Allan M Cyna

Allan M Cyna
SA Pathology | IMVS

FRCA, FANZCA, PhD

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174
Publications
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Introduction
Skills and Expertise

Publications

Publications (174)
Article
A randomised trial published in the British Journal of Anaesthesia describes hypnosis compared with general anaesthesia in 60 children undergoing superficial surgery. We describe a definition of clinical hypnosis; the goals and conduct of hypnotic communication; and its potential as both an adjunct and, in suitable cases, alternative to traditional...
Article
(Anaesthesia. 2022;77(suppl 1):11–20. doi: 10.1111/anae.15601) Nocebo, sometimes recognized as the adverse counterpart to placebo, refers to an increased pain sensitivity related to a previous experience or communication that confers a negative expectation for the course of an intervention. These unfavorable responses potentially can be mitigated b...
Article
Recent evidence suggests that how anaesthesia information is presented may influence patient treatment outcomes. We conducted an observational study of anaesthetic‐based patient information leaflets across NHS Trusts in England for their nocebo terms vs. therapeutic terms, and how adverse effects were presented. In this study, ‘nocebo’ is wording t...
Article
Nocebo refers to non-pharmacological adverse effects of an intervention. Well-intended procedural warnings frequently function as a nocebo. Both nocebo and placebo are integral to the generation of 'real' treatment effects and their associated 'real' side-effects. They are induced or exacerbated by: context; negative expectancy; and negative condit...
Article
Patient satisfaction is routinely used to assess quality of care in medicine. In the field of anesthesia, research has been primarily directed towards developing satisfaction measures in adults with little attention paid to the pediatric population. Satisfaction in pediatric anesthesia and perioperative care is poorly understood. We have identified...
Article
Background: Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of...
Article
Background: The tension between the ideal of informed consent and the reality of the process is under-investigated in spine surgery. Guidelines around consent imply a logical, plain-speaking process with a clear endpoint, agreement and signature yet surgeons' surveys and patient interviews suggest that surgeons' explanation is anecdotally variable...
Article
Background In 2017, a South Australia Perinatal Practice Guideline was introduced state-wide for the use of subcutaneous fentanyl for labour analgesia as a replacement for intramuscular pethidine. We retrospectively reviewed the implementation of this practice change in our institution. Methods A retrospective review of maternal and neonatal case...
Article
Background Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of s...
Article
Background: Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. It can be associated with nausea or vomiting and may pose serious risks to the mother (unconsciousness, pulmonary aspiration) and baby (hypoxia, acidosis, neurological injury). Objectives: To assess the effects of prophylactic interven...
Article
Anaesthetists are key members of teams caring for burn-injured children in almost every aspect of their management. Their role can involve initial resuscitation, intensive care, analgesia, and anaesthesia for multiple procedures both acutely and subsequently for scar management. As key members of burns management teams, effective communication with...
Article
Full-text available
Introduction This study aimed to identify the way information is described and presented by childbirth educators during antenatal classes for expectant parents, and analyse the language structures used when discussing labour and birth. Methods This cross-sectional study of antenatal education was conducted at a single tertiary referral centre for...
Article
At April 2020, this review has been withdrawn. It is correct at the date of publication, and previous versions can be accessed in the 'Other versions' tab on the Cochrane Library. We are aware of new studies to potentially change the conclusions, however the update did not meet the timelines and expectations of Cochrane and the PaPaS review group.
Article
Background: The effect that the route of maternal fentanyl administration has on placental transfer of drug to the neonate is not well studied. Plasma concentration ratios are an indicator of fetal exposure, relative to the mother. Method: A cohort study (n=30) was conducted to measure fentanyl concentrations in maternal plasma, and arterial and...
Article
Background: Single-shot spinal anaesthesia (SSS) and combined spinal-epidural (CSE) anaesthesia are both commonly used for caesarean section anaesthesia. Spinals offer technical simplicity and rapid onset of nerve blockade which can be associated with hypotension. CSE anaesthesia allows for more gradual onset and also prolongation of the anaesthes...
