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John Snow: Anesthesiologist, Epidemiologist, Scientist, and Hero | A 19th century physician was crucial to the establishment of 2 medical specialties-anesthesiology and public health. Everyone whose interest in public health has increased in the last year will be amazed at Dr John Snow's career in anesthesiology. Those who recognize him as the first full-time physician anesthetist will be struck by his development of medical mapping during the Cholera Pandemic of 1848, resulting in one of the fundamental techniques of epidemiology and public health that has continued through today. Snow's accomplishments in anesthesiology and epidemiology reflected a concatenation of science, focus, and creativity. His training in the early 19th century integrated science, medicine, and his keen interest in respiratory physiology. His early clinical exposure to colliery workers in Newcastle was likely influenced by the earlier development of pneumatic medicine. He was committed to the notion that chemistry, especially the use of medicinal gases, would be transformative for medicine. Thus, he was "primed" when the news of the American anodyne ether reached London in 1846. When the third cholera pandemic reached London shortly thereafter, in the fall of 1848, his academic and practical understanding of gas chemistry and pharmacology, respiratory physiology, and anesthetic agents led him to question the popularly promulgated miasma-based theories of transmission. His methodical investigations, research, and perseverance were mirrored in his scholarly work, numerous presentations, and public advocacy. He articulated many scientific principles essential to the early practice of anesthesia-anesthetic potency, quantitative dosing of anesthetic agents, engineering principles required for conserving the latent heat of vaporization, and minimizing the contribution of anesthetic equipment to airway resistance. He moved easily and methodically between these worlds of physiology, chemistry, engineering, clinical medicine, and public health. In his role as the first medical epidemiologist, Snow understood the power of medical mapping and the graphic presentation of data. He was a pioneer in 2 nascent fields of medicine that were historically and remain contemporarily connected. Copyright © 2021 International Anesthesia Research Society. |
Effects of laryngoscope handle light source on the light intensity from disposable laryngoscope blades | A bench-top study was performed to assess the effects of different laryngoscope handles on the light intensity delivered from disposable metal or plastic laryngoscope blades. The light intensity from both the handle light sources themselves and the combined handle and laryngoscope blade sets was measured using a custom-designed testing system and light meter. Five samples of each disposable blade type were tested and compared with a standard re-usable stainless steel blade using three different handle/light sources (Vital Signs LED, Heine 2.5 V Xenon and 3.5 V Xenon). The light intensity delivered by the disposable blades ranged from 790 to 3846 lux for the different handle types. Overall, the 3.5 V Heine handle delivered the highest light output (p < 0.007) in comparison with the other handles. For the disposable blades, the overall light output was significantly higher from the plastic than the metal blades (p < 0.001). © 2014 The Association of Anaesthetists of Great Britain and Ireland. |
Fires and explosions with compressed gases: Report of an accident | A case of near-fire with resultant burns to an anaesthetist is reported. This happened upon opening the regulator valve of an oxygen cylinder which probably had been contaminated with liquid paraffin. Possible mechanisms of the accident is discussed. © 1965 John Sherratt and Son Ltd. |
Comparison of invasive and non-invasive measurement of continuous arterial pressure using the finapres | A comparison was made of arterial pressures measured invasively from a radial arterial cannula and non-invasively from the middle finger using the 2300 Finapres (Ohmeda) during induction and maintenance of anaesthesia. Digital outputs of both pressures were captured directly onto computer hard disk; data recorded during flushing of the arterial line were excluded from analysis. We studied 53 patients undergoing cardiac, major vascular and neurosurgical procedures; 17705 comparisons of systolic, diastolic and mean pressure were analysed. Overall correlations between Finapres and invasive pressures were poor (r = 0.82, 0.68 and 0.78 for systolic, diastolic and mean pressures, respectively). The Finapres exhibited a high level of accuracy and precision in some recordings. However, patient data sets showed marked variability in average pressure differences (invasive minus Finapres) when examined individually or grouped by operation type. Unexplained variations in pressure difference with time and absolute pressure were observed also. Whilst providing useful beat-to-beat information on arterial pressure trends, the Finapres cannot be recommended as a universal substitute for invasive arterial pressure monitoring. © 1991 Copyright: 1991 British Journal of Anaesthesia. |
