The article quoted Professor Spiess at the ANZCA ASM as saying, “Blood transfusions are a religion. They have never been safety or efficacy tested,” he said. “Drug options are carefully tested and regulated through prospective, randomised double-blind testing, but blood transfusion stands apart in that it has predominantly been believed to be helpful and evolved as a pillar of modern medicine.” Read the rest of this entry »
Thanks for this comment…”I am loving being at work - with the usual suspects at the ASM I get to do the meaty cases at work - so Thanks to the congress and Thanks to Allori and the “At work†summaries. I have the best of both worlds.”
If you haven’t enroled to recieve a copy, here’s where you can!
Medicine is of all the arts most noble but owing to the ignorance of those that practice it… Read the rest of this entry »
Caudals are probably one of the most used techniques in paediatric anaesthesia. Generally they are seen to be a low risk procedure, but this is not always the case Read the rest of this entry »
Following on from this session Julia Fleming described to me during coffee how the multiple disciplines associated with providing service to pain patients are working hard to integrate their respective skills and knowledge. A session pioneered by the conference organisers provided Read the rest of this entry »
The major changes include to give (nearly) uninterrupted cardiac compressions, use of biphasic defibrillators and single shocks instead of monophasic salvos, changes to drug dosages and to use of some drugs, and new rates for compressions to breaths. Dr Clifford concentrated mainly on the in theatre scenario, where you have access to all equipment and staff skilled in advanced resuscitation techniques. The newsletter and following links discusses the guidelines and algorithms for paediatrics and adults.
References for review and discussion: Read the rest of this entry »
To Transfuse or not to Transfuse…? “The problem is, most of the transfusions we give are emotional. We see the red stuff coming out and feel we must do something.†When should we, or must we transfuse? What is the actual scientific evidence that transfusion improves patient outcomes? Read the rest of this entry »
We got this note this morning from a happy subscriber. As this project represents upwards of a hundred man and woman hours, we all appreciated your encouragement - thanks mate!
“Thank you. Although I came for the conference the “at work†newsletter is very informative in itself.â€
Loading …Discuss these results and your technique here
“I am genuinely surprised by… Read the rest of this entry »
The first summary newsletter was emailed out to medical practitioners who have requested it this evening. The newsletter homepage is here and links and discussion forums can be found on the following pages.
If you didn’t recieve this newsletter, enroll here to recieve the next one here or contact us here for a reprint.
The Primary examination plays an important function for the college, and in his talk Dr Noonan discussed its origins, purposes, and how it is today. Beginning in 1957, the first Australian Anaesthetic examination was not so very different from those held today. Indeed, as Dr Noonan commented, some of the questions would not be too out of place on a paper now. Read the rest of this entry »
As I was driving into the city this morning I was thinking about the sessions I attended yesterday. The three speakers in the welfare group had a number of themes in common, and it was plain by the standing room only that it resonates strongly within the anaesthetic community as a whole. Professor Merry encouraged us to find a hobby or an interest that you are passionate about, and I was thinking “how can I fit this into life?” Most of the anaesthetists I know start work pretty early in the morning; do either a full day list or a morning and afternoon one, with lunch snatched en-route in the car between hospitals. Read the rest of this entry »
With 100 colleagues signed up for the newsletter and over 1000 hits each day on the site, the first sumary will be mailed out tonight.Â
If you haven’t already requested the summaries, do so here otherwise join in the discussions e.g. Fatigue: “I am a registrar just coming off 7 12h nights…”
The Fluido component system looks to be the latest advance in blood warming technology. Having been used in Europe for some time, this new technology arrived in the Australian market less than three months ago.Â
A landmark study, published in the British medical journal in 1996, listed some interesting statistics. According to the figures, anaesthetists died almost 10 years sooner than hospital medical officers and surgeons! Read the rest of this entry »
He told us an inspiring tale; the progress of his own journey as an addict, firstly to alcohol and then later to prescription drugs and opioids as well. He emphasised again and again how terrifyingly out of control an addict feels, and the resultant self loathing this entails. He was blunt and honest in his story, and made it clear that he did not know why it had happened, only that it had. He stressed that alcohol and drug abuse must be seen as the disease processes they are, and treated in exactly the same manner as cancer or coronary artery disease. He noted the discrepancies in community perceptions of addiction as a disease, and once again it was clear that much more needs to be done to support and treat these vulnerable human beings.
