Anaesthesia
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The Diamedica non-rebreathing valve has been developed for use in draw-over anaesthesia and can be positioned at the common gas outlet. Its performance was evaluated against the Laerdal, Ruben and Ambu valves under laboratory conditions. ⋯ To assess the effects of sterilisation, this procedure was repeated following autoclaving, after which the Diamedica valve exhibited resistance to flow of < 150 Pa at 25 l.min(-1) for inlet resistance and 35 l.min(-1) for outlet resistance. The Diamedica, Ambu and Laerdal valves demonstrated resistance of < 100 Pa when saturated with water, while the Ruben valve exhibited resistance > 500 Pa.
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The Gastro-Laryngeal Tube is a modification of the Laryngeal Tube that provides a dedicated channel for the insertion of a gastroscope. In this study of 30 patients undergoing general anaesthesia for endoscopic retrograde cholangiopancreatography, we evaluated both the effectiveness of airway management with a Gastro Laryngeal Tube and the feasibility of performing it using the endoscopic channel. ⋯ Mean (SD) inspiratory and expiratory tidal volumes were 336 (57) ml and 312 (72) ml, respectively, and oropharyngeal leak pressure was 33.7 (2) cmH(2)O. These data suggest that the Gastro Laryngeal Tube is an effective and secure device for airway management and for use during performance of endoscopic retrograde cholangiopancreatography.
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Neuromuscular blockade is a powerful anaesthetic tool that has the potential for significant adverse outcomes. We sought to explore the national picture by analysing incidents relating to neuromuscular blockade in anaesthesia from the National Reporting and Learning System from England and Wales between 2006 and 2008. ⋯ The main themes identified were: non-availability of drugs (45 incidents, 19%), possible unintentional awareness under general anaesthesia (42 incidents, 18%), potential allergic reaction (31 incidents, 13%), problems with reversal of blockade (13 incidents, 6%), storage (13 incidents, 6%) and prolonged apnoea (11 incidents, 5%). We make recommendations to reduce human error in the use of neuromuscular blocking agents and on future incident reporting in anaesthesia.
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Admission to an intensive care unit is a highly stressful event for both patients and their relatives. Feelings of anxiety, pain, fear and a sense of isolation are often reported by survivors of a critical illness, whilst the majority of relatives report symptoms of anxiety or depression while their relative was in the intensive care unit. Traditionally, infection control concerns and a belief that liberal visiting by patients' relatives interferes with the provision of patient care have led many units to impose restricted visiting policies. ⋯ In order to determine current visiting practice and provision for relatives within intensive care units, a questionnaire was sent to the principal nurse in all units within the United Kingdom. A total of 206 hospitals out of 271 completed the survey (76%). We found that 165 (80.1%) of responding units still impose restricted visiting policies, with wide variations in the facilities available to patients' relatives.
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Practice Guideline
Blood transfusion and the anaesthetist: management of massive haemorrhage.