Teaching the uptake and distribution of halothane: A computer simulation program | A computer aided learning program for teaching the kinetics of uptake and distribution of the inhalational anaesthetic halothane is described. The program is based on a seven‐compartment model which simulates the action of halothane on ventilation and on the cardiovascular system. The program is available to the student in four forms: one with no changes in circulation or respiration, one with the cardiovascular effects of halothane included, one with respiratory effects only, and one with both of these effects combined. The student can study the importance of the influence of halothane on respiration and blood circulation by comparing results from simulations on different models. The simulation is presented as graphs which are continuously displayed on an alphanumeric visual display terminal. Interaction with the program is possible at all times to change the simulation speed, the variables being graphed, the inspired halothane fraction, and the fresh gas flow. Copyright © 1982, Wiley Blackwell. All rights reserved |
A system for storage of references. A method of storage and retrieval of references on a personal microcomputer | A computer program, written in BBC BASIC, for storage and retrieval of literature references on a personal microcomputer Jilted with floppy disc drives is described. The storage capacity is 425 references per 100K disc. A versatile search function allows ready access to references by matching any number of combinations of the following 10 items; authors, name, year and volume of journal, pages, reference number, und up to four key words. The resulting bibliographic list can be formatted to any desired house style. There is a facility for sorting the list into alphabetical order of the authors und the use of a wordprocessor for special print styles on any BBC compatible printer. These two features make retyping the list unnecessary. A search can be done manually while browsing through the references. Advantages of this system over the existing packages are discussed. The program is totally run by on‐screen menus, and it is easy to use, even by a novice. Copyright © 1985, Wiley Blackwell. All rights reserved |
A computer-assisted preanesthesia interview: Value of a computer-generated summary of patient's historical information in th preanesthesia visit | A computer-assisted preanesthesia historical interview and a computer-generated summary have been developed as an aid for preanesthesia rounds. Using a video monitor and a keyboard computer terminal, patients were questioned regarding previous medical, surgical, and anesthetic history, medications, allergies, and other items of particular interest to the anesthesiologist. Computer-generated data were compared to those derived from personal interviewing of patients by anesthesiologists. The computer interview was more accurate (96%, p<0.0005) and less variable than the anesthesiologists in listing correct positive and negative historical information. When the computer interview summary was used in the preanesthesia visit (study 2) the anesthesiologists' assimilation of historical information was greater (82.18%, p<0.005) than when the summary was not used during the preanesthesia visit (73.75%) (study 1). When only positive symptoms and conditions were compared, however, the difference between the computer and the anesthesiologists became more obvious, with more positive findings listed by the computer than by the anesthesiologists. Items missed by anesthesiologists included angina, myocardial infarction, recent upper respiratory infection, asthma, and low back pain. There was stronger agreement between the computer summary and the anesthesiologists in study 2 than in study 1. Items showing improved agreement (p<0.05) from study 1 to 2 were a history of having had a local anesthetic, including adverse reactions, level of physical activity, alcohol use, and smoking. The computer was more correct (p<0.05) than the anesthesiologists in more items in study 1 than in study 2. These findings suggest that a computer-generated summary of the preanesthesia history can enhance the anesthesiologists' assimilation of pertinent information. The computer interview was seen by the physicians as an effective aid, and it was accepted well by patients. |
Nitrous oxide in Bristol in 1836: A series of lectures by William Herapath (1796–1868) | A course of lectures, given by William Herapath in Bristol in 1836, during which nitrous oxide was administered on six occasions, is described. 1983 The Association of Anaesthetists of Great Britain and Ireland |
Declining proportion of publications by American authors in major anesthesiology journals | A decline in the proportion of articles published by American authors in medical journals has been reported. We therefore sought to determine whether the contributions of authors from the United States to the three leading anesthesia journals changed between the years 1980 to 2000. The journals Pain, Anesthesiology, and Anesthesia & Analgesia were selected for evaluation on the basis of their respective impact factors. All clinical studies and basic science studies published in the years 1980, 1985, 1990, 1995, and 2000 were evaluated. The country of origin of the lead author of each article was determined by two of the investigators. X2 Tests and least squares linear regression analyses were used to determine