ANAESTHES IA
of transmission both during intubation and extubation. Growing evidence shows that COVID-19 infection can occur from airborne exposure to the virus.8 Regional anaesthesia, which is not aerosol-generating, thus mitigates the risks associated with Aerosol Generating Procedures (AGP’s), which result in the release of airborne particles (aerosols) from the respiratory tract and could therefore pose a threat if the patient is suffering from the disease. The Royal College of Anaesthetists and Association of Anaesthetists further advised the use of local or regional anaesthesia where practicable and safe to help reduce the demand for key drugs required during the critical care of COVID-19 patients.9 Earlier last year there were reports of anaesthetic medicines being in short supply, with a bid for clinicians to use alternatives.10 As regional anaesthesia numbs only a small part of the body, sedation requires only small amounts of anaesthetic drugs.11 Safira is intended to enhance current regional anaesthesia practice thus mitigating many of these risks. The device is just as relevant in a COVID environment as it is in a non-COVID environment, Dr. Carter concludes: “The technology allows a single operator, to conduct the whole regional block. In a world where social distancing has fast become the norm, this has huge safety implications, minimising the potential points of contact and thus helping to reduce the risks of transmission of COVID-19.”
How the device works
The technology consists of three components: a sterile syringe, a driver and a foot pedal. The driver and foot pedal will complete up to 200 blocks before they need replacing, while the syringe is single use sterile. An alternative operating option is in development to cater for
procedure safer, but it also has a potential economic value, helping to reduce the cost of regional anaesthesia.”
CSJ
References 1. Fong-Soe-Khioe R. Health Economic report Medovate commissioned written by a health economist from the University of East Anglia (UEA)
2. Health Enterprise East (HEE): Research results using a cohort of volunteer anaesthetists
3. Borgeat A, Blumenthal S. Nerve injury and regional anaesthesia [Internet]. Vol. 17, Current Opinion in Anaesthesiology. 2004 [cited 2020 Mar 31]. p.417–21. Available from:
http://www.ncbi.nlm.nih. gov/pubmed/17023899
4. Important Complications of Anaesthesia. Information | Patient
5. Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. Br J Anaesth [Internet]. 2010 [cited 2020 Mar 31];105(S1):97–107. Available from:
https://academic.oup.com/bja/ article-abstract/105/suppl_1/i97/235950
Safira is CE Marked and has FDA approval12
clinician preferences. It is easily assembled and allows the anaesthetist to hold the block needle in one hand, the ultrasound probe in the other, while they control the aspiration and injection themselves using the foot pedal operator. The device will not allow the injection to proceed if the pressure within the syringe goes above a certain threshold level and will automatically stop injection. The anaesthetist can then make necessary checks and adjustments as required, such as needle placement, before easily resetting the Safira system and continuing with the block. Dr. Emad Fawzy adds: “Safira is the first device that makes the procedure suitable for a single operator. It gives the anaesthetist total control over the procedure, avoiding all the communication issues between the anaesthetist and the assistant. For hospitals, it’s not just a device that makes the
6. Heij R, Eldin E, Young P, Carter J, Gibson J, Ali A, et al. Regional Anesthesiology Injection Pressures comparing Skilled Assistants with SAFIRA in a Simulated Ultrasound Guided Technique. In: The Anesthesiology annual meeting [Internet]. 2013 [cited 2020 Mar 31]. Available from: http://www.
asaabstracts.com/strands/asaabstracts/abstract. htm?year=2013&index=17&absnum=3085
7.
https://www.asra.com/page/2905/practice- recommendations-on-neuraxial-anesthesia-and- peripheral-nerve-blocks-dur
8.
https://www.thelancet.com/journals/lanres/article/ PIIS2213-2600(20)30514-2/fulltext
9.
https://icmanaesthesiacovid-19.org/drug-demand- supply-anaesthetic-drug-usage-and-administration
10.
https://www.bbc.co.uk/news/health-52150861 11.
https://www.rcoa.ac.uk/documents/anaesthesia- explained/types-anaesthesia
12. Safira was launched in the US in early 2020, through distribution deals with five US-based companies, including Mercury Medical. It is also available through Vygon in the UK and Europe, as well as other distributors in Australia.
Concerns raised over accidental awareness during C-section
Although accidental awareness during general anaesthesia is rare, and reported experiences have usually only lasted for a few seconds or minutes, the complication remains an important concern for both patients and anaesthetists. A new study published in Anaesthesia shows that 1 in 256 women undergoing pregnancy-related surgery, including Caesarean section, under general anaesthesia experienced awareness – a figure much higher than reported before. A recent national audit into accidental awareness (NAP5) indicated that approximately 1 in every 19,000
patients undergoing general anaesthesia spontaneously reported accidental awareness to medical staff. Although this incidence varied for different types of surgery and patient subgroups, the infrequency of reports was reassuring. Dr. Peter Odor, project lead and consultant anaesthetist at University College Hospital in London, explained: “We identified a complex range of risk factors for awareness, including drug types and variations in practice. Although the incidence of awareness during Caesarean section is much higher than that in the
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general surgical population, it is important to emphasise that general anaesthesia remains safe and around half the patients that experienced awareness did not find it distressing.”
The researchers found an association
with certain anaesthetic drugs (thiopentone) and muscle relaxants. Factors such as emergency operations out-of-hours (late at night) were also associated with awareness. To access the full paper visit: https:// associationofanaesthetists-publications.
onlinelibrary.wiley.com/doi/10.1111/ anae.15385
MARCH 2021
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