Anaesthesia and intensive care
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Anaesth Intensive Care · May 2013
Has the middle-level anaesthesia manpower training program of the West African College of Surgeons fulfilled its objectives?
An audit of the West African College of Surgeons' middle-level Diploma in Anaesthesia program was carried out to determine the current status of the diplomates. Using the West African College of Surgeons' database, social media and personal communications, the current status of Diploma in Anaesthesia graduates spanning 20 years was determined. A total of 303 (97%) out of 311 of graduates were traced. ⋯ The program did not appear to have achieved the objectives of meeting rural middle-level manpower needs in anaesthesia as envisaged. It has, however, boosted the recruitment drive for residency training in anaesthesia. Perhaps a less migrant cadre such as nurses may better serve this function if recruited into a suitably designed training program in countries desiring to use middle-level manpower in anaesthesia.
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Anaesth Intensive Care · May 2013
Primary anaesthetic deaths in Western Australia from 1985-2008: causation and preventability.
This paper reports on the causes and preventability of primary anaesthetic deaths in Western Australia between 1985 and 2008. In Western Australia, it is a legal requirement to report all deaths that occur within 48 hours of an anaesthetic and later deaths if an anaesthetic complication is implicated. A committee assesses whether an anaesthetic factor caused the death (a primary anaesthetic death) or contributed to the death (an anaesthesia-related death). ⋯ In the second 12-year period, there were fewer deaths overall (15 vs 38), proportionately fewer deaths related to failure to oxygenate (one vs six) and proportionately more deaths related to aspiration of gastric contents (four vs two). However, the percentage of deaths considered preventable was similar. These findings can be used to advise patients on anaesthetic risks, to educate anaesthetists about preventable deaths and to encourage the development of even safer anaesthetic drugs and techniques.
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Anaesth Intensive Care · May 2013
Randomized Controlled TrialEffects of dexmedetomidine infusion on laryngeal mask airway removal and postoperative recovery in children anaesthetised with sevoflurane.
We investigated the effects of dexmedetomidine infusion on the end-tidal concentration of sevoflurane required for smooth removal of the laryngeal mask airway (LMA) and on the incidence of respiratory complications during postoperative recovery in paediatric patients anaesthetised with sevoflurane. Eighty-seven patients (ASA 1 or 2, aged 3-7 years) were randomly allocated to receive saline (Group C), 0.5 µg/kg dexmedetomidine (Group D(1)), or 1 µg/kg dexmedetomidine (Group D(2)) after LMA insertion. A predetermined end-tidal sevoflurane concentration for each patient was determined using the Dixon's up-and-down method (starting at 2.2% and step was 0.2%). ⋯ The incidence of breath-holding was significantly lower in Group D(2) (3%) than in Group C (27%; P=0.009), but comparable between Groups D(1) (17%) and C (P=0.385). The incidence of severe coughing was significantly lower in Groups D(1) (14%) and D(2) (6%) as compared to Group C (39%; P=0.005), but comparable between Groups D(1) and D(2) (P=0.323). In conclusion, dexmedetomidine infusion produced a dose-dependent decrease in the end-tidal concentration of sevoflurane required for smooth LMA removal in children and was associated less agitation in the post-anaesthetic care unit.