He talked about the unknown users among the medical community, Read the rest of this entry »
Sandy delivered an interesting series of facts about decreased functioning in response to lack of sleep. His research, along with other studies, shows that there is distinct global decrease in glucose uptake in PET scans of sleep deprived subjects, especially in the thalamus. Various cognitive function tests such as the simple subtraction test score clearly show the effects of long term sleep loss on ability to reason and make decisions. Obviously this implicates strongly on the ability of any medical professional to function at their peak. A study of ANZCA trainees Read the rest of this entry »
Having received rave reviews for their chocolate fountain, our Tyco representative gladly modelled the latest in technical clothing for neonates – the “Oximax Neomaxâ€. The Oximax is the first forehead pulse oximetry sensor for neonates and infants built into a soft fabric hat to provide monitoring less prone motion artefact and peripheral vascular limb changes..
More copies of “Perioperative Transfusion Medicine†were brought today from the conference bookshop but the next hottest book to leave the shelves was the briefcase filler, “Westmead Pocket Anaesthetic Manual”.Â
Quality Assurance is admittedly important in medical practice, and in this session Dr Tuck outlined some of his methods used in building of a framework to support this in his partnership of 15 anaesthetists. It was important, he explained, in the face of the changes in medical indemnity, the shared liability of the partners, and the idiosyncrasies of each individual practitioner. However, there were a number of issues associated with it. These included whose role it was to construct the program, the resources available, the time and money required, and what would be done with the information obtained. Read the rest of this entry »
Frank Moloney addressed the topic of “Rural Practice Continuing Professional Development†(CPD). In this session, Frank Moloney addressed issues relevant to rural CPD. Read the rest of this entry »
At what Hb level would you transfuse a fit and healthy middle aged adult?
Total Votes: 26
Loading …Lots of sessions attended and thoughtful summaries being written…. disposible or reusable airways, what is my transfusion trigger, do I use BIS or Entropy, Desflurane or Sevo, should I try a different antiemEtic?Â
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And Amalia Bell, the youngest attendent at 4 months of age…. who got up early on a Sunday morning and brought along her mum, Deborah Bell from Monash Medical Centre, to hear the prize sessions.
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The hottest selling book following today’s sessions at the Book stall was “Perioperative Transfusion Medicine” by Bruce D Spies, Richard K Spence, and Aryeh Shander. The details of the book are posted below and Mario Ferrari, of RamsayGroup Medical Books, is happy to arrange for your copy to be sent to you on (Australia) 1800 632 066.
Hardcover: 750 pages
Publisher: Lippincott Williams & Wilkins; 1.00 edition (December 1, 2005)
Language: English
ISBN-10: 0781737559
ISBN-13: 978-0781737555
Product Dimensions: 10.9 x 8.6 x 1.5 inches
I can’t help feeling slightly awed as I wander around my first conference. So many people, all older and more experienced! So many stalls, full of equipment and advertisements that I’m not sure I really understand! So many free pens! Read the rest of this entry »
Desflurane has come of age in Australia-NZ and Baxter’s Managing Director, Maree Coy, was present to cut the “Celebrating One Million†cake at the ANZCA ASM. With Baxter now supplying Desflurane, Sevoflurane and Isoflurane to a large number of Australian hospitals, they were keen to tell everyone the news!
Go to PubMed and conduct the two searches. Â
Search 1: (“blood transfusion†AND Outcome)
Search 2: (“blood transfusion†AND “adverse effectsâ€)
What did you find?
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“By the end of my talk you will think that I think that givinga blood transfusion is the worst possible thing that you could do to a personâ€said Professor Spiess, who then went on to ask where the science was. The first big question on Prof Spiess’s listwas “Do blood transfusions improve or worsen outcome?†In a presentation that surveyed the availableliterature, covered lay publications and discussed the behaviour of clinicians inrelation to the decision whether to transfuse or not, Professor Spiess balancedhis argument by saying “but that being said, I am a card carrying member of theAmerican Association of Blood Bankers and … I have saved any number of liveswith a blood transfusionâ€.
A fuller account of the presentation will be available inthe first email newsletter.
It’s started… welcome drinks, an unmistakable bag in the shape of a bottle of volatile and a conference handbook – all 228 pages of it. Time to get a goodnight’s sleep because tomorrow it all kicks off with the plenary session - ‘Blood Transfusion and Outcomeâ€.
