Subject(s)
Anesthetics, Inhalation , Detergents , Drug Packaging/methods , Isoflurane , Medication Errors , Drug Storage , Humans , Nebulizers and Vaporizers , New ZealandABSTRACT
A questionnaire on substance abuse was distributed electronically to the heads of 185 Australian and New Zealand College of Anaesthetists accredited anaesthesia departments in Australia and New Zealand. The response rate was 57%. From January 2004 to December 2013, 61 cases of substance abuse were identified, giving an estimated incidence of 1.2 cases per 1000 anaesthetist years. Of 44 detailed reports completed, the majority were aged between 30 and 49 years, were male and of specialist grade. However, when corrected for gender and grade, the estimated overall incidence was higher in females and twice as high for trainees compared with specialists. When compared with prior surveys, the pattern of substance abuse in Australia and New Zealand appears to have changed significantly, with a notable increase in propofol and alcohol abuse and a decrease in reported cases of opioid abuse. Common presenting features of abuse included intoxication and witnessed abuse. Seventy percent of cases had more than one comorbid condition, most frequently either mental health or family problems. Only 32% of abusers had made a long-term recovery within the specialty. Death was the eventual outcome in 18% overall, with a particularly high mortality associated with propofol abuse (45%). Trainee suicide from all causes was reported at three times the rate of specialists. The findings indicate that substance abuse remains a significant problem in Australia and New Zealand and is associated with a significant mortality rate.
Subject(s)
Anesthesiology/statistics & numerical data , Physician Impairment/statistics & numerical data , Substance-Related Disorders/epidemiology , Surveys and Questionnaires , Adult , Age Distribution , Australia/epidemiology , Female , Humans , Incidence , Male , Mental Health/statistics & numerical data , Middle Aged , New Zealand/epidemiology , Retrospective Studies , Sex Distribution , Suicide/statistics & numerical data , Young AdultSubject(s)
Anesthesia/methods , Aortic Aneurysm, Abdominal/surgery , Guillain-Barre Syndrome/complications , Abdominal Pain/etiology , Aged , Anesthetics, Inhalation/administration & dosage , Anesthetics, Intravenous/administration & dosage , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Atracurium/administration & dosage , Desflurane , Fentanyl/administration & dosage , Follow-Up Studies , Gait Disorders, Neurologic/etiology , Guillain-Barre Syndrome/diagnosis , Humans , Incidental Findings , Isoflurane/administration & dosage , Isoflurane/analogs & derivatives , Male , Monitoring, Intraoperative/methods , Muscle Weakness/etiology , Neuromuscular Nondepolarizing Agents/administration & dosage , Piperidines/administration & dosage , Propofol/administration & dosage , Radiography, Abdominal/methods , Remifentanil , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
A questionnaire investigating substance abuse was sent to 128 anaesthetic departments in Australia and New Zealand of which 100 (78%) replied. Forty-four cases of substance abuse were reported. Abusers were more likely to be male, aged between 25 and 35 years and abusing opioids. Death was the eventual outcome in 24% of cases. Only 19% of abusers made a long-term recovery within the specialty. Initial signs of abuse were most commonly abnormal conduct (63% of the cases) and observed abuse (37%). More than one precipitating cause was identified in 51% of cases, the most frequently reported were mental health and family problems. The pattern of substances abused was similar to that reported in the previous Australasian survey ten years ago. However, in keeping with an international trend, there appears to be an increased use of anaesthetic agents.
Subject(s)
Anesthesiology , Physician Impairment/statistics & numerical data , Substance-Related Disorders/epidemiology , Adult , Australia/epidemiology , Female , Humans , Male , Middle Aged , New Zealand/epidemiology , Retrospective Studies , Surveys and QuestionnairesABSTRACT
This study compares retrospectively the postoperative analgesia provided via intravenous opioids with continuous regional techniques (interpleural and epidural infusions) administered as a clinical routine by an anaesthesia-based Acute Pain Service. In 2630 patients no severe complications resulting in morbidity or mortality occurred; the rate of potentially serious complications was in the 0.5% range and comparable between the techniques. A detailed analysis of a randomised subsample of 340 patients revealed better analgesia at rest and better compliance with physiotherapy under continuous regional analgesia. Techniques of continuous regional analgesia also resulted in fewer incidents of desaturation and fewer side effects. Patient satisfaction with these techniques was higher than with intravenous opioid administration. In conclusion, continuous regional analgesia in a routine clinical setting is comparable to intravenous opioid administration with regard to safety, but results in significantly better analgesia with fewer side effects.
Subject(s)
Analgesia, Epidural , Pain, Postoperative/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Analgesia, Epidural/adverse effects , Analgesia, Patient-Controlled , Bupivacaine/administration & dosage , Female , Humans , Infusions, Parenteral , Male , Middle Aged , Morphine/adverse effects , Morphine/therapeutic use , Pain Measurement , Patient Satisfaction , Pleura , Retrospective StudiesABSTRACT
A technique of peri-ocular infiltration of local anaesthetic for eye surgery is described. The ease of administration of this form of local blockade is highlighted and its low propensity for complication compared with retrobulbar blockade. The involvement of anaesthetists in the performance of local anaesthesia for ophthalmic surgery that utilises this technique is encouraged.
Subject(s)
Anesthesia, Local/methods , Ophthalmologic Surgical Procedures , Bupivacaine/administration & dosage , Humans , Hyaluronoglucosaminidase/administration & dosage , Lidocaine/administration & dosageABSTRACT
The management of a persistent, incapacitating postdural puncture headache that required four consecutive autologous epidural blood patches is presented. Inadequate blood volumes, early patching and steroid in the epidural space are considered as possible causes of failure. Other associated problems and interventions are briefly discussed.
