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Basophil activation test in the diagnostic workup of perioperative anaphylaxis due to neuromuscular blocking agents: A case series and implications for practice. 嗜碱性粒细胞激活试验在神经肌肉阻断剂引起的围手术期过敏性休克诊断工作中的应用:系列病例及对实践的影响。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-04-22 DOI: 10.1177/0310057X241232420
Mahanoor Baig, Nagesh C Nanjappa, G. Perkins, Rachel Di Lernia, V. Thiruvenkatarajan, Pravin Hissaria
In Australia, neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Current investigation of suspected anaphylaxis includes tryptase levels, serum immunoglobulin E (IgE) levels, and skin testing, including intradermal testing and skin prick testing. The gold standard for the diagnosis of a hypersensitivity reaction is a challenge test, but this poses a risk to patient safety. An alternative test, known as the basophil activation test (BAT) is a form of cellular in vitro testing using flow cytometry to measure the degree of basophil degranulation within a sample of blood following exposure to an allergen. This acts as a surrogate marker for mast cell and basophil activation, thereby identifying IgE-mediated allergy. It is most commonly used to supplement equivocal findings from initial in vitro testing to assist in confirming the diagnosis of a hypersensitivity reaction and identify the causative agent. We present a case series in which five patients with suspected anaphylaxis underwent a BAT, demonstrating its role and limitations in allergy testing within Australia.
在澳大利亚,神经肌肉阻断剂是围手术期过敏性休克的主要原因。目前对疑似过敏性休克的调查包括胰蛋白酶水平、血清免疫球蛋白 E (IgE) 水平和皮肤测试,包括皮内测试和皮肤点刺测试。超敏反应诊断的金标准是挑战试验,但这会给患者安全带来风险。另一种检测方法是嗜碱性粒细胞活化检测(BAT),它是一种细胞体外检测方法,使用流式细胞仪测量血液样本中嗜碱性粒细胞在接触过敏原后的脱颗粒程度。它可作为肥大细胞和嗜碱性粒细胞活化的替代标记,从而确定 IgE 介导的过敏。它最常用于补充初步体外检测中不明确的结果,以帮助确诊超敏反应并确定致病因子。我们介绍了一个病例系列,其中有五名疑似过敏性休克的患者接受了 BAT 检测,展示了它在澳大利亚过敏检测中的作用和局限性。
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引用次数: 0
‘On the inhalation of the vapour of Æther, with cases’: The first paper on anaesthesia read before a medical society in Australia 关于吸入乙醚蒸汽,附病例":澳大利亚医学会宣读的第一篇麻醉论文
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-04-19 DOI: 10.1177/0310057x231214552
Rajesh P Haridas
On 7 September 1847, in Melbourne in the Port Phillip District of the Colony of New South Wales, David John Thomas (1813–1871) presented a paper, ‘On the inhalation of the vapour of Æther, with cases’, at an ordinary monthly meeting of the Port Phillip Medical Association. This is the earliest known presentation of a paper on etherisation in Australia. The partial publication of the manuscript in October 1847 in the Australian Medical Journal may have led to it being returned to Thomas in Melbourne. The handwritten manuscript is now preserved in the Medical History Museum, University of Melbourne, Melbourne, Victoria. A transcript of the complete manuscript is now recorded with relevant historical notes.