Article
Research on the nocebo effect has shown that some words can hurt. Pain is defined as ‘unpleasant’ and ‘associated with actual or potential tissue damage’. So, a sensation described as ‘pain’ may function as a negative suggestion or nocebo communication. This can lead to pain being experienced or exacerbated where it would not have been otherwise. T...
Article
This article describes two common hypnotic communication techniques that can be used in anesthesiology and more generally for a variety of medical applications. First, the LAURS (listening, acceptance, utilization, reframing, suggestion) hypnotic communication structure is detailed. This technique allows clinicians to rapidly build patient rapport...
Article
Background: Clinical indicators are powerful tools to quantify the safety and quality of patient care. Their validity is often unclear and definitions extremely heterogeneous. As part of the International Standardised Endpoints in Perioperative Medicine (StEP) initiative, this study aimed to derive a set of standardised and valid clinical outcome...
Article
Background: Perioperative infection and sepsis are of fundamental concern to perioperative clinicians. However, standardised endpoints are either poorly defined or not routinely implemented. The Standardised Endpoints in Perioperative Medicine (StEP) initiative was established to derive a set of standardised endpoints for use in perioperative clin...
Article
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess epidural catheter replacement and intrathecal catheter insertion techniques, in preventing post-dural puncture headache, following inadvertent dural puncture during attempted insertion of an epidural for labour analgesia.
Article
Background: Epidural analgesia is a central nerve block technique achieved by injection of a local anaesthetic close to the nerves that transmit pain, and is widely used as a form of pain relief in labour. However, there are concerns about unintended adverse effects on the mother and infant. This is an update of an existing Cochrane Review (Epidur...
Chapter
Full-text available
Editorial. La maternité se doit d’être joie et bonheur. Pourtant difficultés et souffrances peuvent survenir. C’est là que l’accompagnement par l’hypnose déploie son potentiel. Dans ce dossier thématique, des soignants, sage-femme, obstétricienne, psychologue et anesthésiste, partagent leurs expériences dans l’accompagnement des femmes avant, penda...
Article
Background: The Standardising Endpoints for Perioperative Medicine group was established to derive an appropriate set of endpoints for use in clinical trials related to anaesthesia and perioperative medicine. Anaesthetic or analgesic technique during cancer surgery with curative intent may influence the risk of recurrence or metastasis. However, g...
Article
Objective: This research examined whether negative and positive arousal emotions modify the relationship between experience level and cue utilization among anesthetists. Background: The capacity of a practitioner to form precise associations between clusters of features (e.g., symptoms) and events (e.g., diagnosis) and then act on them is known...
Article
Background: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. Methods: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO...
Article
Background: Maximising patient comfort during and after surgery is a primary concern of anaesthetists and other perioperative clinicians, but objective measures of what constitutes patient comfort in the perioperative period remain poorly defined. The Standardised Endpoints in Perioperative Medicine initiative was established to derive a set of st...
Article
Perineural (Tarlov) cysts are cerebrospinal fluid-containing perineural sacs that are usually located in the sacral spine. While often asymptomatic, they can cause progressive neurological symptoms including pain, paraesthesia and weakness. We present a case of a 24-year-old patient who had uneventful spinal anaesthesia at the L3-4 level for an ele...
Article
Drug errors amongst anaesthetists are common. Although there has been previous work on the system factors involved with drug error, there has been little research on the sequelae of a drug error from the anaesthetist's perspective. To clarify this issue, we surveyed anaesthetists regarding their most memorable drug error to identify associated fact...
Article
Full-text available
Background: Maternal hypotension is the most frequent complication of spinal anaesthesia for caesarean section. It can be associated with nausea or vomiting and may pose serious risks to the mother (unconsciousness, pulmonary aspiration) and baby (hypoxia, acidosis, neurological injury). Objectives: To assess the effects of prophylactic interven...
