Anaesthesia
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Percutaneous tracheostomy is used primarily to assist weaning from mechanical ventilation in the intensive care unit. We report our experiences of 800 such procedures performed in the intensive care unit by a collaborative team (critical care and ENT specialists). Most procedures (85.6%) were performed by residents supervised by the intensive care unit staff. ⋯ No deaths were directly related to percutaneous tracheostomy. The incidence of complications was greater in percutaneous tracheostomy performed by the residents during their initial five attempts compared to their later attempts (9.2% vs 2.6%, p < 0.05). The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure in daily care of intensive care unit patients.
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Bag-valve-mask ventilation is a key component of life support, but only one handheld resuscitator is designed to operate in contaminated or toxic atmospheres. Following Institutional Review Board approval we determined the efficacy of this device. Twenty anaesthetists ventilated a modified manikin, either with or without a combination filter attached to the resuscitator inlet. ⋯ The achieved maximum minute volumes ranged from 13.4 to 4 l x min(-1) in the controls and from 9.5 to 3 l x min(-1) in the filter group. The delay in refilling of the self-inflatable bag may have resulted in reduced achievable minute volumes. The range of the maximum minute volumes in both groups highlights the need for continuous bag-valve-mask ventilator training.
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The compatibility between spinal needles and their introducers varies between manufacturers and can significantly influence the usable length of the spinal needle available resulting in failure to locate CSF in larger patients. The usable length of 90-mm pencil point spinal needles from four manufacturers ranged from 68 to 79 mm when the needle was used in combination with its introducer. ⋯ Using this new introducer the usable needle length of a 90-mm Whitacre needle was increased by a further 7 to 86 mm resulting in only a 4 mm loss of total needle length. The new introducer was well received by users.