Anaesthesia
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We report the occurrence of an accidental pleural puncture by an epidural catheter that happened during the attempted induction of thoracic epidural anaesthesia using a paramedian approach in an awake patient. The incorrect placement of the catheter was recognised while the patient was undergoing thoracoscopic surgery. The possibility of accidental pleural puncture during attempted thoracic epidural catheter placement by either the paramedian or the midline approach should be borne in mind. A misplaced catheter may injure lung tissue and result in a potentially dangerous intra-operative tension pneumothorax.
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Failed intubation associated with difficulty with ventilation is rare. Cricothyrotomy may provide a means of oxygenating the patient, but in practice it may be difficult to perform and does not establish a definitive airway. We report two patients in whom percutaneous tracheostomy was used as an emergency procedure. In both cases placement was extremely rapid and salvaged the situation, leaving a definitive airway.
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All senior house officer posts in the Yorkshire Deanery have been assessed against five parameters. Posts in anaesthesia were among the best with excellent consultant support, good exposure to clinical practice and well-structured education and training. ⋯ Appraisal is a new educational tool which is being used to a greater degree in anaesthetics than in any other specialty. The deficiencies found in anaesthetic posts could be corrected by the universal use of appraisal and solving the recruitment problems that have compromised the delivery of good training in some districts.