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Anaesthetic Practice (anaesthetic + practice)
Selected AbstractsIncrease in the use of rebreathing gas flow systems and in the utilization of low fresh gas flows in Finnish anaesthetic practice from 1995 to 2002ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2005H. Tohmo Background:, The use of rebreathing systems together with low fresh gas flows saves anaesthetic gases, reduces the costs of anaesthesia, causes less environmental and ergonomic adverse effects, i.e. less air contamination in the operating room, and has favourable physiological effects. We assessed whether the use of non-rebreathing vs. rebreathing gas flow systems and high vs. lower fresh gas flows has changed during recent years. Methods:, The use of rebreathing and non-rebreathing systems and the utilization of fresh gas flows were evaluated by sending a questionnaire to the heads of anaesthesia departments at all public health care hospitals in Finland in 1996 and 2003. The data was gathered from the previous years 1995 and 2002, respectively. Results:, The use of rebreathing systems increased from 62% to 83% of all instances of general anaesthesia (P < 0.001). In rebreathing gas flow systems, there was a significant shift from high fresh gas flows (3 l min,1 and more) towards lower fresh gas flows (between 1 to 2 l min,1 and even below 1 l min,1) (P < 0.001). Conclusions:, The benefits of low fresh gas flows have now been achieved in most instances of rebreathing system anaesthesia, which was not the case in 1995. [source] Cost estimates of spinal versus general anaesthesia for fractured neck of femur surgeryANAESTHESIA, Issue 8 2010A. Chakladar Summary It remains uncertain whether spinal anaesthesia is preferable to general anaesthesia for surgical repair of hip fracture, but one determining factor is the comparative cost. A detailed cost analysis relating to 20 consultants' intended anaesthetic practice (which provided information of consumables used) and data from the Brighton Hip Fracture Database was performed to quantify any difference in the costs of administering spinal versus general anaesthesia for patients with hip fracture. Although spinal anaesthesia took significantly longer to administer (mean (SD) time 31 (15) min vs 27 (16) min; p < 0.0001), the mean (SD) cost of spinal anaesthesia (£193.81 (37.49)) was significantly less than the cost of general anaesthesia (£270.58 (44.68); p < 0.0001). The mean percentage cost of anaesthesia was 3.8% of hospital income per hip fracture, and personnel contributed approximately 46% of this cost. While such considerations indicate that spinal anaesthesia is financially preferable, it is unknown whether differential clinical outcomes between regional and general anaesthesia may offset this apparent monetary advantage. [source] No simple fix for fixation errors: cognitive processes and their clinical applicationsANAESTHESIA, Issue 1 2010E. Fioratou Summary Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use ,insight problems' in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice. [source] A documented previous difficult tracheal intubation as a prognostic test for a subsequent difficult tracheal intubation in adultsANAESTHESIA, Issue 10 2009L. H. Lundstrøm Summary We investigated the diagnostic accuracy of a documented previous difficult tracheal intubation as a stand-alone test for predicting a subsequent difficult intubation. Our assessment included patients from the Danish Anaesthesia Database who were scheduled for tracheal intubation by direct laryngoscopy. We used a four-point scale to grade the tracheal intubation. A previous difficult intubation was defined according to the presence of a record documenting a difficult penultimate tracheal intubation-score for the 15 499 patients anaesthetised more than once. Our assessment demonstrates that a documented history of previous difficult or failed intubation using direct laryngoscopy are strong predictors of a subsequent difficult or failed intubation and may identify 30% of these patients. Although previous investigators have reported predictive values that exceed our findings markedly, a documented previous difficult or failed tracheal intubation appears in everyday anaesthetic practice to be a strong predictor of a subsequent difficult tracheal intubation. [source] Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995,2007ANAESTHESIA, Issue 7 2009T. M. Cook Summary The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, ,high risk' is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis. [source] The formulation and introduction of a ,can't intubate, can't ventilate' algorithm into clinical practiceANAESTHESIA, Issue 6 2009A. M. B. Heard Summary Both the American Society of Anesthesiologists and the Difficult Airway Society of the United Kingdom have published guidelines for the management of unanticipated difficult intubation. Both algorithms end with the ,can't intubate, can't ventilate' scenario. This eventuality is rare within elective anaesthetic practice with an estimated incidence of 0.01,2 in 10 000 cases, making the maintenance of skills and knowledge difficult. Over the last four years, the Department of Anaesthetics at the Royal Perth Hospital have developed a didactic airway training programme to ensure staff are appropriately trained to manage difficult and emergency airways. This article discusses our training programme, the evaluation of emergency airway techniques and subsequent development of a ,can't intubate, can't ventilate' algorithm. [source] Emergency cricothyroidotomy: equipment in anaesthetic practiceANAESTHESIA, Issue 4 2009R. Thistlethwaite No abstract is available for this article. [source] Remifentanil in paediatric anaesthetic practiceANAESTHESIA, Issue 3 2009D. F. Marsh Summary Remifentanil is a synthetic opioid, first introduced into clinical practice in 1996. Its unique pharmacokinetic profile has resulted in a gradual increase in its popularity in paediatric anaesthesia. It is an opioid of high potency and rapid clearance, consequently lacking problems of accumulation. These characteristics give it a high degree of predictability and it has become an attractive choice for a wide variety of anaesthetic challenges, from premature neonates to the elderly. Neonates and infants have a higher clearance than older children and, as a result, remifentanil has additional benefits in this group. Remifentanil can be described as the only consistently predictable opioid in paediatric practice. [source] The use of nitrous oxide in paediatric anaesthetic practice in the United Kingdom: a questionnaire survey,ANAESTHESIA, Issue 1 2007T. E. Sheraton Summary Nitrous oxide pollution is common in paediatric anaesthetic practice. A questionnaire was sent to all UK members of the Association of Paediatric Anaesthetists requesting details of three areas of their paediatric practice relating to nitrous oxide: attitudes to its use; current usage; and availability of alternatives. Replies were received from 296 (68%) consultants. Of these, 169 (57%) stated that their use of nitrous oxide had decreased over the last 5 years. One hundred and fifty-eight (54%) considered theatre pollution a problem in paediatric anaesthesia. One hundred and sixty-nine (57%) reported that in normal circumstances potential deleterious effects on patients influenced their use of nitrous oxide, whilst only 70 (24%) felt potential effects on staff influenced usage. Fifty-five (18%) felt there should be some restriction in the availability of nitrous oxide. [source] The use of nitrous oxide in anaesthetic practice: a second questionnaire surveyANAESTHESIA, Issue 3 2003K. A. Henderson No abstract is available for this article. [source] Hypertension and intra-operative incidents: a multicentre study of 125 000 surgical procedures in Swiss hospitals,ANAESTHESIA, Issue 5 2009K. Beyer Summary It is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetics since 1996. The focus was on cardiovascular incidents, though other anaesthesia-related incidents were also evaluated. Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% (95% CI 5.9,6.2%)). The average adjusted odds ratio of cardiovascular risk for chronic hypertension was 1.38 (95% CI 1.27,1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Hypertensive patients are still at risk of intra-operative cardiovascular incidents, while risk heterogeneity across hospitals, despite taking account of casemix and hospital characteristics, suggests variations in anaesthetic practices. [source] | ||||||||||