Welcome
to the home page for the Department of Anaesthesia, Westmead Hospital.
This
web site aims to provide timely information to help staff from the department,
both from work and while at home.
What's
New or Interesting (see the blog too)
We are recruiting
for new registrars positions to start in 2008.
Westmead is
tertiary hospital with a large anaesthetic department. Registrars receive a wide
exposure to all subspecialties and benefit from a supportive educational program.
You can call us for enquiries on
+61 2 9845 6447
Important - job applications must
be done via the NSW Health on-line system which is here
For information and job description
click here
New! Publication
of the Westmead Ultrasound in Anaesthesia Training Manual
May 2007. The manual for the use of ultrasound in anaesthesia is now available. It covers regional anaesthesia and vascular access, and is very helpful for anaesthetists learning this modality. The manual will be used in the Westmead department for training with our ultrasound machines.
You can download it as a PDF or call us for a bound copy.
Department Blog
site
We have now opened our own blog site
(see link above). The blog is like an on-line journal club. People can post
summaries and discuss recent journal articles easily. You only need a
web browser. Everyone can contribute. See it here.
Drug Eluting
Coronary Stents and Restenosis Risk
The FDA has just reviewed the risk
of restenosis of drug eluting coronary stents. It is summarized in this editorial in
the BMJ which concludes -
"Antiplatelet therapy should
not be discontinued at any time"
"If
possible, non-cardiac procedures should be undertaken without stopping clopidogrel"
Mortality increased with delay in surgery for fracture neck of femur.
The BMJ April 22 has a paper looking at this question. This very large observational study of 129,522 patients found, when adjusted for morbidity (using logistic regression for adjustment of confounders), there was a 27% increased risk of mortality when surgery was delayed for more than 24hrs.
Read more here
UK Hospital fined £100 000 for failing to supervise junior surgical trainees
Two SHOs failed to diagnose sepsis
occurring in a 31 year old man following simple knee surgery who later died.
This has caused alarm for other UK hospitals as it places blame on system issues,
not individual negligence. more
details in BMJ. and also the Lancet
Aprotonin: Risky and expensive?
The Jan 26 issue of the NEJM has a study from Mangano's group that finds Aprotonin, when used in cardiac surgery to reduce bleeding, is no better than alternatives yet is associated with increased risk of serious adverse events. Aprotonin had greater risk of of end organ damage (renal, cardiac cerebral) compared with aminocaproic acid or tranexamic acid.
Controversies in Coronary Syndromes (Lancet Jan 6)
This review states that statins and
ACE inhibitors are good, but beta-blockers are more doubtful. PTCA relieves
symptoms but does not improve survival compared with medical therapy. see abstract
New CPR guidelines published (Dec 13 2005)
The American Heart Association has published the latest CPR guidelines here
The short version, pointing out the key changes is here . Overall the emphasis is a simplification of CPR with an emphasis on chest compression.
MERIT study in Lancet
This Australian study examined the benefit of a Medical Emergency Team (MET) to reduce unexpected death, cardiac arrest, or unplanned ICU admission. Interestingly, no benefit was found, however during the study period there was an improvement in patient outcome for both non-MET as well as MET hospitals. There is also discussion with the lead investigator, Ken Hillman, on the 'Heath Report' on ABC radio.
Systematic review of beta-blockers in non-cardiac surgery
This BMJ article is authored by PJ Devereux from the POISE study. This makes important reading as it backgrounds the significance of the POISE study (RCT of metoprolol v placebo in non-cardiac patients).
Its conclusion is that trials to date are encouraging but too unreliable. We await the POISE study.
Are endoluminal AAA grafts really beneficial?
Two important studies are in the Lancet and the data is not encouraging for widespread endoluminal use.
Compared with open repair, and compared with no surgery in high risk patients, no definite benefit was shown (just that endoluminal grafting cost more)
Latest on COX-2 and NSAIDS
Juni has an informative editorial in the current BMJ to help resolve question of cardiac risk
See here
Neuraxial analgesia in early labour does not increase risk of caesarian section
The Feb 17 issue of the NEJM reports from an RCT that neuraxial analgesia in early labour does not increase the chances of having a C-section. The associated editorial concludes "for those who experience severe pain in early labor and desire analgesia, the findings reported by Wong et al. make it clear that safe, effective pain relief with the use of regional anesthetics should not be withheld simply because an arbitrary degree of cervical dilatation has not yet been achieved."
