Anaesthesia
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The purpose of this investigation was the description of structure and process quality based on the analysis of 1612 fibreoptic intubations. We evaluated all fibreoptic intubations (nasotracheal in awake patients and orotracheal in anaesthetised patients) from a previously described database over a period of 2 years. We assessed structure quality by evaluating the distribution of the fibreoptic intubations across all staff anaesthetists, and process quality by analysing the number of attempts, the time required, the cases where we had to switch to conventional intubation and the complications. ⋯ Within 3 min, 93.9% of all fibreoptic intubations were successfully completed. In 24 cases, fibreoptic intubation was abandoned. Severe nasal bleeding as a major complication occurred in 1.3% of the nasotracheal intubations.
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Randomized Controlled Trial Clinical Trial
A new formulation of nasal fentanyl spray for postoperative analgesia: a pilot study.
Twenty-four gynaecological patients receiving postoperative patient-controlled analgesia were enrolled in an open cross-over pilot study evaluating two new formulations of nasal fentanyl spray. The primary outcome was the bioavailability of nasal fentanyl in comparison with intravenous fentanyl. This manuscript describes the clinical outcomes of quality of postoperative analgesia and patient acceptability. ⋯ There was no significant difference in side-effects. Four patients experienced mild nasal stinging and although 10 (42%) preferred intravenous administration, seven (29%) preferred intranasal and six (25%) had no preference. We conclude that these formulations of fentanyl, delivered as nasal spray, have potential clinical utility.
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Current professional guidelines concerning information and consent for anaesthesia are a fair representation of English law. However, they reject the need for specific, written consent for anaesthesia, a position which is in accordance with other Western jurisdictions. ⋯ However, for the very reason that there are a large number of risks associated with anaesthesia (risks that are unknown to the majority of surgeons), together with the possibility of the courts moving towards a reasonable patient standard of information disclosure (as a result of the introduction of human rights legislation into English law), it is our view that the Association of Anaesthetists of Great Britain and Ireland should change their guidelines and advise anaesthetists to obtain separate, written affirmation from patients that certain risks and consequences of anaesthesia have been explained to them. In addition, a standardised consent form for anaesthesia may prove invaluable in retrospectively defending a claim of negligence founded around information disclosure, by recording exactly the risks and consequences of interventions discussed by the anaesthetist and the patient.