Anaesthesia
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Disposable bronchoscopes such as the Ambu aScopeTM 3 are marketed as 'single use' The risks of contamination from prolonged device storage before possible re-use are unknown. Following clinical bronchoscopy in patients whose lungs were mechanically ventilated, 20 aScopeTM 3's bronchoscopes received a standard 'social clean' and were then stored. Subsequent paired saline flush and swab samples were taken at time zero, and at 24 h and 48 h. ⋯ Our study demonstrates that aScopeTM 3's should not be re-used on the same patient, as clinically significant growth of micro-organisms occurs frequently, despite adequate social cleaning. Culture of bronchoscopes themselves may be a potentially useful diagnostic tool in the context of pulmonary infection. Our data make it clear that these devices are single use and not single patient use.
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Letter Practice Guideline
AAGBI: Consent for anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland.
Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.
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Observational Study
A prospective, cohort evaluation of major and minor airway management complications during routine anaesthetic care at an academic medical centre.
The aim of this study was to develop an audit tool to identify prospectively all peri-operative adverse events during airway management in a cost-effective and reproducible way. All patients at VU University Medical Center who required general anaesthesia for elective and emergency surgical procedures were included during a period of 8 weeks. Daily questionnaires and interviews were taken from anaesthesia trainees and anaesthetic department staff members. ⋯ There were 12 (0.42%) unanticipated ICU admissions, two patients (0.07%) required a surgical airway. There was one (0.04%) death, one cannot intubate cannot oxygenate (0.04%), one aspiration (0.04%) and eight (0.29%) severe desaturations < Sp O2 50%. We suggest that our method to determine and investigate airway management-related adverse events could be adopted by other hospitals.
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A large number of randomised trials authored by Yoshitaka Fujii have been retracted, in part as a consequence of a previous analysis finding a very low probability of random sampling. Dr Yuhji Saitoh co-authored 34 of those trials and he was corresponding author for eight of them. We found a number of additional randomised, controlled trials that included baseline data, with Saitoh as corresponding author, that Fujii did not co-author. ⋯ Comparison of graphs revealed multiple coincident or near-coincident curves across a large number of publications, a finding also inconsistent with random sampling. Combining the continuous and categorical probabilities of the 32 included trials, we found a very low likelihood of random sampling: p = 1.27 × 10-8 (1 in 100,000,000). The high probability of non-random sampling and the repetition of lines in multiple graphs suggest that further scrutiny of Saitoh's work is warranted.
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The ability to gently ventilate a patient's lungs using a self-inflating bag requires a properly working adjustable pressure-limiting (APL) valve. We compared the performance of the APL valves of the GE Aisys CS(2) and the Draeger Fabius anaesthetic machines during closure and opening from 1-20 and from 20-1 cmH2 O, using standardised experimental baby and adolescent patient lung models. Airway pressures and inspiratory tidal volumes were measured using an ASL-5000 test lung and a GE Aisys CS(2) near-patient spirometry sensors. ⋯ Airway pressures in the Draeger Fabius APL valves demonstrated a near linear increase and decrease. Airway pressure values measured in the Draeger Fabius were never higher than those set by the APL valves, whereas in the GE Aisys CS(2) , they considerably exceeded set pressures (by up to 27 cmH2 O). We conclude that the performance of the GE Aisys CS(2) APL valve does not allow safe bag-assisted ventilation of a patient's lungs.