The
COX-2 debate intensifies
The TGA today (Feb 10) has announced that all COX-2 inhibitors will carry box warnings about CVS adverse effects. Also it was announced that registration for Parecoxib will be withdrawn. The FDA will consider all safety data in a review commencing Feb. 16 (see website).
The concern is that the adverse CVS effects are a class effect and will result
in restricted use of all COX-2's.
Coronary Artery Revascularization Prophylaxis (CARP) trial
It is now published in the NEJM. The abstract is here.
There is an associated editorial by Kim Eagle (from AHA guidelines) which particularly emphasises the potential benefit of beta-blockers (and maybe statins too) read it here.
Shows no survival benefit for vascular patients having CABG prior to their vascular surgery.
Prophylactic revascularization performed before major elective vascular surgery does not provide short-term benefit or improve long-term survival and can delay or prevent surgery in patients with coronary artery disease. The findings emphasize the importance of appropriate perioperative medical therapy, including beta blockers, aspirin, and statins.
In the Coronary Artery Revascularization Prophylaxis (CARP) trial, which randomized 510 patients to revascularization or no revascularization, about 23% of both groups had died at 2.7 years from cardiac causes. Percutaneous coronary intervention was performed in 59% and in 41% coronary artery bypass grafting. Procedural related deaths after revascularization was 1.7%, and there were no complications related to stroke, loss of limb, or dialysis. CARP was reported at the 2004 Scientific Sessions of the American Heart Association.
It is now reported in the NEJM. The abstract is here.
There is an associated editorial by Kim Eagle (from AHA guidelines) which particularly emphasises the potential benefit of beta-blockers (and maybe statins too) read it here.
More Vioxx scandal
The Lancet (6th November) has a scathing
editorial and article about the fact that Merck senior executives knew of the
cardiovascular risk of Vioxx. Furthermore, emails discovered by the Wall Street
Journal indicated Merck staff should use a strategy to down play the risk -
'Vioxx Dodge Ball'.
The editorial is here
The Westmead Anaesthetic Manual, 2nd edition, is out now!
The new edition of this popular book is now available.
Information
is available from Amazon or by contacting the Department
Rofecoxib (Vioxx) withdrawn from sale.
This has occurred following the risk of cardiac events.
However, this is likely to be not just a Vioxx problem. An article in the October 21 NEJM suggests that this a common COX2 inhibitor effect. We will need to see if it Dynastat (Parecoxib) will be included
BMJ October 23rd
A
review on general anaesthesia in patients with sleep apnoea. here
US
- Joint Commission on Accreditation of Healthcare Organizations:
Awareness under Anaesthesia
Oct 6th. JCAHO has issued
an alert to healthcare organizations emphasizing the risk of awareness
under anaesthesia. It has published a policy to reduce awareness and
manage patients when it does. more
here
The popular press has also picked up on the story
Risk
prediction in surgery
You
may be interested in this
site which provides online risk assessment tools
(e.g. POSSUM and its variants).
It tends
to overestimate risk in low risk patients/surgery, but is more accurate
for high risk scenarios.
It can
help you quantify risk, rather than just use clinical impression. It
may be helpful in preoperative consultations and in discussions with
the surgeons and patients.
Important
Articles - must reads!
Clonidine
reduces cardiac mortality by half for up to two years after surgery
See
the August
issue of Anesthesiology. Patients received clonidine as preop tablet
followed by transdermal patch for four days compared with placebo.
Is
high or low PEEP better in ARDS?
This
study
in the NEJM shows no difference hospital mortality
Dopamine
has no role in ICU?
This review article
in Anesthesia and Analgesia concludes that not only is there no benefit
for renal or splanchnic effects, but it is probably hazardous due to
adverse effects on renal function, gut mucosa, gut motility, catabolism
and pituitary function, immune function, thyroid function, and ventilatory
drive.