1847 年 9 月 7 日,大卫-约翰-托马斯(1813-1871 年)在新南威尔士殖民地菲利普港区墨尔本的菲利普港医学协会月度例会上发表了一篇题为 "关于吸入乙醚蒸汽及病例 "的论文。这是澳大利亚已知最早的一篇关于乙醚化的论文。1847 年 10 月,该手稿在《澳大利亚医学杂志》(Australian Medical Journal)上部分发表,这可能导致手稿被送回墨尔本的托马斯手中。手稿现保存在维多利亚墨尔本的墨尔本大学医学史博物馆。现在记录了完整手稿的誊本以及相关的历史注释。
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引用次数: 0
Thanks to Reviewers 感谢审稿人
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-04-15 DOI: 10.1177/0310057x241233456
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引用次数: 0
Simulated impact of lift car sizes on transport of critical care patients: Informing the design of the New Dunedin Hospital 模拟电梯轿厢尺寸对运送危重病人的影响:为新达尼丁医院的设计提供依据
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-04-15 DOI: 10.1177/0310057x241226720
Sheila G Barnett, Katherine M Stephens
The New Dunedin Hospital (NDH) is New Zealand’s largest health infrastructure build. Here we describe the use of a simple simulation-based hospital design exercise to inform the appropriate lift car size for critical care intrahospital transfers in the NDH. The intensive care unit (ICU) user group tested a series of entries and exits of simulated complex patient transfers in mocked-up lift cars of three different dimensions. Time taken to enter and exit the lift were recorded, reflecting the relative difficulty of transfer. Qualitative assessments were made of ease and perceived safety of transfer. These simulations demonstrated that recommended standard patient lift cars, often proposed for critical care transfers, could not physically accommodate all complex ICU transfers. A size of 1800 mm wide (W) × 3000 mm deep (D) had the physical capacity to permit all simulated ICU transfers, but with staff and patient risk. As lift car size increased to 2200 mm W × 3300 mm D, the simulation demonstrated reduced transfer times, smoother entry and exit, improved access to the head end of the bed, and reduced risk of disconnection or dislodgement of lines and airway support. The resultant clinical recommendations for the dimensions of a critical care lift car surpass current international health architecture guidelines and may help to inform future updates. The NDH project benefited from an objective assessment of risk, in language familiar to clinicians and healthcare architects. The outcome was an upsizing of the two ICU-capable lifts.
新达尼丁医院(NDH)是新西兰最大的医疗基础设施。在此,我们介绍了如何通过简单的模拟医院设计来确定 NDH 重症监护院内转运所需的电梯轿厢尺寸。重症监护室(ICU)用户组在三种不同尺寸的模拟移位机车中测试了一系列复杂病人转运的模拟出入口。记录了进入和离开移位机所需的时间,以反映移位的相对难度。对转运的难易程度和安全感进行了定性评估。这些模拟结果表明,通常建议用于重症监护转运的标准病人移位机车无法满足所有复杂的重症监护室转运需求。1800 毫米宽(W)×3000 毫米深(D)的尺寸在物理上能够容纳所有模拟 ICU 转运,但会给工作人员和病人带来风险。当移位机轿厢尺寸增加到 2200 毫米宽 × 3300 毫米深时,模拟结果表明移位时间缩短、进出更顺畅、床头通道更通畅、管路和气道支持断开或脱落的风险降低。由此产生的关于重症监护移位机尺寸的临床建议超过了当前的国际健康建筑指南,可能有助于为未来的更新提供参考。用临床医生和医疗建筑师熟悉的语言对风险进行客观评估,使 NDH 项目受益匪浅。其结果是扩大了两台可用于重症监护室的升降机的尺寸。
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引用次数: 0
Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists perioperative anaphylaxis management guideline 2022 澳大利亚和新西兰麻醉过敏小组/澳大利亚和新西兰麻醉师学院围手术期过敏性休克管理指南 2022
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-04-08 DOI: 10.1177/0310057x231215823
Robyn Tran, Karen Pedersen, Helen Kolawole, Peter Roessler, Richard Scolaro
Perioperative anaphylaxis is a potentially life-threatening emergency that requires prompt recognition and institution of life-saving therapy. The Australian and New Zealand College of Anaesthetists and Australian and New Zealand Anaesthetic Allergy Group have partnered to develop the anaphylaxis management guideline along with crisis management cards that are recommended for use in suspected anaphylaxis in the perioperative setting. This is the third version of these guidelines with the second version having been published in 2016. This article contains the revised Australian and New Zealand Anaesthetic Allergy Group/Australian and New Zealand College of Anaesthetists perioperative anaphylaxis management guideline, with a brief review of the current evidence for the management of anaphylaxis in the perioperative environment.