Article
Aims: To determine the prevalence of psychological distress in Australian Junior Medical Officers (JMOs) and investigate the determinants associated with psychological distress over a three year (2014-2016) period. Methods: JMOs were surveyed using the 2014-2016 JMO Census (n = 220, 399, and 466 each year, response rate approximately 15%). Level...
Chapter
Traditionally during training, clinicians focus upon gaining pharmacological knowledge and procedural and technological skills. This often leaves trainees failing to appreciate the effects of communication on patient perceptions and experiences and the power of communication to elicit positive therapeutic patient outcomes. Effective communication s...
Chapter
Communication is an essential skill required for a clinician to practice effectively. The impact of negative types of communication on patient outcome has been demonstrated. In particular, the use of warnings or negative suggestions are associated with increased pain and anxiety in patients having potentially painful procedures. It is rare to find...
Chapter
Hypnosis can be defined as an altered conscious state of focused attention which involves absorption, some dissociative elements, and an increased responsiveness to suggestion. Suggestions are verbal or non-verbal communications leading to subconscious changes in perception, mood, or behaviour. The main value of hypnosis as a technique in managing...
Article
( BJOG. 2015 Jun;122(7):983–992) Pethidine (meperidine) is the most commonly administered opioid for labor pain in women unable or unwilling to undergo epidural analgesia. It has a slow onset and the potential for adverse effects, due in part to the active metabolite norpethidine (normeperidine), which has been associated with neuronal depression i...
Chapter
Full-text available
Background: This review is one in a series of Cochrane reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. This review updates an earlier version of the review of the same title. Objectives: To examine the eff...
Article
Background: The impact of communication within the perioperative period is an area of increasing research interest. Suggestions are phrases or actions that can lead to subconscious nonvolitional changes in patient perception, mood, and/or behavior. Statements functioning as suggestions may induce positive or negative perceptual responses and exper...
Article
There is a wide range of practice amongst obstetric anaesthetists when obtaining consent for women requesting labour epidural analgesia. This is the first prospective observational study recording the number and types of risks mentioned and whether the risk was quantified. Statements of benefits and alternatives to the procedure were also noted. Fo...
Article
Background: Emergence agitation (EA) is a common behavioral disturbance after sevoflurane anesthesia in children. Propofol 1 mg · kg(-1) bolus at the end of sevoflurane anesthesia has had mixed results in reducing the incidence of EA, whereas propofol infusion throughout anesthesia maintenance seems effective but is more complex to administer. If...
Article
Objective To compare the efficacy of fentanyl administered via the subcutaneous (s.c.) or intranasal (i.n.) route with intramuscular (i.m.) pethidine in labouring women requesting analgesia.DesignA randomised controlled trial three-armed, parallel-design.SettingA regional hospital and the largest tertiary maternity centre in South Australia.SampleO...
Article
Objective To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Design Randomised controlled clinical trial, conducted from December 2005 to December 2010. Setting The largest tertiary referral centre for maternity care in South Australia. Population A cohort of 448 women at >34 weeks o...
Article
Background: Sevoflurane is an inhaled volatile anaesthetic that is widely used in paediatric anaesthetic practice. Since its introduction, postoperative behavioural disturbance known as emergence agitation (EA) or emergence delirium (ED) has been recognized as a problem that may occur during recovery from sevoflurane anaesthesia. For the purpose o...
Article
Women frequently request regional analgesia during labour, yet little is known about how long it takes before they become comfortable. This prospective observational study aimed to determine various time-points following maternal request for regional analgesia in labour until comfort was achieved. It was conducted in two tertiary referral centres f...
Article
Postoperative pain remains a significant problem following paediatric surgery. Premedication with a suitable agent may improve its management. Clonidine is an alpha-2 adrenergic agonist which has sedative, anxiolytic and analgesic properties. It may therefore be a useful premedication for reducing postoperative pain in children. To evaluate the evi...