associations between the source of publication (United States or abroad) and year of publication. The proportion of American publications in the leading anesthesia specialty journals was found to be decreasing over the period 1980-2000 because of an increase in the rate of publication from abroad that is disproportionate to the increase in the total number of publications in the journals over that time. The reasons for changes in anesthesia-related publications by American authors were not established by this study. The authors speculate that multiple factors are involved, including an increased emphasis on clinical care over research because of economic constraints, American publication in journals other than the leading specialty journals, and the increased quality of submissions from abroad. |
A near disaster from piped gases | A defect in a piped medical gas supply resulted in a patient developing cyanosis. The following investigation revealed several faults which are discussed. Copyright © 1984, Wiley Blackwell. All rights reserved |
Anaesthetic equipment for a developing country | A development aid project to Malawi is described. This involved the development of a suitable anaesthetic machine for use in underdeveloped countries and the selection of a suitable oxygen concentrator to provide it with air and oxygen. All government hospitals were provided with anaesthetic equipment and personnel were trained to keep it regularly serviced. Follow up testing of reliability was undertaken. The cost benefit to the country amounted to £234084 (sterling) per year. This is the first instance of widespread use of standardized anaesthetic equipment which includes oxygen concentrators. © 1991 British Journal of Anaesthesia. |
Evaluation of a device for the measurement of the evoked tensions of the rectus abdominis muscle | A device was developed to measure the evoked tensions of the rectus abdominis muscle which consisted of a fluid‐filled reservoir wedged between the rectus abdominis muscle and a self‐retaining retractor. The evoked contractions of the rectus muscle were compared with that of the tibialis anterior muscle in twelve dogs anaesthetised with pentobarbitone. Significantly greater amounts of tubocurarine were required to depress the response to train‐of‐four stimuli and the twitch tensions of the rectus muscle than the tibialis. The tibialis recovered faster, spontaneously or after neostigmine, than the rectus in eight of the animals; the opposite occurred in the other four. The present device can be useful during surgery for the evaluation of abdominal muscle tension. 1983 The Association of Anaesthetists of Great Britain and Ireland |
Diazepam as an adjunct in propanidid anaesthesia for abortion | A double-blind study of the effects of diazepam as an adjuvant to propanidid anaesthesia for legal abortion has shown that the incidence of nausea and vomiting was significantly reduced as a result of giving diazepam, and that, in general, the conditions of anaesthesia were more acceptable with diazepam. The diazepam group had a prolongation of the time to recovery of consciousness but this was not considered unacceptable. © 1974 John Sherratt and Son Ltd. |
Tracking the early acquisition of skills by trainees | A form of sequential analysis has been developed to track performance of tracheal intubation by novice intubators. One hundred and nineteen trainees completed logbooks during their attachment to the Departments of Anaesthesia and these data were used to produce rates of success for sequential attempts at the procedure. A grid was created from this on which future trainees could report their performance. A boundary drawn on the grid can be used as a trigger to indicate the need for more basic instruction. |
Pre‐registration house surgeons: A questionnaire study of anaesthesia–related knowledge and approach to pre‐operative investigations | A group of newly qualified preregistration House Officers completed a questionnaire relating to their knowledge of anaesthetic drugs and to their appreciation of complications which may, in whole or in part, have required some knowledge of anaesthesia. Considerable gaps in knowledge were demonstrable, not only in matters that might arguably be regarded as strictly within the province of anaesthesia, but also in respect of basic pharmacology. The same House Officers were also questioned as to the necessity for various basic pre‐operative investigations prior to six everyday surgical procedures. This demonstrated a marked propensity for House Officers to overinvestigate patients as compared to the requirements of practising anaesthetists. The discrepancy was most marked with respect to pre‐operative chest X rays. However, considerable disparity was also demonstrable amongst a group of experienced anaesthetists as to their requirements for pre‐operative investigations. Permitting students greater exposure to anaesthesia in the undergraduate curriculum could go a long way towards improving this situation. Copyright © 1992, Wiley Blackwell. All rights reserved |
