Rural Anaesthesia Journal Club: with Alex and Mel

This is the second installment of the Rural Anaesthesia Down Under (RADU) Journal Club.

In this episode, I am joined by Drs Alex Harris and Melanie Little – both local, fellow Broome GP Anaesthetists. We got together and had a chat about 5 papers covering 4 topics:

1. Perioperative anaphylaxis (the NAP6 Audit)
2. Dose adjustment for spinal anesthesia in Caesarean
3. The RELIEF trial – restrictive vs. liberal fluids for major abdo surgery
4. The “Drowned Airway algorithm” – how to approach this scenario.

If you are not a podcast person then there is a brief written summary of the points below.  Otherwise, you can listen to the podcast here, or download it in the usual ways – iTunes etc.

NAP6 Infographic

Link to the Fulltext of the NAP6 Audit

Should we be adjusting the dose of spinal anaesthesia based on the patient’s weight or height… or both?   Ummmm… maybe not in 2018.

2 papers discussed here:

Harten et al from Anaesthesia, 2005

Siddiqui et al, Korean Journal Anaesthesia, 2016

How much fluid is enough?  Are too many bags a bad thing?  The pendulum has come to rest somewhere in the middle when it comes to fluid therapy for patients undergoing big belly operations.

So for the average 80 kg bloke having a hemicolectomy this equation for “liberal” means:  800mls bolus at induction, 640 mls/hr as the operation goes on (~ 2 L for a3-hour op) then 120 ml/hr on the ward… this would seem a pretty standard amount of fluids where I work, not exactly flooding in a liberal sense.

OK, that is it – have a listen and feel free to comment on the podcast link or the Facebook page if you are one of the 450 odd Aussie GPAs

Casey

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