Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Sep 2002
Appraisal and reassessment of the specialist in anaesthesia.
Appraisal and reassessment of the physician is an integral part of ensuring that 'quality of care' provided by the health care system is the best possible within the constraint of resources. Assessment tools used for initial certification at completion of medical school as a general physician and for initial certification as an anaesthesiologist are discussed. The expansion of core or general physician competencies to include behavioural, communication and evidence-based resource management skills in addition to knowledge and clinical skills is reviewed. ⋯ Examples of each level are given. Re-certification of anaesthesiologists currently occurs in two distinct ways: by examination and through continuing medical education. Details of each approach are included.
-
Education is a core activity of academic departments but pressure from universities to maximize research income and research productivity, and from hospitals to deliver a more efficient clinical service, has pushed the importance of education into third place in many departments. Academic departments of anaesthesia can make significant contributions to undergraduate teaching. Students appreciate the one-to-one teaching which they receive from anaesthetists and the range of practical skills which they can learn. ⋯ Teaching methods are changing, and there are opportunities to exploit e-learning on Intranet sites, and anaesthesia simulators, in both undergraduate and postgraduate education. Clinical governance issues and increasing scrutiny by authorities which fund teaching or set professional standards have resulted in demands for evidence that educational objectives are being met and that assessment systems are robust. There is a recognition that education has a cost, and resources are available from universities and hospitals to support the teaching activities of academic departments of anaesthesia.
-
Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSingle-injection applications for foot and ankle surgery.
Foot or ankle surgery is often performed in an ambulatory care setting. The post-operative pain that follows can be moderate to severe in intensity and difficult to control with oral analgesics. Regional anaesthetic techniques have been advocated for such procedures. ⋯ Patients can be safely discharged even when long-acting local anaesthetics are used. In major surgery a continuous technique can be proposed. When the prone position is impossible the lateral approach is an efficient alternative.
-
Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewThe Holy Grail: long-acting local anaesthetics and liposomes.
The ability to provide an extended duration of analgesia of days following a single injection without the need for catheters, pumps and infusion systems would be a great benefit in acute and chronic pain. Exciting progress is being made in our ability to combine local anaesthetics with liposomes and polymer microspheres. These interesting formulations in animal models have allowed up to 4 days of analgesia. Their use clinically will be a great advance which could possibly occur in the near future.
-
Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSpinal anaesthesia: local anaesthetics and adjuncts in the ambulatory setting.
Intrathecal lidocaine remains a popular choice for ambulatory spinal anaesthesia due to its reliability, rapid onset and predictable rapid recovery profile. However, concerns with transient neurological symptoms (TNS) and their significant association with lidocaine have generated interest in alternative local anaesthetic agents to provide adequate spinal anaesthesia with the briefest possible recovery period. ⋯ Controversies regarding the possible lower risk of TNS with newer spinal anaesthetic techniques and new discharge criteria are reviewed. The final section provides technical pearls to optimize ambulatory spinal anaesthetic outcomes.