Nikolay Ivanovich Pirogov: A surgeon's contribution to military and civilian anaesthesia | A key figure in the development of anaesthesia in Russia was the surgeon Nikolay Ivanovich Pirogov (1810-1881). He experimented with ether and chloroform and organised the general introduction of anaesthesia in Russia for patients undergoing surgery. He was the first to perform systematic research into anaesthesia-related morbidity and mortality. More specifically, he was one of the first to administer ether anaesthesia on the battlefield, where the principles of military medicine that he established remained virtually unchanged until the outbreak of the Second World War. © 2014 The Association of Anaesthetists of Great Britain and Ireland. |
Assessment of a hygroscopic heat and moisture exchanger for paediatric use | A laboratory study of a widely available heat and moisture exchanger marketed for paediatric use was undertaken. The deadspace, measured by volume displacement, was 12 ml, similar to that of a standard catheter mount for paediatric use. Pressure drop across the device was measured at several different flows in five samples of the device in both the dry and wet state. Calculated resistance proved to be markedly lower when compared with that of other anaesthetic equipment such as tracheal tubes, and with similar humidification devices for paediatric use. Copyright © 1991, Wiley Blackwell. All rights reserved |
Measurement of low concentrations of halothane in the atmosphere using a portable detector | A Leakmeter, available from Analytical Instruments Limited, designed for detection of low concentrations of volatile halogenated hydrocarbons in industrial situations, proved suitable for measurements of halothane in the atmosphere. The Leakmeter consists of three components, an electron capture detector housed within a handpiece and fitted with a probe, a control unit which processes the signal from the detector and displays the output on a meter, and an argon carrier gas supply. The power supply is either mains or rechargeable battery operated. The whole instrument is compact and easily portable. |
Closed circuit anaesthesia: A new approach | A logical development of the closed circuit is described, from a basic resuscitation device, through various modifications, to a circle system incorporating an oxygen demand valve, adsorbers for both carbon dioxide and halothane, and some specific safety features. The behaviour of the circuits has been investigated in relation to elimination of nitrogen, concentrations of halothane and circuit leaks. © 1977 Copyright: Macmillan Journals Ltd. |
The gas chromatographic estimation of halothane en blood using electron capture detector unit | A method for quantitative estimation of low concentrations of halothane in blood by gas chromatography and electron capture detection has been described. The mean recovery of halothane from blood in the range of 7.10-26.12 mg/100 ml was 96.98% (SD 227). The mean of the standard deviations of duplicate extractions was 0.87. With low blood halothane concentrations 112.54-323.00 /* μg/100 ml, the mean per cent recovery was 107.41% (SD 5.18) and the mean of the standard deviations of duplicate extractions was 2.89. © 1972 John Sheratt and Son Ltd. |
A modified Dawkins epidural indicator: A useful teaching aid | A modified Dawkins epidural indicator may be assembled with inexpensive, disposable, sterile components found in any American hospital. It consists of the barrel of a standard tuberculin or 1-cc (long) insulin syringe which is attached to a 3-way plastic stopcock, which in turn is attached to the hub of the epidural needle so that the barrel is at right angles to the needle shaft in the vertical plane. The total weight is 5.3 g. The device is operational when the barrel is filled with sterile saline. It is attached to the hub of the needle when the tip is close to the ligamentum flavum. The entire unit is advanced toward the dura while closely observing the meniscus. As the needle enters the epidural space downward, movement of the meniscus is seen. If inadvertent puncture of the dura should occur, upward movement of the meniscus is seen as the tube fills with cerebrospinal fluid. The subarachnoid position of the needle may be also confirmed by a Valsalva maneuver causing upward movement of the meniscus. |
Hydrodynamic evaluation of a new anaesthetic gas scavenging system | A new anaesthetic gas scavenging system is described. The resistence of the system appears to below. When input gas flow rate in the system was zero or 150 litre min-1, misuse of the system produced pressure changes at its collecting points of 26 Pa subatmospheric and 630 Pa above atmospheric pressure, respectively. Suggestions to develop the system and increase its safety are presented. © 1983 The Macmillan Press Ltd. |
Vitrectomy: a new challenge for the anesthesiologist | A new surgical procedure, vitrectomy, for the alleviation of blindness caused by previously intractable vitreous disease, is described. Special demands of vitrectomy upon the anesthesiologist are enumerated. Problems presented by a patient population, 83% of whom suffered from severe diabetes mellitus and/or hypertension with a variety of complications, are discussed. The anesthetic technique used on 47 patients undergoing vitrectomy is described. |
Special Article: Howard Dittrick: curator to the McMechans' legacy journal. | A noted medical historian and museum curator, Canadian American Howard Dittrick was a Cleveland gynecologist who served as Directing Editor of Current Researches in Anesthesia and Analgesia (1940-1954). In the aftermath of World War II, even after Congresses of Anesthetists had resumed, Dittrick and his editorial board allowed their yellow, then tan-covered journal, the so-called "yellow peril," to languish into near irrelevance. |
