Hinkelbein, J. et al. | European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults | European Journal of Anaesthesiology
Procedural sedation and analgesia (PSA) has become a widespread practice given the increasing demand to relieve anxiety, discomfort and pain during invasive diagnostic and therapeutic procedures.
The European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology have created a taskforce of experts that has been assigned to create an evidence-based guideline and, whenever the evidence was weak, a consensus amongst experts on: the evaluation of adult patients undergoing PSA, the role and competences required for the clinicians to safely perform PSA, the commonly used drugs for PSA, the adverse events that PSA can lead to, the minimum monitoring requirements and post-procedure discharge criteria.
A search of the literature from 2003 to 2016 was performed by a professional librarian and the retrieved articles were analysed to allow a critical appraisal according to the Grading of Recommendations Assessment, Development and Evaluation method.
These guidelines contain recommendations on PSA in the adult population. It does not address sedation performed in the ICU or in children and it does not aim to provide a legal statement on how PSA should be performed and by whom. The National Societies of Anaesthesiology and Ministries of Health should use this evidence-based document to help decision-making on how PSA should be performed in their countries.
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Bush, S.H. et al. (2017) BMJ Open. 7:e013809
Objective: To determine the accessibility and currency of delirium guidelines, guideline summary papers and evaluation studies, and critically appraise guideline quality.
Conclusions: Delirium guidelines are best sourced by a systematic grey literature search. Delirium guideline quality varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Adding more knowledge translation resources to guidelines may improve their practical application and effective monitoring. More delirium guideline evaluation studies are needed to determine their effect on clinical practice.
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Aldecoa, C. et al. (2017) European Journal of Anaesthesiology. 34(4) pp. 192-214
Postoperative delirium (POD) is an adverse postoperative complication that can occur in patients of any age, from children to the elderly. Its incidence varies in the various age groups and is substantially influenced by patient-related risk factors that are variably distributed and differentially accumulate in the different age groups. Elderly patients are generally thought to be at higher risk because predisposing risk factors such as cognitive impairment, comorbidity, sensorial deficits, malnutrition, polymedication, impaired functional status and frailty (a condition that can only be observed among aged patients) accumulate and overlap with ageing.
Moreover, POD (refer to the specific definition in the ‘Paediatric patients’ section) is a common complication in children of pre-school age (5 to 7 years): whether this is due to age-related psychological issues or to additional inflammatory effects on the brain cannot currently be determined. There is a limited number of studies on cognitive outcomes in children. For the USA, the Food and Drug Administration (FDA) recently recommended cautious indications for anaesthesia and surgery in children aged less than 3 years. In Europe, the ESA launched an initiative, the EUROpean Safe Tots Anaesthesia Research (Eurostar) Initiative Task Force to promote translational research on anaesthesia neurotoxicity and long-term outcomes after paediatric anaesthesia and surgery.
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Nondrug treatment alternatives should be considered as first-line therapy for patients with low back pain according to an updated clinical practice guideline from the American College of Physicians | Anesthesiology News
The new guideline offered three main recommendations for treating acute (less than four weeks), subacute (four to 12 weeks) and chronic (>12 weeks) LBP:
- Nonpharmacologic treatments such as acupuncture, heat packs and massage are strongly recommended because acute or subacute LBP is expected to improve over time regardless of treatment.
- Nonpharmacologic treatment such as exercise, multidisciplinary rehabilitation, yoga and tai chi should be initially used for patient with chronic LBP.
- Only after these treatments are deemed ineffective should nonsteroidal anti-inflammatory drugs be considered as first-line therapy.
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Service pressures and the role of anaesthetists in training – joint RCoA & AAGBI statement
The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain & Ireland (AAGBI) have issued the following statement in light of some anaesthetists in training being asked to work outside of their usual scope of practice due to recent unprecedented demands on clinical services:
Patient safety should be the first priority of all NHS staff at all times. To support the needs of patients, and their safety, we believe the following principles are important when redeployment of trainees in our specialty is being considered although some of the points made would be equally applicable to non-trainee colleagues:
- Trainee anaesthetists should be redeployed from their normal duties only in exceptional circumstances, and for the shortest possible length of time. The decision to do so should be made only by the Medical Director or deputy taking account of all service pressures and the clinical environment pertaining at that time.
- Trainee anaesthetists should never practice beyond their competence. Trainees working in unfamiliar environments must have clear lines of supervision and responsibility established, and they must always receive adequate induction and be familiar with local governance arrangements.
- It is important that those trainees asked to help support a part of the service under pressure are selected equitably from all of the medical staff competent to contribute to that aspect of the hospital’s clinical activity and that the number of sessions each redeployed trainee spends in another clinical service is closely monitored.
- If as a result of a change in duties an anaesthetic trainee misses an important training opportunity, it should be clearly outlined how this training will be accessed in a timely manner once the crisis has passed. We would encourage trainees to reflect on their experiences of working under these circumstances with their educational supervisors so that trainers can fully understand the problems trainees face and the potential for learning in these unfamiliar environments.
The decision to alter a trainee anaesthetist’s duties should be communicated by the Medical Director to the local Guardian of safe working, the trainee’s educational supervisor, RCoA Tutor (who should inform the relevant RCoA Regional Advisor) and Postgraduate Dean at the earliest opportunity. This should outline the circumstances that led to the redeployment being necessary; how long it will last for and the actions that will be put in place to avoid a recurrence in the future”.
This is a consensus document produced by expert members of a Working Party established by the AAGBI.
Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients’ autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.
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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
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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