British journal of anaesthesia
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We describe the use of the continuous wave oesophageal Doppler monitor (ODM II) in the perioperative management of a patient with chronic obstructive coronary artery disease undergoing transmyocardial revascularization (TMR). The use of ODM II allowed both quantitative and qualitative assessment of cardiac function relatively noninvasively. It detected the successful transmyocardial penetration of a laser beam during operation by visual and auditory phenomena in addition to reflecting improvement in cardiac performance after operation.
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Eleven anaesthetists completed a simulated anaesthetic which was deliberately complicated by a slow progressive bradycardia followed by an episode of severe bronchospasm. After the simulation, each anaesthetist was asked to complete an anaesthetic chart and a critical incident report. Considerable discrepancies were found between the anaesthetists' written accounts, a videotape of their performance and actual data from the simulator. ⋯ Only four anaesthetists mentioned bradycardia in their written description and none accurately described the changes in arterial pressure during the episode of bronchospasm. The findings are in keeping with other studies which suggest that people record events as "schemata" rather than as collections of discrete facts. These results have significant implications for those involved in the teaching of anaesthesia and in the analysis of critical incidents.