Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 2010
Case ReportsUltrasound-guided axillary plexus block in a child with dystrophic epidermolysis bullosa.
We report the use of ultrasound-guided axillary brachial plexus block in a child with dystrophic epidermolysis bullosa needing surgical treatment of the right hand. The regional anaesthesia was used in association with sedation/ anaesthesia. This technique is suitable for these difficult patients because it can minimise the risk of new bullae formation due to palpation of landmarks or unintentional intra- or subcutaneous injections. ⋯ This management plan provided good surgical conditions, early postoperative analgesia, minimised stress for the patient and avoided the need to manipulate the airway with instruments and the associated risk of mucosal bullae. The classification and breadth of clinical manifestation of epidermolysis bullosa is complex and briefly summarised. The anaesthetist should clarify the details of a particular patient's form of epidermolysis bullosa, especially in terms of mucosal involvement, as this may greatly influence planning for a procedure.
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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.
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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
Influence of leg position on the depth and sonographic appearance of the sciatic nerve in volunteers.
We investigated the effect of leg position on the depth of the sciatic nerve and quality of ultrasound images taken at the proximal and mid-thigh level. Twenty-one volunteers with average body mass index were recruited to represent the younger population receiving sciatic nerve blocks for sports injury surgery. The volunteers were placed in the lateral position, with the hip flexed and with the hip in a neutral (extended) position. ⋯ More clinicians favoured the proximal sciatic image with the leg in the neutral position. Although statistically significant, the depth difference is probably not a major clinical consideration in most patients with an average body mass index. We suggest clinicians place the leg in the most ergonomically favourable position when performing sciatic nerve blocks in the proximal thigh in these patients.
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Anaesth Intensive Care · Nov 2010
Vocal cords-carina distance in anaesthetised Caucasian adults and its clinical implications for tracheal intubation.
Previous work has assessed vocal cords-carina distance in Chinese patients and compared it to commonly used tracheal tubes. In addition, an attempt was made to identify surface anatomy measurements with short tracheas. We have examined the length of tracheas in Caucasian patients and compared it with currently used tracheal tubes. ⋯ The best predictors in our study of vocal cords-carina distance less than 11.3 cm were a height of < or = 182 cm, an ulnar length of < or = 31.2 cm or a thyroid to xiphisternum distance of < or = 31.8 cm. This correlation is poor however and prediction of vocal cords-carina distance remains difficult clinically. It was therefore concluded that surface anatomy measurements are a poor predictor of vocal cords-carina distance.