Statistical Process Control: No Hits, No Runs, No Errors? | A novel intervention or new clinical program must achieve and sustain its operational and clinical goals. To demonstrate successfully optimizing health care value, providers and other stakeholders must longitudinally measure and report these tracked relevant associated outcomes. This includes clinicians and perioperative health services researchers who chose to participate in these process improvement and quality improvement efforts (“play in this space”). Statistical process control is a branch of statistics that combines rigorous sequential, time-based analysis methods with graphical presentation of performance and quality data. Statistical process control and its primary tool—the control chart—provide researchers and practitioners with a method of better understanding and communicating data from health care performance and quality improvement efforts. Statistical process control presents performance and quality data in a format that is typically more understandable to practicing clinicians, administrators, and health care decision makers and often more readily generates actionable insights and conclusions. Health care quality improvement is predicated on statistical process control. Undertaking, achieving, and reporting continuous quality improvement in anesthesiology, critical care, perioperative medicine, and acute and chronic pain management all fundamentally rely on applying statistical process control methods and tools. Thus, the present basic statistical tutorial focuses on the germane topic of statistical process control, including random (common) causes of variation versus assignable (special) causes of variation: Six Sigma versus Lean versus Lean Six Sigma, levels of quality management, run chart, control charts, selecting the applicable type of control chart, and analyzing a control chart. Specific attention is focused on quasi-experimental study designs, which are particularly applicable to process improvement and quality improvement efforts. Copyright © 2018 International Anesthesia Research Society |
Comparison of four different display designs of a novel anaesthetic monitoring system, the 'integrated monitor of anaesthesia (IMA)'. | A novel monitoring system (integrated monitor of anaesthesia, IMA) which integrates three components of general anaesthesia on one single display was developed. The focus of this study was to evaluate the performance and user-friendliness of four different display designs. Four interface displays of the IMA were developed, including one numerical, one numerical and graphical (mixed numerical-graphical), one only graphical, and one an advanced two-dimensional graphical display. Each of the four displays was evaluated in a random order by 10 staff anaesthetists and 10 residents/fellows using a set of five scenarios. Scenarios involved one or more abnormal variables that participants had to verbally phrase. For each interface test, reaction time, response accuracy, and NASA-Task Load Index were measured and compared. The numerical, graphical, and advanced-graphical interfaces yielded similar median reaction times, respectively, 7.99 s (5.15-10.79), 8.21 s (6.20-11.88), and 9.43 s (6.19-13.3). Reaction times were significantly shorter (P<0.006) with the mixed numerical-graphical interface: 6.26 s (4.52-8.32). The correct response rate was significantly lower in the graphical interface. The three others presented no statistical difference when compared among each other. The mixed numerical-graphical interface yielded a significantly lower NASA-TLX than the numerical and the advanced-graphical interfaces (19/100 vs 34/100, P<0.003). A mixed numerical-graphical display design appears to present the best results in terms of user reaction times, response accuracy, and performance index when detecting abnormal critical events. |
Consensus statement on perioperative use of neuromuscular monitoring | A panel of clinician scientists with expertise in neuromuscular blockade (NMB) monitoring was convened with a charge to prepare a consensus statement on indications for and proper use of such monitors. The aims of this article are to: (a) provide the rationale and scientific basis for the use of quantitative NMB monitoring; (b) offer a set of recommendations for quantitative NMB monitoring standards; (c) specify educational goals; and (d) propose training recommendations to ensure proper neuromuscular monitoring and management. The panel believes that whenever a neuromuscular blocker is administered, neuromuscular function must be monitored by observing the evoked muscular response to peripheral nerve stimulation. Ideally, this should be done at the hand muscles (not the facial muscles) with a quantitative (objective) monitor. Objective monitoring (documentation of train-of-four ratio =0.90) is the only method of assuring that satisfactory recovery of neuromuscular function has taken place. The panel also recommends that subjective evaluation of the responses to train-of-four stimulation (when using a peripheral nerve stimulator) or clinical tests of recovery from NMB (such as the 5-second head lift) should be abandoned in favor of objective monitoring. During an interim period for establishing these recommendations, if only a peripheral nerve stimulator is available, its use should be mandatory in any patient receiving a neuromuscular blocking drug. The panel acknowledges that publishing this statement per se will not result in its spontaneous acceptance, adherence to its recommendations, or change in routine practice. Implementation of objective monitoring will likely require professional societies and anesthesia department leadership to champion its use to change anesthesia practitioner behavior. Copyright © 2017 International Anesthesia Research Society. |