围手术期过敏性休克是一种可能危及生命的紧急情况,需要及时识别并采取救生治疗措施。澳大利亚和新西兰麻醉师学院与澳大利亚和新西兰麻醉过敏小组合作开发了过敏性休克管理指南以及危机管理卡,建议用于围术期环境中的疑似过敏性休克。这是这些指南的第三版,第二版已于 2016 年发布。本文包含澳大利亚和新西兰麻醉过敏小组/澳大利亚和新西兰麻醉师学院围手术期过敏性休克管理指南修订版,并简要回顾了围手术期过敏性休克管理的现有证据。
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引用次数: 0
Comment on: The financial and environmental impact of purchased anaesthetic agents in an Australian tertiary hospital. 评论:在澳大利亚一家三级医院购买麻醉剂的财务和环境影响。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231202267
Robert R Tooley, Dale A Currigan, Christopher H Mitchell
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引用次数: 0
Exploring anaesthetists' views on the carbon footprint of anaesthesia and identifying opportunities and challenges for reducing its impact on the environment. 探讨麻醉师对麻醉碳足迹的看法,并确定减少其对环境影响的机会和挑战。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-11-24 DOI: 10.1177/0310057X231212211
Matilde Breth-Petersen, Alexandra L Barratt, Forbes McGain, Justin J Skowno, George Zhong, Andrew D Weatherall, Katy Jl Bell, Kristen M Pickles

A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system. The purpose of this qualitative interview study was to understand anaesthetists' perspectives on the carbon footprint of anaesthesia, and views on shifting practice towards more environmentally sustainable options. Anaesthetists were recruited from four hospitals in Western Sydney, Australia. Data were organised according to the capability-opportunity-motivation model of behaviour change. Twenty-eight anaesthetists were interviewed (July-September 2021). Participants' age ranged from 29 to 62 years (mean 43 years), 39% were female, and half had completed their anaesthesia training between 2010 and 2019. Challenges to the wider use of greener anaesthetic agents were identified across all components of the capability-opportunity-motivation model: capability (gaps in clinician skills and experience, uncertainty regarding research evidence); opportunity (norms, time, and resource pressures); and motivation (beliefs, habits, responsibility and guilt). Suggestions for encouraging a shift to more environmentally friendly anaesthesia included access to education and training, implementing guidelines and audit/feedback models, environmental restructuring, improving resource availability, reducing low value care, and building the research evidence base on the safety of alternative agents and their impacts on patient outcomes. We identified opportunities and challenges to reducing the carbon footprint of anaesthesia in Australian hospitals by way of system-level and individual behavioural change. Our findings will be used to inform the development of communication and behavioural interventions aiming to mitigate carbon emissions of healthcare.

