Anaesthesia and intensive care
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Anaesth Intensive Care · Mar 2008
Adverse physiological events under anaesthesia and sedation: a pilot audit of electronic patient records.
Review of perioperative activity including adverse events, throughput and compliance with 'best practice', can theoretically be used to optimise healthcare delivery. Computer-based analysis of electronic patient records could provide a practical means to manage quality improvement. This pilot study examined the effectiveness of such a system in practice. ⋯ The adverse event incidence during colonoscopy and laryngospasm/hypoxia during desflurane anaesthesia was 6.3% and 1.3% respectively. This decreased to 2.8% (P <0.005) and 0.13% (P <0.0001) respectively for the nine months following feedback and the introduction of guidelines. Anaesthesia information systems can be an effective quality improvement tool and may enhance existing tools such as incident reporting systems.
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The history of the development of humidifiers as a necessary accompaniment to mechanical ventilation is a fascinating one. In New Zealand in the 1960s, Fisher and Paykel, an established importer of a variety of household appliances, launched into the design and manufacture of humidifiers following the requirements envisaged at that time, for optimal use in the intensive care setting. This was a completely new venture for the company and led to the establishment of a separate Fisher and Paykel Health Care company for medical equipment manufacture, which has continued successfully to the present day.
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Anaesth Intensive Care · Jan 2008
The influence of passive leg elevation on the cross-sectional area of the internal jugular vein and the subclavian vein in awake adults.
The aim of this study was to evaluate the influence of passive leg elevation and Trendelenburg position on the cross-sectional area (CSA) of the internal jugular (II) and subclavian veins (SCV). Ultrasound imaging was used for the following measurements of both the IJV and SCV baseline in the supine position (control); Trendelenburg position 15 degrees; reverse Trendelenburg position 15 degrees and passive leg elevation 50 degrees. Twenty healthy male volunteers were studied. ⋯ Mean CSA of the SCV was 0.92 +/- 0.23 cm2 in control, 0.98 +/- 0.17 cm2 in the Trendelenburg position, 0.86 +/- 0.21 cm2 in the reverse Trendelenburg position and 0.93 +/- 0.18 cm2 during passive leg elevation. The results indicate that passive leg elevation increases the CSA of the IJV, but has little effect on the SCV. The CSA of the IJV appears to be influenced more by gravitational factors than the SCV.
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Anaesth Intensive Care · Jul 2008
Anaesthesia trainees' exposure to airway management in an Australian tertiary adult teaching hospital.
The purpose of this study was to estimate the exposure of trainees to airway management techniques in an Australian tertiary adult teaching hospital. Anaesthesia records for all patients over a 20-week period were reviewed and the following data were obtained: the presence of a trainee, the type of airway used, the grade of the laryngoscopic view and the use of non-standard laryngoscopy for intubation. Data was recorded contemporaneously and analysed retrospectively. ⋯ As there is no previous study to determine experience gained by trainees, we are unable to establish whether there has been a decrease in experience, however we believe this is likely. Although competency is difficult to assess, it may be that this data has implications for training, unsupervised practice and rostering. Experience in certain airway skills may need to be supplemented using techniques such as simulation.