensations prior to potentially painful procedures have been shown to increase pain. We aimed to determine whether the reporting of pain and its severity is affected by the way it is assessed during anaesthesia follow-up after caesarean section. Following caesarean section, 232 women were randomised prior to post-anaesthesia review. Group N participants were asked questions containing the negative word ‘pain’, “Do you have any pain?” and then asked to rate it on a 0 to 10 point Verbal Numerical Rating Scale. Group P participants were asked questions using more positive words, “How are you feeling?” and “Are you comfortable?”. Data are presented as median, interquartile range. In Group N, 63 participants (54.3%) reported pain compared with only 28 participants (24.1%) in Group P (P .001). There were no significant differences between groups for Verbal Numerical Rating Scale at rest: Group N 2 (0 to 3) vs Group P 1 (0 to 4) P=0.97, or Verbal Numerical Rating Scale with movement, Group N 5 (3 to 6) vs Group P 5 (3 to 6.3) P=0.90. The assessment of pain after caesarean section, using more positive words, decreases its incidence but does not affect its severity when measured by pain scores. Words that focus the patient on pain during its assessment may lead some to interpret sensations as pain which they might not do otherwise. These findings may have important implications when assessing and researching postoperative pain.
Publisher: Elsevier BV
Date: 04-2019
Publisher: SAGE Publications
Date: 10-2004
DOI: 10.1177/0310057X0403200513
Abstract: Clinical hypnosis is a skill of using words and gestures (frequently called suggestions) in particular ways to achieve specific outcomes. It is being increasingly recognised as a useful intervention for managing a range of symptoms, especially pain and anxiety. We surveyed all 317 South Australian Fellows and trainees registered with ANZCA to determine their use, knowledge of, and attitudes towards positive suggestion, hypnosis and hypnotherapy in their anaesthesia practice. The response rate was 218 anaesthetists (69%). The majority of respondents (63%) rated their level of knowledge on this topic as below average. Forty-eight per cent of respondents indicated that there was a role for hypnotherapy in clinical anaesthesia, particularly in areas seen as traditional targets for the modality, i.e. pain and anxiety states. Nearly half of the anaesthetists supported the use of hypnotherapy and positive suggestions within clinical anaesthesia. Those respondents who had experience of clinical hypnotherapy were more likely to support hypnosis teaching at undergraduate or postgraduate level when compared with those with no experience.
Publisher: Wiley
Date: 08-10-2008
Publisher: Wiley
Date: 2022
DOI: 10.1111/ANAE.15601
Abstract: Nocebo refers to non‐pharmacological adverse effects of an intervention. Well‐intended procedural warnings frequently function as a nocebo. Both nocebo and placebo are integral to the generation of ‘real’ treatment effects and their associated ‘real’ side‐effects. They are induced or exacerbated by: context negative expectancy and negative conditioning surrounding treatment. Since the late 1990s, the neuroscience literature has repeatedly demonstrated that the nocebo effect is mediated by discrete neurobiological mechanisms and specific physiological modulations. Although no single biological mechanism has been found to explain the nocebo effect, nocebo hyperalgesia is thought to initiate from the dorsal lateral prefrontal cortex subsequently triggering the brain's descending pain modulatory system and other pain regulation pathways. Functional magnetic resonance imaging shows that expectation of increased pain is accompanied by increased neural activity in the hippoc us and midcingulate cortex which is not observed when analgesia is expected. Functional magnetic resonance imaging studies have shown that the anterior cingulate cortex is pivotal in the perception of affective pain evoked by nocebo words. Research has also explored neurotransmitters which mediate the nocebo effect. The neuropeptide cholecystokinin appears to play a key role in the modulation of pain by nocebo. Hyperalgesia generated by nocebo also increases the activity of the hypothalamic–pituitary–adrenal axis as indicated by increases in plasma cortisol. The avoidance or mitigation of nocebo needs to be recognised as a core clinical skill in optimising anaesthesia care. Embracing the evidence around nocebo will allow for phrases such as ‘bee sting’ and ‘sharp scratch’ to be thought of as clumsy verbal relics of the past. Anaesthesia as a profession has always prided itself on practicing evidence‐based medicine, yet for decades anaesthetists and other healthcare staff have communicated in ways counter to the evidence. The premise of every interaction should be ‘primum non nocere’ (first, do no harm). Whether the context is research or clinical anaesthesia practice, the nocebo can be ignored no longer.
Publisher: SAGE Publications
Date: 03-2009
DOI: 10.1177/0310057X0903700211
Abstract: Carnitine palmitoyl transferase (CPT) type 2 deficiency is a disorder of mitochondrial fatty acid oxidation. In situations where energy stores are inadequate, such as may occur during labour, women with CPT type 2 deficiency are at risk of rhabdomyolysis. There is limited experience in the management of women with this condition in labour. We report a case of successful labour management of a woman with CPT type 2 deficiency, together with a brief review of the published case reports and a discussion of the issues surrounding anaesthetic management.
