Complications associated with maxillary nerve block anaesthesia via the greater palatine canal

This paper documents the type, frequency and duration of complications associated with regional anaesthesia of the maxillary nerve via the greater palatine canal in a series of 101 patients treated in the Oral Surgery Department, United Dental Hospital of Sydney.     

Anaesthesia monitoring: the human factors component of technology transfer

Resistance to change in monitoring practices from within the anaesthesiology community is a formidable obstacle, and coercive and exhortatory solutions are likely to be unsuccessful in some situations. An analysis of publications about technology transfer and professional obsolescence, and application of this data to the practice of anaesthesia, reveals various stresses that technology transfer from research areas to the workplace may induce in vulnerable anaesthesiologists and account for their attitudes. It is suggested that the invaluable pronouncements of high profile anaesthesiologist groups must be supplemented by supportive behaviour by physicians and administrators at an institutional level. The human factors issues to be addressed include: (i) Monitored data acquisition skills. (ii) Possibility of acting on monitored data. (iii) Assistance for personal insight into attitudinal difficulties that may be encountered. (iv) Data supporting the value of the device. (v) Ergonomically effective integration of the monitor into the work station.Alternatively the perceptions of potential users may accurately reflect changes in their status in the new work situation created by monitors, and decision making aids that may or may not be derived from them. Thus, plans to present job satisfaction in related clinical areas or to associate the proposed new system with evaluation of its effect on patient outcome will be necessary. In this way the clinician becomes involved in clinical research, a quality of personal and quality care development.     

Neuroblastoma and anaesthesia

The haemodynamic problems associated with anaesthesia and neuroblastoma were reviewed in 52 children who underwent 138 operations at The Hospital for Sick Children, London, UK. At diagnosis 42 patients (81%) had elevated urinary catecholamine metabolites; nine (17%) were hypertensive, of whom eight were treated with adrenergic blockade. The incidence of intra-operative hypertension due to excess catecholamine release was 9% (13/138), and was confined to the group undergoing tumour excision (29%; 13/45). Hypertension was observed more frequently in patients who had not received chemotherapy. It was effectively controlled by labetalol. Patients symptomatic of catecholamine secretion before surgery should be managed in a similar manner for those with a phaeochromocytoma. Surgical manipulation of the tumour predisposes to paroxysmal hypertension. Careful monitoring is advised.     

Anaesthetic management during awake craniotomy in a 12-year-old boy

We present our approach to the preoperative preparation and anaesthetic management for awake craniotomy in a 12-year-old boy. Management included conscious sedation with a propofol infusion plus local anaesthetic infiltration of the scalp, periosteum, and dura. The complications which may be encountered during such procedures and their treatments are reviewed.     

Regional anaesthesia in ambulatory surgery

Regional anaesthesia provides many advantages and can be practised safely in ambulatory surgery. It provides better postoperative pain control, avoids many complications associated with general anaesthesia and shortens recovery time. However, extra time required, associated complications and acceptance of patients are the factors of concern in practising regional anaesthesia in an ambulatory setting. This review will discuss various regional anaesthesia techniques suitable for outpatients.     

Office-based anaesthesia for vitreoretinal surgery

The objectives of this study were to consider the effectiveness of local anaesthesia (LA) for office-based vitreoretinal (VR) surgery, the requirement to supplement the anaesthetic blockade, the demographic pattern of the sample and the acceptance of LA by patients. This prospective observational audit involved 111 patients that had undergone 128 VR procedures. Assessment data included: patient’s information, details of type of anaesthetic, and pain during surgery. A clinical audit was also carried out with telephone survey to establish the postoperative use of analgesics, the frequency of nausea, emesis, and insomnia. Results suggest that VR surgery can be carried out effectively and safely with LA, in an office-based surgery, provided that experienced surgeons exist. We noted a high degree of patient acceptance, a reasonable level of postoperative pain and a low frequency of nausea and vomits.     

Anaesthesia for primary repair of cleft lip and cleft palate: a review of 244 procedures

The peri-operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8-year-period was studied. A marked increase in the extent of intra-operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra-operative blood transfusion. Post-operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not significantly reduce the operative blood loss. A post-operative pyrexial illness was significantly associated with the presence of a positive pre-operative nasal and throat swab and this could be significantly reduced by pre-operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine peri-operatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post-operative pyrexia which could however be significantly reduced by the use of pre-operative antibiotics.     

Development of the Diploma in Clinical Dentistry (Conscious Sedation and Pain Control) Faculty of Dentistry, University of Sydney

The Diploma in Clinical Dentistry (Conscious Sedation and Pain Control) of the Faculty of Dentistry, University of Sydney, is the first dedicated programme devoted to this field in Australia. Its development followed a decision by the Dental Board of New South Wales to require a formal qualification from the University of Sydney before dental practitioners could offer sedation and pain management in practice.
The programme is conducted at Westmead Hospital in conjunction with the Department of Anaesthetics, and satisfies the guidelines developed by the Royal Australasian College of Dental Surgeons and the Royal Australasian College of Surgeons.
The course is conducted either over one or two years, with block sessions requiring attendance at Westmead Hospital, together with assignments which are completed outside the block sessions. In this way, a dental practitioner enrolled in the programme is able to continue practice.
The block sessions need not be completed over one year, but must be completed within two years.     

Larsen's syndrome: anaesthetic implications. Six case reports

Six cases were examined to review the important anaesthetic implications of Larsen's syndrome. Potential problems arising in these patients are highlighted and emphasis placed on cervical spine and airway/respiratory management.     

Patients' desire for information about anaesthesia: Danish attitudes

Background : Patients' desire for information about anaesthesia has been examined in a number of Commonwealth countries but not in Scandinavia. A questionnaire was distributed to form a basis for giving Danish patients more appropriate preoperative information.
Methods : 201 preoperative patients in Denmark were asked to complete a questionnaire. The patients were divided into subgroups according to: age, gender, residential origin, ASA group, educational level, type of anaesthesia planned and number of previous anaesthetics.
Results : Patients from a city area required significantly more information than patients from a rural/urban area about pre-medication drugs, drips/catheters, pain/pain relief and complications. Men more than women preferred to know about dangerous complications. Information about pain /pain relief, duration of anaesthesia, and influence of anaesthesia on daily activities such as eating, drinking, mobilisation was given the highest priority, while unpleasant information such as about complications and needles was given the lowest priority. Meeting the anaesthetist and information about alternative methods of anaesthesia and premedication drugs were given only moderate priority. Ranking information in Denmark was significantly correlated with Scotland, Canada and Australia, despite profound differences in priority. More often than Danish patients, Australian patients felt they had right to know, and especially about complications.
Conclusion : Patients from a city area required more information than patients from a rural/urban area. Information about the influence on daily activities was preferred to unpleasant information. Ranking information in Denmark was correlated with a number of Commonwealth countries.