Cadaveric dissection demonstrated the lumbar plexus to lie within the substance of psoas major, with the major branches of the lumbar plexus emerging into the psoas compartment adjacent to the L5 vertebra. Within psoas major, the lateral femoral cutaneous and femoral nerves were separated from the obturator nerve by a muscular fold in 36 of 60 plexuses. Anatomical variations were common, with the accessory obturator nerve being identified in 12 per cent of plexuses. All previously described lumbar plexus block approaches positioned the needle within close proximity to the lumbar plexus. Modifications to these approaches may increase efficacy and reduce complication rates.
Recent studies have indicated that despite stringent sterilization processes, the reusable silicone laryngeal mask airway (LMA) has the potential for disease transmission through residual biological debris. As a result, a polyvinyl chloride (PVC) disposable LMA has been introduced. This randomized trial involved 138 spontaneously ventilating adult patients who underwent elective surgery requiring airway management with an LMA to determine whether there is a clinical difference between the disposable Portex® LMA (PLMA) and the standard reusable LMA in terms of ease of insertion, intra-operative cuff pressures and postoperative incidence of sore throat. There was no significant difference in first attempt insertion success rates (79% vs 84%) or difference in the incidence of postoperative sore throat observed between the two groups. Cuff pressure increases with nitrous oxide anaesthesia were significantly larger with the reusable LMA. The disposable PLMA provided a suitable airway in spontaneously ventilating patients without the risk of disease transmission inherent in a reusable device.
Research into gene therapy and genetically modified organism (GMO) medicines is intensifying. Whilst there are only a small number of GMO medicines which have successfully reached registration, Australian hospital pharmacy departments may find themselves in a position where they are required to handle, prepare and dispense this emerging class of therapy in a clinical trial setting. This article explores current literature concerning the management of GMO medicines in a hospital setting. Currently, the bulk of GMO medicines employ the use of viral vectors to deliver therapeutic genetic material into patients. The use of biohazardous agents such as viral vectors presents a new set of safety risks to both patients and pharmacy staff. Pharmacists need to be aware of the safety risks surrounding the use of GMO medicines and implement procedures to handle these medicines safely. Further, pharmacists will need to be familiar with the Gene Technology Act 2000 in addition to the state and federal regulations governing the use of medicines in Australia.
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