This online program is entitled ‘At Work’. The goal of the program is to provide for colleagues who have not been able to attend the ANZCA ASM. The program is offered freely, at no charge.
The term “ANZCA†is only made in the term “ANZCA ASM†which is the name of the event being covered. On every page in the side-bar the following affiliation statement reads, “It is important to note that this site and Allori is not affiliated with ANZCA (see Disclaimers).†The first line of the legal disclaimers reads: “This site and Allori is not affiliated or associated with ANZCA.â€
Please feel free to contact us directly to clarify any further questions you may have. We hope that the site extends the impact of ANZCA ASM 2007 for those that had to remain ‘at work’ to cover those of us who came.
The site has been up for 4 days and today had 270 unique visitors. One in four visitors have requested a summary of the ANZCA ASM sessions to be emailed to them by enrolling here. What do the rest of you want? Please tell us by voting…
What do you most want from the ANZCA ASM?
Total Votes: 18
Loading …Please leave all other comments here.
Did you see the comments below on Nitrous, a sticky obstetric situation and a difficult airway hint?
Email your colleagues and tell them about the site so we can all learn from each other!
We are emailing out summaries from ANZCA ASM 2007. While general comments will be posted on this site, ‘session’ summaries will emailed to registered medical doctors only.
If you are an Anaesthetist, Pain Medicine Physician or Intensive Care Physician licensed to practice in Australia, New Zealand, Hong Kong, Malaysia or Singapore you are invited to join the fastest-growing medical community by doctors, for doctors.
It doesn’t cost anything. We will only contact you with educational updates and will not share your email address with anyone else. If you are a medical doctor and wish to join with your peers please enter your email address below:
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If you are not a medical doctor and wish to discuss how you could be involved, please contact us here.
This paper discusses recent studies assessing various commercially available electro-encephalograh devices with respect to their use and effectiveness in children and infants during anaesthesia.Several recent physiological studies suggest that for older children the bispectral index, entropy, Narcotrend index, cerebral state index and the A-Line ARX index all change with induction and have reasonable correlations with doses of anaesthetic agent. There is consistent evidence that the performances are substantially poorer in infants. The bispectral index is the most widely studied device.
This made me think..
Dr Andrew Davidson is presenting dduring the free paper session on Saturday 26 May. Have you tried some of the indexes in your paediatric practice, and how would you rate various electro-encephalograph devices?
Trauma - probably the most excitng and challenging cases any anaesthetist faces. Whether it’s a motorbike accident, a ruptured AAA or a haemorrhaging gunshot wound, a trauma theatre is full of split second decision making. This problem based forum is a chance for you to share your experiences in these big cases.
Dr Pierre Bradley is presenting Trauma Cases in the OR - Saturday 26 May - PBLD 3. What have your experiences been? What has worked for you, what hasn’t; how are new technologies helping to improve outcomes in these patients?
On Tuesday morning the Great Debate will be presided over by Rod Westhorpe. The question is not which side Dan Sessler or Paul Myles will take (although I’m kind of curious to know) but whether nitrous should be used or not. Where do you stand? Vote below and see what others have said.
Do you still use nitrous?
Total Votes: 15
Loading …Until the day, what do you think…?
(click on the Comments link above)
The use of epidural and spinal anaesthesia has revolutionised surgical obstetrics. However there are times when it may not be appropriate to have your patient awake, or medical reasons why a regional anaesthetic is impossible. There are also those cases where an operative delivery becomes inevitable, and often it is necessary to proceed rapidly.
In these circumstances, what are the factors to consider when deciding if a block is an appropriate method of anaesthesia for delivery?
What is a reasonable time frame for decision to delivery: does this influence which method is used? Given the 17-fold increase in complications with general anaesthetics, how do we deal with the patient who insists she doesn’t want to be awake?
How often is an emergency so desperate that a block technique is “too slow”
How do we ensure that our patients are adequately informed about the various options and the implications of their choices? Can we reasonably expect them to make a sensible informed decision in an emergency situation when they may be terrified that their baby is in danger?
Come to discuss the implications of regional versus general anaesthesia in obstetric emergencies - bring your questions.
Dr Jenny Carden
Saturday 26 May PBLD6
Bariatric surgery presents a whole range of challenges for the anaesthetist!
We are emailing out summaries from ANZCA ASM 2007. While general comments will be posted on this site, ‘closed session’ summaries will emailed to registered medical doctors only.
