Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2010
The use of ProSeal laryngeal mask airway in caesarean section--experience in 3000 cases.
In this single biggest study to date of 3,000 women undergoing elective Caesarean section under general anaesthesia with the LMA ® ProSeal™, there was only one case of regurgitation, and no aspiration.
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Anaesth Intensive Care · Nov 2010
Can learning to sustain life be BASIC? Teaching for the initial management of the critically ill in Australia and New Zealand.
Commonly in Australia and New Zealand, initial intensive care support of critically ill patients is by non-intensive care trained medical and nursing staff Basic Assessment and Support in Intensive Care (BASIC) is an internationally run short course to assist practitioners to gain knowledge and skills to manage the early hours of critical illness. The aim of this study was to assess the performance and acceptance of the BASIC course as conducted in an Australian metropolitan teaching hospital and a major regional centre in New Zealand. Performance on pre- and post-course multiple choice examinations and the overall course assessment by all participants attending between 2005 and 2009 was analysed. ⋯ The post-course examination score was predicted by pre-course examination score (beta = 0.22, 95% confidence interval 0.17 to 0.27), nursing occupation, (beta = -3.96, 95% confidence interval -5.03 to -2.90) and the availability of a scenario-based simulation module (beta = 0.22, 95% confidence interval 0.17 to 0.27, R2 = 0.38, P < 0.001). Participants generally found they had learned a great deal from the program and that the course material was of an appropriate level. The BASIC course was found to be a positive learning experience for health care practitioners inexperienced in the management of the critically ill.
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Anaesth Intensive Care · Nov 2010
In situ simulation training for paediatric cardiorespiratory arrest: initial observations and identification of latent errors.
In response to a successful, although difficult resuscitation in one of our paediatric wards, we developed and implemented an educational program to improve the resuscitation skills, teamwork and safety climate in our multidisciplinary acute-care paediatric service. The program is ongoing and consists of didactic presentations, high-fidelity in situ simulation and facilitated debriefing to encourage reflective learning. The underlying goal, to provide this training to all staff over a two-year period, should be achieved by late 2011. ⋯ These included inconsistent leadership behaviours, inadequate delegation of areas of responsibility, failure to communicate problems during the execution of technical tasks (such as difficulty opening the resuscitation trolley) and failure to challenge inadequate or inappropriate therapy (such as poor chest expansion during bag-mask ventilation). In addition, we unexpectedly discovered seven latent errors in our clinical environment during the first nine months of course delivery. The most disturbing of these was that participants repeatedly struggled to identify and overcome the locking-mechanism and tamper-proof device on a newly introduced resuscitation trolley.
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Anaesth Intensive Care · Nov 2010
Comparative StudyA comparison of electronic and handwritten anaesthetic records for completeness of information.
Complete documentation in anaesthetic records is important for patient management, research and quality assurance and has medicolegal implications. This study compares the completeness of information contained in electronic versus handwritten intraoperative anaesthetic records. A sample of 70 handwritten records was randomly selected from anaesthesia performed in the month prior to implementation of the Integrated Injectable Drug Administration and Automated Anaesthesia Record System and compared to a similar sample of electronic records generated eight months later. ⋯ There was no overall difference in the completeness of electronic versus handwritten records. Several differences did exist however, highlighting both clinically important advantages and deficiencies in the electronic system. Records from both systems sometimes lacked important information.