Abstract Aim We objectively re-assessed prescribing of analgesia for surgical admissions at Watford General Hospital, in accordance with Trust Guidelines Method Total of 117 Patients. We collected data prospectively in the 1st Cycle 21/09/2021 – 04/10/2021 and in the 2nd Cycle 04/01/2022 – 17/01/2022. Intervention was through virtual poster and daily reminders to on-call team Results & Conclusions When patients were prescribed analgesia, compliance to Analgesia Trust guidelines vastly improved from 50% to 79%. Most non-compliant prescriptions were prescribed more strong opioids excessively. Action Plan We plan to disseminate audit findings to clinical staff in acute services and provide Junior doctors a teaching session on guidelines
Currently, there is a worldwide pandemic of overweight and obesity. The consequences of obesity include noncommunicable diseases such as ischaemic heart disease, hypertension, stroke, diabetes mellitus, cancer, and premature death. Obesity is now treated as a disease. Bariatric surgery is the gold standard to treat obesity; however, pharmacological agents are now being widely adopted in the management of obesity. This only means that the number of persons on anti-obesity drugs is on the rise, and they can present for surgery, both bariatric and non-bariatric, and in the intensive care unit. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are currently the most widely prescribed drugs for diabetes mellitus and obesity, and newer drugs are coming up. The anaesthesiologist and intensivist managing these cases need to be aware of these drugs, their pharmacology, and how they can affect the anaesthetic management and perioperative outcomes. New guidelines for these medications have been released to guide clinical practice for anaesthesiologists. We conducted a literature search related to this topic using databases and search engines (Medical Literature Analysis and Retrieval System Online {MEDLINE}, Embase, Scopus, PubMed, and Google Scholar) using words such as ‘obesity,’ ‘GLP1-agonists,’ ‘semaglutide,’ ‘tirzepatide,’ ‘perioperative period,’ ‘adverse effects.’ The search revealed some systematic reviews, meta-analyses, original articles and case reports regarding the safety and efficacy of newer anti-obesity drugs and some interesting perioperative observations and clinical experiences related to their use in the surgical patient. We discuss in this narrative review the current widespread adoption of the new weight loss drugs and its implications in anaesthesia and critical care.
Abstract Background Analgesics are amongst the most commonly prescribed drugs within a hospital setting. Often prescribed based on clinical judgement and perceived pain, without formal evaluation. They are integral to patients comfort and experience. A study in 2008 showed that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief, while another study in 2010 showed that the average cost per patient for readmission due to pain was $1,869 (≈£1,571) per visit. Aim Methods Review of drug charts of all the neck of femur patients admitted from 04/10/2022 to 22/10/2022 (30 in total). Recorded patient pain score extracted from admission clerking. Results Conclusion Pain score tends not to be recorded at the time of admission and analgesia is prescribed based on clinical judgement. Therefore, a poster of new Trust guidelines for patients admitted with Neck of Femur Fractures (NOF) was circulated amongst Orthopaedics department and A&E in Watford General Hospital, United Kingdom.
Introduction: Patella fracture can occur due to direct injury to the knee or indirect eccentric contraction of the quadriceps tendon. These injuries can present in different configurations which require acceptable reduction and good fixation. Patients are at risk of not only losing their knee extensor mechanism but also having a defective patellofemoral articulation. Hence, the main aim in treating such fractures is to restore the knee extensor mechanism. Surgical options for treating patella fracture include tension band wiring, wiring through cannulated screws, fixation with plate, and suture anchor (SA) fixation. Case Report: We demonstrate a new fixation technique for patella fracture with SAs in two of our patients. They presented with patella fracture following a fall and sustained closed injury with intact distal neurovascular status. The authors describe their technique using double-loaded SAs to obtain anatomical reduction and solid fixation. With three SAs, each inserted in a third portion of a distal fragment. Conclusion: There are several modalities and techniques available for fixation of patella fracture. However, authors recommend that their described novel technique can provide more strength and satisfactory outcome. Furthermore, this technique uses a smaller incision compared to conventional suture tunnel repair as in this technique only the fracture that needs to be exposed distally. Keywords: Patella fracture, suture anchor, quadriceps tendon.
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