Evaluation of a computer simulation program for teaching halothane uptake and distribution | A pilot evaluation of a simulation program used during a tutorial for the teaching of uptake and distribution of the inhalational anaesthetic halothane shows a highly significant improvement in the students' answers after the tutorial using a ‘before and after’ questionnaire. The students showed an understanding of the program's display and model limitations. This encourages the further use of the program. Copyright © 1982, Wiley Blackwell. All rights reserved |
A constant current peripheral nerve stimulator (neurostim t4): Description, and evaluation in volunteers | A pocket-size, battery-powered peripheral nerve stimulator featuring a calibrated constant current floating output (max. 80 mA) was evaluated in unanaesthetized volunteers. Modes of stimulation included continuous 1 Hz, continuous train-of-four every 15 s, and on-demand tetanus (50 Hz per 5 s). Within the limits of 0-250 V, voltage adjusted automatically for 0. 2-ms mono-phasic square pulses. Between 20 and 80 mA, the dial error of current intensity was less than ±5%. Maximum allowable resistance for the generation of 40-mA pulses was 5 kΩthat is five times the average tissue impedance as measured in 15 volunteers. With surface electrodes, the current intensity required for maximal indirect muscle stimulation in another 50 individuals was 38± 23mA (mean±SD). With up to 80 mA stimulus current, supramaximal nerve stimulation was obtained in 94% of the volunteers. © 1985 British Journal of Anaesthesia. |
Continuing medical education by anaesthetists in Scotland: Activities, motivation and barriers | A postal questionnaire survey was carried out to determine the activities, motivation and barriers to continuing medical education amongst career grade anaesthetists in Scotland. Four hundred and ten consultants and 49 non-consultant career grade anaesthetists were surveyed with a response rate of 84.5%. All respondents had taken part in some educational activities in the past two years. Over 80% had attended 10 or more departmental meetings and over 90% had attended meetings of a Regional society or National meetings. Less than 50% had attended for clinical experience with a colleague and only 20% had done so in another centre. There were trends of changing educational activity with increasing age. The most common motivation was to keep up to date for current clinical duties with keeping up to date for teaching second, but younger consultants were more likely to undertake continuing medical education activities in case their clinical duties changed. Perceived barriers to continuing medical education were similar for internal and external activities but funding was less of a limitation for those working in district general hospitals. There is scope for encouraging activities such as clinical experience with a colleague and a need to explore in greater detail the perception of barriers to continuing medical education and their influence on participation. |
The current practice of tracheostomy in the United Kingdom: A postal survey | A postal questionnaire was sent to 228 intensive care units throughout the United Kingdom to determine aspects of current tracheostomy practice. From the number of units responding (n = 178, 78%), the majority (n = 173, 97%) practised percutaneous tracheostomy as opposed to open surgical tracheostomy. The Blue Rhino single dilator was the most popular technique (n = 114, 64%). Percutaneous tracheostomy is increasingly carried out under bronchoscopic guidance (n = 148, 83%); however, there remains considerable variation in the timing of tracheostomy and only 61 units (34%) have set follow-up procedures. © 2005 Blackwell Publishing Ltd. |
A survey of paediatric dental anaesthesia in Scotland | A postal survey of NHS hospital-based anaesthetists providing out-patient anaesthesia for dental procedures in children under 10 years of age was conducted in February 1999. Information was sought about quality of care and common practice in Scotland. The experience of the anaesthetists involved in such work was substantial, but the monitoring used did not meet current standards, with only 16% of respondents indicating use of a full range of standard devices. Separate recovery facilities were available to 99%, and all had access to a defibrillator, but the qualifications of dedicated assistant and recovery staff were lacking in 14 and 30%, respectively. Intravenous access was not obtained routinely after inhalational induction of anaesthesia by up to 71% (49%, never; 22%, sometimes). Systemic analgesia or local anaesthesia was used by 88%. Discharge times ranged from 10 min to 6 h. |
