Anaesthesia
-
Over recent years there has been an increase in the implementation of goal-directed therapy using minimally invasive haemodynamic monitoring techniques to guide peri-operative care. Since the introduction of the pulmonary artery flotation catheter in the 1980s, various haemodynamic monitors have been developed, each associated with their own benefits and limitations. Goal-directed therapy has been well-established as a standard of care in the peri-operative period and has largely been associated with a reduction in morbidity and mortality. ⋯ We should therefore not look at the effects of goal-directed therapy in isolation but as part of a progressive care bundle. Additionally, other markers of haemodynamic status have also begun to be further appreciated and these are worthy of further investigation. We feel that the future for haemodynamic monitoring remains promising with new areas of interest continuously emerging, but further research is still required.
-
Review
Monitoring the anaesthetist in the operating theatre - professional competence and patient safety.
This article about competence and patient safety in anaesthesia was inspired by a statement in the 2015 AAGBI guidelines on monitoring during anaesthesia: 'the presence of an appropriately trained and experienced anaesthetist is important for patient safety during anaesthesia'. The review starts with a structured description of competence, presenting five dimensions of it; the first two dimensions are identical with the two classical attributes of competence, practical skills and theoretical knowledge. Concerning skills, the value of aiming for a high level of proficiency early in a traning programme is pointed out, and deliberate practice is given as an example of a pedagogical model where aiming for excellence is a core idea. ⋯ Intuitive expert knowing, lastly, concerns the tacit dimension of knowledge and skills, which enables professional experts to quickly find a working solution for most clinical problems. The final part of the review is about the 'when' and 'how' of competence assessment. The main message is the importance of assessing the competence of clinically active anaesthetists regularly during their whole career.
-
A narrative review was carried out to identify articles on monitoring of teamwork, with particular relevance to anaesthetists. The papers reviewed showed that team monitoring takes place both implicitly and explicitly in the anaesthetic environment. ⋯ Information shared during a formal briefing is more likely to be recalled, and provides a basis for a shared team mental model. A number of studies appeared to show that targeted teamwork training has a positive impact on both teamwork and patient safety.
-
Measurement allows us to quantify various parameters and variables in natural systems. In addition, by measuring the effect by which a perturbation of one part of the system influences the system as a whole, insights into the functional mechanisms of the system can be inferred. ⋯ What is often more important is the description of trends in measured variables. In this article, we give some examples - focussed around oxygen sensors - of how new sensors can make important measurements and might in the future contribute to improved clinical management.
-
Monitors using near-infra red spectroscopy to assess cerebral oxygenation levels non-invasively in discrete areas of the brain have been used clinically for over 20 years. Interest has intensified recently, especially during cardiac surgery, and there are now five commercially available devices. Despite the attraction of being able to measure oxygen supply/demand in such a critical area, there has been only limited uptake of this technology in overall clinical anaesthetic practice. This narrative review aims to explore not only the rationale for using this technology but also the factors which have restricted its more widespread use.