The European Board of Anaesthesiology recommendations for safe medication practice

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011 | (2017) European Journal of Anaesthesiology .34(1) pp.4-7

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They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists.

The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

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Use of ultrasound for spinal anesthesia in a super morbidly obese patient

Morimoto, Y. et al. (2017) Journal of Clinical Anesthesia. 36 pp. 88–89

Heather Spears, Wellcome Images

Image source: Heather Spears – Wellcome Images // CC BY-NC-ND 4.0

Highlights

  • We report the application of ultrasound prescan for spinal anesthesia to morbid obesity patient.
  • The transverse view of the patient’s lumbar spine showed the posterior dura, transverse process, and posterior vertebral body below the thick fat tissue.
  • At this point, spinal anesthesia was successfully performed.
  • Pre-insertion ultrasound guidance for spinal anesthesia was useful in this morbidly obese patient with a BMI of 50.

Read the full abstract here

Care of the eye during anaesthesia and intensive care

 O’Driscoll, A. & White, E. Anaesthesia and Intensive Care Medicine. Published online: November 26 2016

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Image source: Dianne Harris – Wellcome Images // CC BY-NC-ND 4.0

 

Perioperative eye injuries and blindness are rare but important complications of anaesthesia. The three causes of postoperative blindness are ischaemic optic neuropathy, central retinal artery thrombosis (these can exist in tandem and have been described as ischaemic oculopathies) and cortical blindness.

This review aims to improve anaesthetists’ knowledge of orbital anatomy, ocular physiology and the mechanisms of perioperative eye injuries to help reduce their occurrence.

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Opioid doses and the survival of advanced cancer patients receiving palliative care

Sathornviriyapong, A. et al. BMC Palliative Care. Published online: 21 November 2016

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Image source: Adrian Wressell, Heart of England NHSFT – Wellcome Images // CC BY-NC-ND 4.0

Background: Concerns that opioids may hasten death can be a cause of the physicians’ reluctance to prescribe opioids, leading to inadequate symptom palliation. Our aim was to find if there was an association between different opioid doses and the survival of the cancer patients that participated in our palliative care program.

 

Conclusions: Our study has demonstrated that different opioid doses in advanced cancer patients are not associated with shortened survival period.

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Childhood & adolescent risk and prognostic factors for musculoskeletal pain

Huguet, A. et al. (2016) Pain. 157(12) pp. 2640–2656

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Image source: Tim Ellis – Wellcome Images // CC BY-NC-ND 4.0

A variety of factors may be involved in the development and course of musculoskeletal (MSK) pain.

We undertook a systematic review with meta-analysis to synthesize and evaluate the quality of evidence about childhood and adolescent factors associated with onset and persistence of MSK pain, and its related disability.

No study was identified that examined prognostic factors for MSK pain–related disability. High-quality evidence suggests that low socioeconomic status is a risk factor for onset of MSK pain in studies exploring long-term follow-up. Moderate-quality evidence suggests that negative emotional symptoms and regularly smoking in childhood or adolescence may be associated with later MSK pain. However, moderate-quality evidence also suggests that high body mass index, taller height, and having joint hypermobility are not risk factors for onset of MSK pain. We found other risk and prognostic factors explored were associated with low or very low quality of evidence.

Additional well-conducted primary studies are needed to increase confidence in the available evidence, and to explore new childhood risk and prognostic factors for MSK pain.

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Breakthrough cancer pain: twenty-five years of study

Mercadante, S. & Portenoy, R. K. (2016) Pain157(12) pp. 2657–2663

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Breakthrough cancer pain (BTcP) is an episode of severe pain that “breaks through” a period of persistent pain at least partly controlled by a stable opioid regimen. Although mentioned in the literature decades ago, it has been only 25 years since the first effort to define and measure it.

Controversy about the definition of BTcP continues despite an international effort to achieve consensus. Nevertheless, common approaches to measurement of BTcP have led to a robust literature, including many surveys that have described prevalence, characteristics, and association with adverse outcomes. Measurement also has been important for clinical trials of new drug formulations specifically designed for BTcP. Several approaches have been reported in the literature, although most of them have never been substantiated with appropriate studies. Administration of an opioid as needed is the most common treatment.

Twenty-five years of research has produced a more refined understanding of the safety and efficacy of oral opioids in this context, and provided the clinical trials data necessary to attain regulatory approval of multiple new formulations specifically developed for BTcP. Transmucosal formulations of fentanyl may provide meaningful analgesia within 5 to 15 minutes. Given the difference in cost, transmucosal formulations should be considered in a subset of patients with BTcP, including those with pain that are not adequately controlled with an oral drug and those with distress associated with the rapid pain onset. The long-term use of opioids for BTcP remains to be clarified. Future studies should assess the potential of personalized treatment of BTcP.

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