麻醉师在实践中从具有高全球变暖潜势的麻醉气体转向低排放技术(例如全静脉麻醉),可为卫生系统节省大量碳。这个定性访谈研究的目的是了解麻醉师对麻醉的碳足迹的看法,以及对将实践转向更环保的可持续选择的看法。麻醉师从澳大利亚西悉尼的四家医院招募。根据行为改变的能力-机会-动机模型组织数据。对28名麻醉师进行了访谈(2021年7月至9月)。参与者的年龄从29岁到62岁不等(平均43岁),39%是女性,一半在2010年至2019年期间完成了麻醉培训。在能力-机会-动机模型的所有组成部分中确定了更广泛使用绿色麻醉剂的挑战:能力(临床医生技能和经验的差距,研究证据的不确定性);机会(规范、时间和资源压力);以及动机(信念、习惯、责任和内疚)。鼓励转向更环保的麻醉的建议包括获得教育和培训,实施指南和审计/反馈模型,环境重组,改善资源可用性,减少低价值护理,以及建立替代药物安全性及其对患者预后影响的研究证据基础。我们确定了通过系统级和个人行为改变的方式减少澳大利亚医院麻醉碳足迹的机会和挑战。我们的研究结果将用于告知旨在减少医疗保健碳排放的沟通和行为干预的发展。
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引用次数: 0
Observational study of the effect of ketamine infusions on sedation depth, inflammation, and clinical outcomes in mechanically ventilated patients with SARS-CoV-2. 氯胺酮输注对机械通气SARS-CoV-2患者镇静深度、炎症及临床转归影响的观察研究
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231201184
David Wyler, Marc C Torjman, Ron Leong, Michael Baram, William Denk, Sara C Long, Richard J Gawel, Eugene R Viscusi, Irving W Wainer, Eric S Schwenk

Severely ill patients with COVID-19 are challenging to sedate and often require high-dose sedation and analgesic regimens. Ketamine can be an effective adjunct to facilitate sedation of critically ill patients but its effects on sedation level and inflammation in COVID-19 patients have not been studied. This retrospective, observational cohort study evaluated the effect of ketamine infusions on inflammatory biomarkers and clinical outcomes in mechanically ventilated patients with SARS-CoV-2 infection. A total of 186 patients were identified (47 received ketamine, 139 did not). Patients who received ketamine were significantly younger than those who did not (mean (standard deviation) 59.2 (14.2) years versus 66.3 (14.4) years; P = 0.004), but there was no statistically significant difference in body mass index (P = 0.25) or sex distribution (P = 0.91) between groups. Mechanically ventilated patients who received ketamine infusions had a statistically significant reduction in Richmond Agitation-Sedation Scale score (-3.0 versus -2.0, P < 0.001). Regarding inflammatory biomarkers, ketamine was associated with a reduction in ferritin (P = 0.02) and lactate (P = 0.01), but no such association was observed for C-reactive protein (P = 0.27), lactate dehydrogenase (P = 0.64) or interleukin-6 (P = 0.87). No significant association was observed between ketamine administration and mortality (odds ratio 0.971; 95% confidence interval 0.501 to 1.882; P = 0.93). Ketamine infusion was associated with improved sedation depth in mechanically ventilated COVID-19 patients and provided a modest anti-inflammatory benefit but did not confer benefit with respect to mortality or intensive care unit length of stay.

COVID-19重症患者很难镇静,通常需要大剂量镇静和镇痛方案。氯胺酮可有效辅助重症患者镇静,但其对COVID-19患者镇静水平和炎症的影响尚未研究。这项回顾性、观察性队列研究评估了氯胺酮输注对机械通气的SARS-CoV-2感染患者炎症生物标志物和临床结局的影响。共确定186例患者(47例接受氯胺酮治疗,139例未接受氯胺酮治疗)。接受氯胺酮治疗的患者明显比未接受氯胺酮治疗的患者年轻(平均(标准差)59.2(14.2)岁对66.3(14.4)岁;P = 0.004),但两组间体重指数(P = 0.25)和性别分布(P = 0.91)差异无统计学意义。接受氯胺酮输注的机械通气患者的Richmond激动-镇静量表评分降低具有统计学意义(-3.0 vs -2.0, P 0.001)。在炎症生物标志物方面,氯胺酮与铁蛋白(P = 0.02)和乳酸(P = 0.01)的减少有关,但与c反应蛋白(P = 0.27)、乳酸脱氢酶(P = 0.64)或白细胞介素-6 (P = 0.87)的减少没有关联。氯胺酮给药与死亡率无显著相关性(比值比0.971;95%置信区间0.501 ~ 1.882;p = 0.93)。氯胺酮输注与机械通气的COVID-19患者镇静深度的改善有关,并提供适度的抗炎益处,但在死亡率或重症监护病房住院时间方面没有益处。