Publisher: SAGE Publications
Date: 12-2001
DOI: 10.1177/0310057X0102900607
Abstract: The laryngeal mask airway (LMA) has been shown to be useful in airway maintenance during resuscitation. The intubating laryngeal mask (ILM) is a modified LMA permitting both ventilation and rapid endotracheal intubation. We aimed to compare the LMA and the ILM with regard to ease of insertion and successful ventilation by inexperienced personnel. We have used anaesthetized, apnoeic, non-paralysed patients as a model to simulate resuscitation. Following standardized training, non-anaesthetic medical staff with no previous experience in laryngeal mask airway insertion (novices) inserted either the LMA or ILM in 55 patients following induction of anaesthesia. There were no differences between the two patient groups included in our study with regard to mean age and body mass index (BMI). The success rate for inserting the airway device and achieving a significant end-tidal CO 2 recording within two minutes was 23/28 for the LMA (82.1%) and 22/27 for the ILM (81.5%). Reasons for failure included inability to insert the ILM past the teeth and insertion of the LMA upside down. There were no clinically relevant differences in the mean time to airway insertion and successful ventilation (62.6 vs 62 seconds) or expired tidal volume (781 vs 767 ml) for the LMA and ILM respectively. We conclude that the ILM is as easily inserted and effectively used as an LMA by novices and, because it allows the option of facilitating endotracheal intubation, may be the preferred device for maintaining an airway during resuscitation.
Publisher: Wiley
Date: 13-06-2013
DOI: 10.1111/ANAE.12335
Publisher: Oxford University Press
Date: 11-11-2020
DOI: 10.1093/OSO/9780199577286.001.0001
Abstract: This book provides anesthetists, intensivists and other critical care staff with a comprehensive resource that offers ways of improving communication in everyday clinical practice, and provides practical communication tools that can be used in difficult or unfamiliar circumstances. It demonstrates how communication can be structured to improve patient care and safety with numerous practical ex les and vignettes illustrating how the concepts discussed can be integrated into clinical practice, and presents ideas in a way that enhances clinical interactions with patients and colleagues and facilitate the teaching of trainees. Edited by practicing anesthetists with particular expertise in teaching communication, and with contributions from expert clinicians based in North America, Europe and Australasia, this book will stimulate and complement the development of comprehensive resources for communication skills teaching in anesthesia and other related professional groups.
Publisher: Wiley
Date: 12-09-2014
Publisher: John Wiley & Sons, Ltd
Date: 23-04-2008
Publisher: Wiley
Date: 19-04-2004
Publisher: SAGE Publications
Date: 04-2006
DOI: 10.1177/0310057X0603400209
Abstract: Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior to administering regional analgesia in labour. We surveyed consultant members of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric anaesthesia, in order to identify and compare which risks of regional analgesia they report discussing with women prior to and during labour. We also asked about obstetric anaesthetists’ beliefs about informed consent, the type of consent obtained and its documentation. Of 542 questionnaires distributed, 291 responses (54%) were suitable for analysis. The five most commonly discussed risks were post dural puncture headache, block failure, permanent neurological injury, temporary leg weakness and hypotension. Obstetric anaesthetists reported discussing a mean of 8.0 (SD 3.8) and 10 (SD 3.8) risks in the labour and antenatal settings respectively. Nearly 20% of respondents did not rank post dural puncture headache among their top five most important risks for discussion. Seventy percent of respondents indicated that they believe active labour inhibits a woman's ability to give ‘fully informed consent’. Over 80% of respondents obtain verbal consent and 57 (20%) have no record of the consent or its discussion. Obstetric anaesthetists reported making a considerable effort to inform patients of risks prior to the provision of regional analgesia in labour. Verbal consent may be appropriate for labouring women, using standardized forms that serve as a reminder of the risks, and a record of the discussion. Consensus is required as to what are the levels of risk from regional analgesia in labour.
Publisher: Wiley
Date: 14-05-2021
DOI: 10.1111/PAN.14197
Abstract: Patient satisfaction is routinely used to assess the quality of care in medicine. In the field of anesthesia, research has been primarily directed toward developing satisfaction measures in adults with little attention paid to the pediatric population. Satisfaction in pediatric anesthesia and perioperative care is poorly understood. We have identified existing satisfaction measures in pediatric perioperative care and examined their similarities and differences. A search of relevant published trials up to January 2021 identified 17 studies using 14 unique satisfaction measures of perioperative care in children. Eleven of these assessed satisfaction multidimensionally while three assessed overall satisfaction of parents with their child's anesthesia. Of the six dimensions of satisfaction identified, all were duplicated to some degree across studies. The dimensions were: “staff rapport and communication” and “anesthetic and nursing quality of care” in eight satisfaction measures “information giving” in seven measures “postoperative symptom control” in six “hospital experience” in five and “involvement in decision‐making” in three. The most important items from the parents' perspective were: “staff rapport and communication ” “information giving ” and “decision‐making”. No study examined all dimensions of satisfaction. Although all studies questioned parents, only three asked satisfaction questions of the child. No study was analyzed the child's direct responses. In three studies, parental involvement in decision‐making was reported to be important as a satisfaction measure of their child's perioperative care. Of the few existing satisfaction measures evaluated, there is no accepted standard in current practice. Future studies identifying the important determinants of satisfaction in pediatric perioperative care, perhaps also using a Delphi approach with parents, might allow for the development of a patient‐focused standardized measure in this setting.
