A clinical audit of an office-based anaesthesia service for dental procedures in Victoria.

There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017. We collected demographic data, information about anaesthesia technique, and surgical features. We assessed our findings against the Australian and New Zealand College of Anaesthetists (ANZCA) day surgery policy documents. During the specified period, we provided anaesthesia or sedation for 1,323 patients. Their ages ranged from two to 93 years (mean [standard deviation] 33.3 [18.6] years). Ninety-three percent of patients were American Society of Anesthesiologists (ASA) physical status classification 1 or 2. Patient demographics were in line with ANZCA day surgical policy documents. Total intravenous anaesthesia was used in 1,054 of the 1,096 documented general anaesthesia cases. There were three unplanned hospital transfers (annual incidence 0.07%). As this was the first Australian criteria-based audit of office-based anaesthesia (OBA) for dental procedures, we cannot compare our findings directly to previous studies. However, we feel that our patient demographics fell within acceptable ANZCA day procedure standards and our adverse event rate was both very low and similar to other published international adverse event rates. Our audit indicates that with careful screening processes, patient selection and medical governance, OBA is a viable model of care for patients undergoing dental procedures.

Operative treatment of destructive spondyloarthropathy of the lumbar spine in a patient on chronic dialysis.

We present a patient with end-stage renal disease treated by chronic dialysis, in whom progressive destructive spondyloarthropathy of the lumbar spine was successfully managed by fusion with internal fixation, resulting in relief of pain and restoration of activity.

Acute renal failure in leptospirosis--a 12-year survey.

From the beginning of 1974 to the end of 1985 141 persons in Slovenia (population 1.9 million) contracted leptospirosis 49 patients were 50 years old or more. All the patients have survived. 8 male patients aged from 18 to 44 had more severe acute renal failure (ARF), 5 of whom were treated with hemodialysis. The authors found that this 100% survival rate did not agree with the findings of many other researches which quote a relatively high mortality rate among older patients. In all 8 patients kidney function was good 1 year or more after ARF. The authors consider that the survival of patients with ARF depends on early and appropriate supportive treatment, which also includes intensive hemodialysis.