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引用次数: 0
A weighing method for measuring nitrous oxide leakage from hospital manifold-pipeline networks. 一种测量医院歧管管网氧化亚氮泄漏的称重方法。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-11-25 DOI: 10.1177/0310057X231198123
Steven J Gaff, Victor X Chen, Eugenie Kayak

Nitrous oxide is a potent greenhouse gas and ozone-depleting agent with a long atmospheric lifetime. Several previous reports indicate that over half of supplied nitrous oxide is wasted from leaking manifold-pipeline systems infrastructure prior to patient use, and that remediating leaks can have significant environmental benefits. We describe an accurate, simple and cost-effective cylinder weighing method to quantify nitrous oxide leak from the manifold-pipeline network at our tertiary non-obstetric facility. Nitrous oxide cylinder depletion was prospectively compared with clinical usage derived from the electronic medical record over an 18-day period. A total of 1932 l (3.62 kg) of nitrous oxide was used in 35 operating theatre cases during the period. This was only 16.5% of actual cylinder depletion (11,686 l; 21.88 kg), indicating that 83.5% (9754 l; 18.26 kg) of nitrous oxide had leaked to the atmosphere (376 ml/minute; 22.6 l/hour; 542 l/day). The fraction of nitrous oxide wasted was consistent with a retrospective analysis of the previous 2-year period at the site that compared purchasing records with estimated clinical use. If maintained over a year, the leak would be equivalent to 101 tonnes of carbon dioxide per annum.

一氧化二氮是一种强效的温室气体和臭氧消耗剂,具有很长的大气寿命。先前的几份报告表明,在患者使用之前,超过一半的供应氧化亚氮被浪费在泄漏的歧管管道系统基础设施中,并且修复泄漏可以带来显着的环境效益。我们描述了一种准确,简单和具有成本效益的钢瓶称重方法,以量化一氧化二氮泄漏从我们的三级非产科设施的歧管管网。在18天的时间内,前瞻性地比较了一氧化二氮气瓶耗竭与来自电子病历的临床使用情况。在此期间,共在35个手术室病例中使用了1932 l (3.62 kg)氧化亚氮。这仅仅是实际汽缸损耗的16.5% (11,686 l;21.88 kg),表示83.5% (9754 l;18.26千克的一氧化二氮泄漏到大气中(每分钟376毫升;22.6升/小时;542升/天)。一氧化二氮浪费的比例与该地点前2年期间的回顾性分析一致,该分析将采购记录与估计的临床使用进行了比较。如果维持一年以上,泄漏量将相当于每年101吨二氧化碳。
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引用次数: 0
Percutaneous electrical nerve stimulation in post-mastectomy neuropathic pain: A case report. 经皮神经电刺激治疗乳房切除术后神经性疼痛1例。
IF 1.5 4区 医学 Q2 Medicine Pub Date : 2024-03-01 Epub Date: 2023-12-02 DOI: 10.1177/0310057X231199800
Gary W Wong, Akhilesh K Tiwari

Post-mastectomy pain syndrome (PMPS) is a type of chronic postsurgical pain that can be severe, debilitating and frequently encountered in clinical practice. Multiple studies have focused on prevention, identifying risk factors and treating this condition. Nonetheless, PMPS remains a complex condition to treat effectively. In this case report, we describe the use of percutaneous electrical nerve stimulation in a breast cancer patient who experienced PMPS refractory to conventional treatments.

乳房切除术后疼痛综合征(PMPS)是一种慢性术后疼痛,可能是严重的,使人虚弱,在临床实践中经常遇到。多项研究都集中在预防、识别风险因素和治疗这种疾病上。尽管如此,经前症候群仍然是一种难以有效治疗的复杂病症。在这个病例报告中,我们描述了使用经皮神经电刺激的乳腺癌患者谁经历了难治性PMPS传统治疗。
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引用次数: 0
期刊
Anaesthesia and Intensive Care
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