Article
To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Randomised controlled clinical trial, conducted from December 2005 to December 2010. The largest tertiary referral centre for maternity care in South Australia. A cohort of 448 women at >34 weeks of gestation, with a singleton pregna...
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Full-text available
We investigated the incidence of and risk factors for persistent pain after caesarean delivery. Over a 12-month period, women having caesarean delivery were recruited prospectively at an Australian tertiary referral centre. Demographic, anaesthetic and surgical data were collected and at 24 hour follow-up, women were assessed for immediate postoper...
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Full-text available
Background The use of negative words, such as 'sting' and 'pain', can increase patient pain and anxiety. We aimed to determine how pain scores compare with comfort scores and how the technique of pain assessment affects patient perceptions and experiences after operation.Methods After Caesarean section, 300 women were randomized before post-anaesth...
Article
This cross-sectional survey was designed to evaluate the current practice of anaesthetists in Australia and New Zealand with regard to aseptic technique and needle type during the performance of single-shot caudal blocks. Professional bodies suggest that full aseptic precautions be taken during the administration of caudal or epidural blocks. It ha...
Article
Full-text available
Background: This review is one in a series of Cochrane Reviews investigating pain management for childbirth. These reviews all contribute to an overview of systematic reviews of pain management for women in labour, and share a generic protocol. We examined the current evidence regarding the use of hypnosis for pain management during labour and chi...
Article
We investigated block heights that anaesthetists considered adequate for caesarean section to proceed under spinal anaesthesia. During 3 months, 15 obstetric anaesthetists recorded block height to touch, pinprick or cold when spinal anaesthesia was considered satisfactory for caesarean section to proceed. Median (IQR [range]) block height for touch...
Article
Detecting inadvertent dural puncture during labour epidural insertion can be difficult when using a loss of resistance to saline technique. Testing fluid for glucose that leaks from a Tuohy needle may confirm the presence of cerebrospinal fluid and infer inadvertent dural puncture. This study compared the glucose content of intrathecal fluid obtain...
Article
The SHAM (Serious Harm and Morbidity) scale was developed to categorise the severity of potential complications of placebo control interventions in the context of local anaesthesia research. A convenience sample of 43 anaesthetists used the SHAM scale to grade ten published randomised controlled trials investigating local anaesthesia nerve blocks....
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Full-text available
Objective: To compare the personal preferences of pregnant women, midwives and obstetricians regarding a range of physical, psychosocial and pharmacological methods of pain relief for childbirth. Method: Self-completed questionnaires were posted to a consecutive sample of 400 pregnant women booked-in to a large tertiary referral centre for mater...
Article
Review objectives The quantitative objective is to identify the effectiveness of intravenous iron administration on the correction of iron deficiency anaemia in the perioperative setting. More specifically, the objectives are to identify the effectiveness of iron infusion on the rate of red blood cell (RBC) transfusion and incidence of transfusion...
Article
Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. A convenience sampl...
Article
Evidence suggests that anaesthetists’ communication can affect patient experience. There is a lack of guidance for anaesthetists as to the optimal verbal communication to use during insertion of epidurals on the labour ward. We recorded the verbal communication used by 14 anaesthetists during the siting of epidural catheters in women on the labour...
Article
Placebo controls are frequently used to 'blind' participants, trial personnel and outcome assessors to intervention and control in clinical trials. Effective blinding of treatment reduces the risk of performance bias (differences between groups in the care provided apart from the intervention being evaluated) and detection bias (differences between...
Article
Hypnosis can be a useful therapeutic adjunct to pharmacological analgesia or anaesthesia in obstetrics. However, it is rarely considered a primary anaesthetic technique and is seldom employed in the acute surgical setting. Few obstetricians and anaesthetists currently utilise this technique in their clinical practice. We present a case report of a...
