Anaesthesia
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Multicenter Study
Availability of lipid emulsion in obstetric anaesthesia in the UK: a national questionnaire survey.
There is evidence that administration of lipid emulsion improves outcome in cardiovascular collapse secondary to local anaesthetic toxicity. We sent a questionnaire to the lead consultant anaesthetist in every consultant-led labour ward in the UK asking about local guidelines for treatment of cardiac arrest, and whether or nor lipid emulsion was available on the labour ward and included in the guideline. We received replies from 195 (86%) labour wards. ⋯ Of the 95 labour wards where lipid emulsion was readily available, 80 (84%) had a recommended dose regimen for its administration. Around three-quarters of labour wards in the UK either have lipid emulsion available or plan to obtain it. This uptake should ideally be 100%.
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Randomized Controlled Trial
Retention of drug administration skills after intensive teaching.
We have identified deficiencies in medical students' drug administration skills, and we attempted to address them with interactive online teaching modules and simulated critical incident scenarios. Short-term improvements have been evident with this intensive effort, but medium-term retention of skills has not been measured. A drug administration lecture, an online module and a simulated emergency scenario were offered to final year clinical students. ⋯ Participation in the simulated scenario only significantly improved examination scores when supplemented by online teaching (p = 0.002). Intensive drug administration teaching using an online module and high fidelity simulation improves drug administration skills in the medium term. Students found simulation much more engaging than online teaching.
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We investigated the in vitro performance of the CeVOX system for continuous monitoring of central venous oxygen saturation by spectrophotometry (Pulsion Medical Systems, Munich, Germany). Oxygen inflow into the system was varied, and oxygen saturation values measured by CeVOX were documented. Blood samples were simultaneously taken to assess oxygen saturation by co-oximetry, and values were compared by Bland-Altman analysis. ⋯ Saturation measured by CeVOX underestimated that measured by co-oximetry at higher oxygen concentrations and overestimated it at lower oxygen concentrations. There was a nearly linear correlation of the mean bias, suggesting a systematic error. We conclude that the current version of the CeVOX system does not reliably reflect oxygen saturation.
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Delayed emergence from anaesthesia and neurological disturbances have been reported in patients undergoing parathyroidectomy who received methylene blue (MB) pre-operatively. We hypothesised that MB would decrease propofol requirements. The Bispectral index (BIS) and a target-controlled infusion of propofol were used in two groups of 11 matched patients. ⋯ During induction, clinical sedation scores and BIS values were significantly lower at the predicted effect-site propofol concentration of 2 microg x ml(-1) in the MB compared with the control group. Intra-operatively, although similar BIS values were achieved in the two groups, patients pretreated with MB required a mean 50% lower dose of propofol compared with controls. In view of these findings, care should be taken to ensure an adequate depth of anaesthesia by titrating the administration of anaesthetic agents whenever MB is infused peri-operatively.
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Review Case Reports
Subarachnoid haematoma after spinal anaesthesia mimicking transient radicular irritation: a case report and review.
I report a patient with a spinal subarachnoid haematoma after difficult spinal anaesthesia who presented with symptoms of radicular irritation, and who recovered with conservative management. Subarachnoid haematoma is rare after spinal anaesthesia; a literature review found nine cases. ⋯ Other risk factors included antiplatelet and anticoagulant therapy, and direct spinal cord trauma. All the previous cases required decompressive laminectomy.