Filtered
blood shortens hospital stay
This study in the BMJ
showed that filtering blood for leukocytes shortened hospital stay by
more than 2 days and reduced multiple organ failure by 30%
B-Aware
study
This long anticipated study has just appeared in the
Lancet.
Key findings are that in a high risk group, BIS monitoring reduced awareness
by 82% . The cost per patient was US$16, NNT was 138 and the cost of
prevention one case was US$2200. See also the associated editorial.
SAFE
study
This is the large RCT of saline
versus albumin in ICU patients. There was no difference in mortality
at 28 days. See also related editorial. However its not all resolved.
Excluded where burns and cardiac patients, and subgroup analysis suggests
differences for trauma and sepsis patients. Watch for the letters to
the editor to follow!
Reviews
about IV fluid therapy
See this review about recent knowledge
of IV fluid therapy in Anaesthesia
and Analgesia (Dec)
See this
article about the possible benefit of less aggressive fluid resuscitation
in major trauma.
BMJ
has theme issue on communicating risk
This is very timely. It contains some very useful and revealing
insights when a patient asks "What are the risks doctor". click
here
Obstetrics:
Review of recent Developments in Obstetrics in BMJ (13th Sept.).
click
here
Covers pre-eclampsia, C-sections,
low dose epidurals and avoidance of routine CTG monitoring.
Safe
drug in use breast feeding.
Here is a good summary to safe use of drugs
in breast feeding i.e. post LSCS. click
here
Look
for the September Issue of Anesthesia and Analgesia for these significant
review articles
Robert D. Stevens, Haran Burri,
and Martin R. Tramer
Pharmacologic Myocardial Protection in Patients Undergoing Noncardiac
Surgery: A Quantitative Systematic Review
Duminda N. Wijeysundera and W. Scott Beattie
Calcium Channel Blockers for Reducing Cardiac Morbidity After Noncardiac
Surgery: A Meta-Analysis
What's
new and interesting from the non-Anaesthetic world
This
weeks BMJ makes the bold statement
"The most important BMJ for 50 years? "
and has a paper titled
"A strategy to reduce cardiovascular disease by more than 80%"
The
authors claim that taking a combination poly-pill could reduce the incidence
of IHD and stroke by 80%.
The editorial asks what cardiologist and cardiac surgeons should now
do - maybe retrain as psychiatrists??
Other
news
Congratulations to Nicole Phillips who was placed first in the recent
College final FANZCA exam
Obstetric
Anaesthesia news:
The Obstetric SIG teleconference gave and excellent overview about topical
issues. It is worth looking again at some of the lecture by down loading
them in PowerPoint from the Global Telehealth site.
Click here for link
Good review article on inhalational anaesthetics here
See
the updates on the pain pages here
See
the new presentations and lectures at the meetings
page.
Obstetric
guidelines now available
here
Summary
of recommendations
from
department AIMs meetings here
About Westmead Hospital
Westmead
Hospital was first opened in 1978 as a 975 bed teaching hospital of
the University of Sydney. It is located in Western Sydney, some 40 minutes
drive west of Sydney's CBD, and serves a population of 1.5 million people.
The
Westmead Hospital Department of Anaesthesia is part of the University
of Sydney Department of Anaesthesia, it is staffed by some 40 consultants,
20 registrars and four senior registrars/provisional fellows. The Department
head is Assoc/Prof. Peter Klineberg .
The
Department provides anaesthesia services for the 16 theatre Operating
Room suite, 10 room Delivery suite, Radiology, Endoscopy as well as
the Westmead Hospital Dental Clinical School.
Anaesthetic
sub specialties provided by the Department include: Cardiac and Thoracic
Anaesthesia (including transoesophageal echocardiography), Neurosurgical
Anaesthesia, ENT Anaesthesia, Anaesthesia for Head & Neck and Burns
Surgery, Transplant surgery, Obstetric Anaesthesia, Trauma Anaesthesia
and Acute, Cancer + Chronic Pain Management. There is also good exposure
to the more routine cases such as orthopaedics and general surgery.
An
active teaching program is in place for both the FANZCA Primary and
Final Fellowship examinations.
Last updated
Sunday, 12 August, 2007
