Anaesthesia
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We describe the use of a questionnaire to define the difficulties in providing anaesthesia in Uganda. The results show that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to deliver safe anaesthesia to a child and 6% to deliver safe anaesthesia for a Caesarean section. ⋯ Solutions require improvements in local management, finance and logistics, and action to ensure that the importance of anaesthesia within acute sector healthcare is fully recognised. Major investment in terms of personnel and equipment is required to modernise and improve the safety of anaesthesia for patients in Uganda.
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Nitrous oxide pollution is common in paediatric anaesthetic practice. A questionnaire was sent to all UK members of the Association of Paediatric Anaesthetists requesting details of three areas of their paediatric practice relating to nitrous oxide: attitudes to its use; current usage; and availability of alternatives. Replies were received from 296 (68%) consultants. ⋯ One hundred and fifty-eight (54%) considered theatre pollution a problem in paediatric anaesthesia. One hundred and sixty-nine (57%) reported that in normal circumstances potential deleterious effects on patients influenced their use of nitrous oxide, whilst only 70 (24%) felt potential effects on staff influenced usage. Fifty-five (18%) felt there should be some restriction in the availability of nitrous oxide.
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Summary The aim of this prospective observational study was to document patterns of ventilation during manual hyperinflation by physiotherapists. Manual hyperinflation with a Mapleson-F system was performed on the same patients on two consecutive days. Patterns of ventilation were recorded using a heated pneumotachometer, pressure transducer and custom designed data acquisition and analysis systems. ⋯ All the physiotherapists achieved an increase in volume which was delivered within a safe and effective pressure range and without cardiovascular compromise. Most (26 out of 34 sessions) performed the technique in the way recommended for enhancing secretion clearance. This is the first study to document comprehensively the pattern of ventilation during manual hyperinflation and provides the basis for further clinical trials evaluating its effectiveness for secretion clearance and volume restoration.