The use of anaesthetic rooms for induction of anaesthesia: A postal survey of current practice and attitudes in Great Britain and Northern Ireland | A postal survey was sent to all anaesthetic departments in the UK to identify current practice and gain insight into anaesthetists' attitudes regarding the use of anaesthetic rooms for induction of general anaesthesia. Replies were received from 247 (88%) departments. Of these, 10 (4%) departments routinely anaesthetise all patients in theatre. The main reason for change was patient safety. Of those who routinely use the anaesthetic room for induction of anaesthesia, only 5% have made provision to change to in-theatre induction. An estimated £30 million has been spent on equipping anaesthetic rooms since 1994; with the result that 91% of departments where anaesthetic room induction occurs, now have monitoring that complies with the current Association of Anaesthetists of Great Britain and Ireland guidelines. The majority of the responders who use anaesthetic rooms perceived induction in theatre to result in reduced efficiency, increased patient anxiety, a worse teaching environment and no improvement in patient safety. This was in contrast to the attitudes of respondents from hospitals where in-theatre induction occurs. Only 9.7% of all respondents believed that clinical governance would necessitate a change to anaesthetizing all patients in theatre compared to 25% who believed that the increasing costs of monitoring equipment would lead to a change. Overall 79% of respondents prefer to use the anaesthetic room, 16% prefer in-theatre induction and 5% expressed no preference. However, of those who routinely anaesthetic in theatre, 70% thought it to be preferable. |
Job satisfaction, stress and burnout in Australian specialist anaesthetists | A postal survey was sent to specialist anaesthetists in Australia looking at aspects of job satisfaction, dissatisfaction and stress. Burnout was measured using the Maslach Burnout Inventory. The response rate was 60% (422/700) with the majority of respondents being male (83%). Stressful aspects of anaesthesia included time constraints and interference with home life. Experienced assistants and improved work organisation helped to reduce stress. The high standard of practice and practical aspects of the job were deemed satisfying, whereas poor recognition and long hours were the major dissatisfying aspects of the job. With respect to burnout, high emotional exhaustion, high levels of depersonalisation and low levels of personal achievement were seen in 20, 20 and 36% of respondents, respectively. Female anaesthetists reported higher stress levels than males (p = 0.006), but tended to prioritise home/work commitments better than males (p = 0.05). Private practitioners rated time issues of high importance compared with public hospital doctors, whereas public hospital doctors rated communication problems as being more significant than with private specialists. Although burnout levels are high in anaesthetists, they compare favourably with other medical groups. There are, however, aspects of the anaesthetist's job that warrant further attention to improve job satisfaction and stress. |
A postoperative analysis of the patient's view of anaesthesia in a Netherlands’ teaching hospital | A postoperative questionnaire was used in 129 patients who had undergone a wide range of surgical procedures in order to investigate their personal experience of anaesthesia. The most frequent complaints were of feeling cold on waking up, sore throat, vomiting and muscle pains, all of which are capable of reduction by a change in anaesthetic technique. The total number of patients who had one or more complaints was 107 (82.9%). More than a third of the patients were afraid of the anaesthetic, as distinct from the operation. Most had received a pre‐operative visit from the anaesthetist which was greatly appreciated. A few patients believed they could have been better informed of possible sequelae. More than 30% were not visited by the surgeon before the operation. A routine postoperative interview, using a preformulated questionnaire, is a good way to assess and maintain a high quality of anaesthesia. Copyright © 1990, Wiley Blackwell. All rights reserved |
Unexpected, difficult laryngoscopy: A prospective survey in routine general surgery | A prospective study of unexpected, difficult laryngoscopy was carried out. During a 7-month period, all general surgery patients in whom the trachea was intubated were assessed; only those with obvious neck pathology were excluded. Ease or difficulty of laryngoscopy was graded by a standard method. There were no grade 4 cases and no failed intubations in a total of 1387 cases. There were significant differences in the results recorded by different individuals; this did not correlate with seniority or with the type of surgery. Four factors have been identified which help to explain these discrepancies. These findings are analysed in relation to the training of junior staff, with particular reference to obstetric anaesthesia. © 1991 British Journal of Anaesthesia. |
