British journal of anaesthesia
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Randomized Controlled Trial
Bispectral index-guided induction of general anaesthesia in patients undergoing major abdominal surgery using propofol or etomidate: a double-blind, randomized, clinical trial.
In a double-blind, randomized trial, we compared the haemodynamic effects of a bispectral index (BIS)-guided etomidate and propofol infusion for anaesthesia induction in patients undergoing major abdominal surgery. ⋯ Our study showed that the use of propofol resulted in less hypertension and tachycardia at and after intubation than etomidate. But even with the reduced doses given with the BIS-guided protocol, it often caused significant hypotension.
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Randomized Controlled Trial Multicenter Study
Challenging authority during a life-threatening crisis: the effect of operating theatre hierarchy.
Effective operating theatre (OT) communication is important for team function and patient safety. Status asymmetry between team members may contribute to communication breakdown and threaten patient safety. We investigated how hierarchy in the OT team influences an anaesthesia trainee's ability to challenge an unethical decision by a consultant anaesthetist in a simulated crisis scenario. ⋯ This study did not show a significant effect of OT team hierarchical structure on trainee's ability to challenge authority; however, the results are concerning. The challenges were suboptimal in quality and there was an alarming high rate of blood checking and administration in both groups. This may reflect lack of training in appropriately and effectively challenging authority within the formal curriculum with implications for patient safety.
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Pressure recording analytical method (PRAM) is a novel, arterial pulse contour-based method for measuring cardiac output (CO). Validation studies of PRAM in children are few, and have not assessed both absolute accuracy and ability to track changes in CO across a broad case mix. We aimed to compare CO as measured by PRAM with that using a transpulmonary dilution method in a cohort of critically ill children. ⋯ There is an unacceptably poor agreement between UD and PRAM. We do not recommend the use of PRAM for measuring CO in critically ill children with the current algorithm.