Anaesthesia
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A postal survey of arterial blood sampling practices in 280 intensive care units throughout England and Wales found that very few measures are taken to reduce diagnostic blood loss in adult intensive care patients from arterial sampling. The average volume of blood withdrawn to clear the arterial line before sampling is 3.2 ml; subsequently returned to the patient in only 18.4% of intensive care units. ⋯ In paediatric units, the average volume withdrawn was 1.9 ml and this was routinely returned in 67% of units. Some aspects of arterial blood sampling practices identified in this survey may contribute to iatrogenic anaemia in intensive care patients.
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Comparative Study
Arterial flow waveforms from pulse oximetry compared with measured Doppler flow waveforms apparatus.
This study compared derived arterial flow waveforms, extracted from pulse oximeter waveforms, with Doppler flow waveforms. Fingertip pulse oximeter waveforms and radial artery Doppler flow waveforms were measured simultaneously in volunteers. The pulse oximeter waveforms were processed to extract the arterial flow waveforms and these were compared with the measured Doppler waveforms. They were very similar.
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Compared with the Henderson-Hasselbalch approach, the Stewart approach may better describe the mechanisms of acid-base physiology and disorders. We prospectively examined the acid-base disorders of 100 routine blood samples from critically ill patients using Stewart's physical chemistry analysis. The median results were pH 7.45, PaCO2 5.5 kPa, bicarbonate 27.2 mmol.l-1 and base excess 3 mmol.l-1. ⋯ The median reference total weak-acid concentration was 11.1 mmol.l-1. The measured median total weak-acid concentration was 6.8 mmol.l-1. From Stewart's approach, the most likely explanation for the overall alkalosis was decreased total weak-acid concentration resulting from decreased plasma albumin concentration.
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Royal College of Anaesthetists Tutors have a key role in the delivery of postgraduate anaesthetic training in the UK. We report the results of a postal questionnaire sent to all College Tutors in April 2000. An 89% response rate (253 of 283 Tutors) was received. ⋯ In addition, a proportion had other administrative duties. The average time spent on College Tutor duties was 1.6 notional half days. Almost two-thirds of Tutors received some resources (time or remuneration) for their duties.