Article
Placebos play a vital role in clinical research, but their invasive use in the context of local anaesthetic blocks is controversial. We assessed whether recently published randomised controlled trials of local anaesthetic blocks risked harming control group patients in contravention of the Declaration of Helsinki. We developed the 'SHAM' (Serious H...
Article
Background Induction of general anaesthesia can be distressing for children. Non‐pharmacological methods for reducing anxiety and improving co‐operation may avoid the adverse effects of preoperative sedation. Objectives To assess the effects of non‐pharmacological interventions in assisting induction of anaesthesia in children by reducing their an...
Article
These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for assisting the induction of anaesthesia in children. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006447. DOI: 10.1002/14651858.CD006447.pub2. Further i...
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Full-text available
Negative or harsh words such as 'pain' and 'sting' used to describe sensations prior to potentially painful procedures have been shown to increase pain. We aimed to determine whether the reporting of pain and its severity is affected by the way it is assessed during anaesthesia follow-up after caesarean section. Following caesarean section, 232 wom...
Article
Background: The transversus abdominis plane (TAP) block is a peripheral nerve block which anaesthetises the abdominal wall. The increasing use of TAP block, as a form of pain relief after abdominal surgery warrants evaluation of its effectiveness as an adjunctive technique to routine care and, when compared with other analgesic techniques. Object...
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Full-text available
Suggestions are statements that evoke an image in the listener’s mind. They may be positive, evoking an image of peace and hope or a desirable mood and behaviour, or they may be negative, eliciting thoughts of pain and doom. Once mentioned, the suggestion is front and centre: ‘You probably even didn’t think of an endotracheal tube before we mention...
Article
This book provides anesthetists, intensivists and other critical care staff with a comprehensive resource that offers ways of improving communication in everyday clinical practice, and provides practical communication tools that can be used in difficult or unfamiliar circumstances. It demonstrates how communication can be structured to improve pati...
Article
Anaesthetists usually develop their communication skills through experience over many years of trial and error. Much angst can be avoided by learning some simple techniques that can facilitate interactions during the delivery of anaesthesia care. Caring for children from newborn to adolescence provides the anaesthetist with unique opportunities to...
Article
The perioperative period can be a life-changing event for many patients, the effects of which can be lifelong for better or worse. The anaesthetist’s communication at this time can have a profound impact on the care of their patients in the matter of both short-term cooperation and long-term perceptions of their hospital experience. Induction of an...
Article
Many of the communications commonly encountered in anaesthetic practice elicit subconscious responses, and, because this is so, they frequently go unrecognized. This form of communication involves verbal and non-verbal cues also known as suggestions that can elicit automatic changes in perception or behaviour. Much of this chapter is based on langu...
Article
Anaesthetic culture tends to view patients as physiological specimens to which pharmacological and technical procedures are applied and utilized to optimize various measurable parameters. However, this aspect is only one small part of a patient’s anaesthetic care. The medical model to which many anaesthetists still cling is very much a paternalisti...
Article
Needle phobia describes an anticipatory fear of needle insertion, and is a well-recognized clinical entity of particular relevance to the anaesthetist. It may affect up to 10 % of the general population, is more common in the young, and can prevent patients from seeking medical care by avoiding immunizations, necessary blood tests or hospital proce...
Article
Emergence delirium (ED) is of increasing interest since the introduction of short-acting volatiles such as sevoflurane. We compared the Pediatric Anesthesia Emergence Delirium (PAED), Watcha and Cravero scales for assessing the presence of ED in 117 of 118 consecutive children <18 years recovering from general anesthesia. The primary measure was th...
Article
Communication between patients and anaesthetists is being recognised as an increasingly important aspect of clinical care. Patients need to understand the nature and consequences of any proposed procedure prior to giving informed consent. In this regard, anaesthetists have a responsibility to provide adequate information about anaesthesia and relat...

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