If you are an Anaesthetist, Pain Medicine Physician or Intensive Care Physician licensed to practice in Australia, New Zealand, Hong Kong, Malaysia or Singapore you are invited to join the fastest-growing medical community by doctors, for doctors. It only takes two minutes to register and doesn’t cost anything to be a member.
It is:
We will only contact you with educational updates and will not share your email address with anyone else.
If you are not a medical doctor and wish to discuss how you could be involved, please contact us here.
If you are a medical doctor and wish to join with your peers (300 and growing) please enter your email address below:
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Dr Liz Prentice.
Monday 28 May - workshop.
Have you begun using ultrasound to guide your needle placement in regional techniques?
This workshop is hands on and designed to give you practice in using ultrasound to locate the brachial, femoral and sciatic nerve plexuses to facilitate expert placement of regional blocks.Preliminary data suggests that use of ultrasound improvesblock success rates and decreases the risk of complications, especially nerve damage. The recent advent of ultrasound use in regional techniques addresses many of the shortcomings of current techniques.
How have you found the introduction of ultrasound in your workplace?
What issues need to be considered when selecting patients to use ultrasound assisted techniques?
How can anaesthetists be trained in the use of ultrasound guided techniques?
The use of regional anaesthetic blocks for ocular surgery is becoming commonplace as more centres opt for day procedures to optimise patient throughput. Both retrobulbar and peribulbar techniques are easily performed by trained anaesthetists, but like all regional techniques, and are not without risk. Sub Tenon’s blocks seem to be less risky in terms of long term serious complications, but are there reliable studies published comparing the two groups? Persistent diplopia due to strabismus, rectus muscle trauma, subconjunctival haemorrhage and oedema, ptosis, local anaesthetic spread to CNS, entropion, oculocardiac reflex and retrobulbar haemorrhage have all been reported in both types of block.
Come along with your experiences to share and learn from your colleagues (Tuesday 29 May, PBLD 33).
Each day we’ll discuss and summarise sessions on this website. We trust that this will be worthwhile and benefit Fellows and Trainees that can’t attend. To subscribe to email summaries of the ANZCA ASM 2007 sessions, please subscribe here: http://conferences.pubmedinpractice.com/subscribe-to-new-posts/ Â
We can’t cover all of the sessions so if after viewing the program there are sessions that you would specifically covered, please email me here.
The program is here: http://www.anzca2007asm.com/files/ANZCA_Program.pdf
Join in:
Perioperative transfusion plays a major role in maintaining the health of patients undergoing surgery. However, doubt has been thrown on the current practices of red cell transfusion in terms of both safety and efficacy. As such, questions as to the improvement of current protocols become relevant. It can be seen that up to 80% of blood products transfused at operation are consumed by between 15% to 20% of cardiac procedure patients. These high-risk patients must thus be identified and methods for limiting excess use of red blood products implemented. In the case of cardiac surgery, research has found that there are six significant variables that indicate risk. “(1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and (6) noncardiac patient comorbidities.†The same study also investigated blood-conservation techniques, finding several effective measures. But though many difficulties and some possible measures are known, there remain many factors and issues to be investigated. Questions are raised as to other possible methods of blood conservation, and their future implementation. These key issues, to be discussed at the conference by Bruce Speiss, will remain significant for the future of surgery for some time yet.
This workshop will look at the supraglottic and infraglottic approaches to managing a difficult airway and/or intubation. A wide range of devices will be available to use with the assistance and support of a specialist. Some things to consider prior to the workshop may be:
Crises are a part of medical and surgical life: unpredictable, stressful, and often difficult to manage. The ability to react and cope with such a situation is very important for medical professionals. These simulations, run by the St Vincent’s Simulation Unit provide the opportunity to practice these skills in a controlled environment, and to debrief with colleagues afterwards. In these sessions, the focus will be on crisis resource management, teamwork and leadership, situational awareness, co-ordination, and stress and error management. Participants will experience a brief lecture on issues raised by simulation, before being introduced to the simulation itself. After an exercise, a debriefing session allows for the discussion of issues raised, and of the performance itself. A number of situations and debriefs will be run before the session concludes. While the session is primarily aimed at those with little simulation exposure, it also provides an excellent opportunity for all to discuss issues, refine skills, and practice their own talents on the managing of crises.
The scientific program can be found here.