Publisher: Wiley
Date: 24-01-2011
DOI: 10.1111/J.1365-2044.2010.06560.X
Abstract: Placebos play a vital role in clinical research, but their invasive use in the context of local anaesthetic blocks is controversial. We assessed whether recently published randomised controlled trials of local anaesthetic blocks risked harming control group patients in contravention of the Declaration of Helsinki. We developed the 'SHAM' (Serious Harm and Morbidity) scale to assess risk: grade 0 = no risk (no intervention) grade 1 = minimal risk (for ex le, skin allergy to dressing) grade 2 = minor risk (for ex le, subcutaneous haematoma, infection) grade 3 = moderate risk (with or without placebo injection) (for ex le, neuropraxia) and grade 4 = major risk (such as blindness, pneumothorax, or liver laceration). Placebo interventions of the 59 included trials were given a SHAM grade. Nine hundred and nineteen patients in 31 studies, including six studies with 183 children, received an invasive placebo assessed as SHAM grade ≥ 3. A high level of agreement (78%, κ = 0.80, p < 0.001) for SHAM grades 0-4 increased to 100% following discussion between assessors. More than half of the randomised controlled study designs subjected patients in control groups to risks of serious or irreversible harm. A debate on whether it is justifiable to expose control group patients to risks of serious harm is overdue.
Publisher: Elsevier BV
Date: 09-1991
DOI: 10.1093/BJA/67.3.341
Abstract: Previous attempts to introduce non-invasive monitoring of ventilation of spontaneously breathing patients into routine practice have been unsuccessful. The Aberdeen University Respiratory Alarm (AURA) allows such monitoring by utilizing the pyroelectric property of polarized polyvinylidine fluoride sensors to detect temperature changes that occur during breathing into an oxygen delivery face mask. A quartz crystal oscillator generates pulses that allow measurement of interexpiratory time and ventilatory frequency. The system incorporates LED digital displays, a bargraph and audiovisual alarms. An analog output permits display and analysis of the sensed signals. AURA performed satisfactorily in both volunteer studies and six patients in the clinical setting. AURA may be an appropriate respiratory transducer in those patients requiring oxygen therapy.
Publisher: Wiley
Date: 18-10-2004
Publisher: SAGE Publications
Date: 08-1999
DOI: 10.1177/0310057X9902700411
Abstract: In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Ex les of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some as priorities for obstetric anaesthesia audit. There was however no consistency as to what data should be collected. Many responses suggested a perceived need to collect clinical data without knowing what to do with it. Our survey has highlighted confusion between three distinct objectives a dataset for obstetric anaesthesia record keeping, data required for continuing patient management in hospital and, a specific minimal dataset for clinical audit purposes. We conclude that current Australasian obstetric anaesthesia audit strategies are inadequate to develop a minimal dataset for cost-effective clinical audit.
Publisher: Elsevier BV
Date: 04-2009
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.WOMBI.2011.12.002
Abstract: To compare the personal preferences of pregnant women, midwives and obstetricians regarding a range of physical, psychosocial and pharmacological methods of pain relief for childbirth. Self-completed questionnaires were posted to a consecutive s le of 400 pregnant women booked-in to a large tertiary referral centre for maternity care in South Australia. A similar questionnaire was distributed to a national s le of 500 obstetricians as well as 425 midwives at: (1) the same hospital as the pregnant women, (2) an outer-metropolitan teaching hospital and (3) a district hospital. Eligible response rates were: pregnant women 31% (n=123), obstetricians 50% (n=242) and midwives 49% (n=210). Overall, midwives had a greater personal preference for most of the physical pain relief methods and obstetricians a greater personal preference for pharmacological methods than the other groups. Pregnant women's preferences were generally located between the two care provider groups, though somewhat closer to the midwives. All groups had the greatest preference for having a support person for labour with more than 90% of all participants wanting such support. The least preferred method for pregnant women was pethidine/morphine (14%). There are differences in the personal preferences of pregnant women, midwives and obstetricians regarding pain relief for childbirth. It is important that the pain relief methods available in maternity care settings reflect the informed preferences of pregnant women.
Publisher: Wiley
Date: 14-07-2015
Publisher: John Wiley & Sons, Ltd
Date: 08-07-2009
Publisher: Wiley
Date: 24-08-2011
DOI: 10.1111/J.1365-2044.2011.06852.X
Abstract: Evidence suggests that anaesthetists' communication can affect patient experience. There is a lack of guidance for anaesthetists as to the optimal verbal communication to use during insertion of epidurals on the labour ward. We recorded the verbal communication used by 14 anaesthetists during the siting of epidural catheters in women on the labour ward a classification of the language used was subsequently devised. We found that commands and information statements were the most common types of communication used. In idual anaesthetists differed markedly in their use of positive and negative verbal language. This classification of verbal communication that we produced may be of value in future training and research of verbal communication used by anaesthetists on the labour ward.
No related grants have been discovered for Allan Cyna.