An analysis of critical incidents in a teaching department for quality assurance A survey of mishaps during anaesthesia | A prospective survey was conducted from April 1984–January 1985 and April 1985–January 1986 to study the frequency of critical incidents and factors associated with them. Eighty‐six mishaps were reported in the first period, the majority of which were because of human error (80.3%);the must common were the transmission of gases and vapours and errors in drug administration. Factors frequently associated with these mishaps were failure to perform a normal check and lack of familiarity with equipment or technique. An anaesthesia equipment checklist was incorporated in the survey during the second period and 43 mishaps were reported. This decrease in incidence may have resulted from the anaesthesia apparatus checklist, awareness of mishaps since they were discussed regularly at departmental meetings, and new anaesthesia machines (eight older machines were replaced during the first period and 11 at the beginning of the second). Copyright © 1988, Wiley Blackwell. All rights reserved |
A combined oxygen concentrator and compressed air unit: Assessment of a prototype and discussion of its potential applications | A prototype combined oxygen concentrator and air compressor is described. Laboratory assessment demonstrated satisfactory oxygen concentrations, flows, pressures and reliability. Its various modes of use in clinical practice are described. It is likely to be a valuable method to provide oxygen for anaesthesia both in remote areas and where nitrous oxide‐free anaesthesia is required, as well as a reliable alternative to commercially produced oxygen for therapeutic purposes. Copyright © 1988, Wiley Blackwell. All rights reserved |
Experiences and attitudes of consultant and nontraining grade anaesthetists to continuing medical education (CME) | A questionaire survey was sent to 164 consultant anaesthetists with the aim of investigating their experiences and attitudes to continuing medical education. The response rate was 79%. Most anaesthetists were motivated to achieve the required number of credits and for the majority of anaesthetists, regional, national and internal departmental discussion meetings were the mainstay of educational activities. The educational standard of available activities could be improved to include more workshop-style learning opportunities and to make journal reading a creditable continuing medical education activity. The place of research is questioned. There was doubt as to whether sanctions such as withdrawing recognition for training should be imposed on departments where some anaesthetists fail to achieve the required number of credits and whether this would motivate anaesthetists to achieve the set standards. Continuing medical education was felt to be effective and the main barriers to attending educational activities are discussed. |
Intensive care in England and Wales: A survey of current practice, training and attitudes | A questionnaire circulated to members of the Intensive Care Society in England and Wales brought 101 replies, representing 74 hospitals, including 16 teaching hospitals. Anaesthesia is the dominant specialty in this field and the majority of general units included in this survey are staffed and directed by consultants from this specialty, though their involvement in such work varies widely. Only about half the units are largely supervised by consultants with a heavy commitment to it. The junior staff too are predominantly anaesthetists. Whilst the FFARCS examination strongly emphasises the importance of intensive care to the specialty, only about half the members believe present training in this field, including academic activity, is satisfactory. The dearth of full‐time training posts, their brevity and their domination by the teaching hospitals are major problems. There is considerable support for the idea of National Training Standards, and for a full‐time training period of not less than 2 years, including special experience in certain fields, for those with a special interest in and aptitude for this type of work. But there is much less support for a Diploma. Despite this agreement on special training, only a small minority of members believe intensive care work should largely be restricted to separate career specialists, ‘intensivists’. However most recognise the need for each unit to have a largely full‐time manager and coordinator, whose personal qualities are more important than his original specialty. Most units have one kind of problem or another, the most common being a shortage of money and nurses. Copyright © 1981, Wiley Blackwell. All rights reserved |
The role of anaesthetists as seen by nurses in training | A questionnaire designed to assess knowledge and altitudes towards the anaesthetist and his work was distributed to 320 nurses in training. The results of the survey are presented and discussed. Copyright © 1983, Wiley Blackwell. All rights reserved |
Use of adrenaline in obstetric analgesia | A questionnaire on the use of adrenaline in obstetric analgesia was completed by 87 obstetric anaesthetists: 71% of consultants in teaching hospitals were prepared to use adrenaline mixed with local anaesthetics compared with 33% of consultants in district hospitals; they had a similar duration of obstetric anaesthetic experience. Test doses containing adrenaline were not commonly used in labour, but were more often used prior to elective Caesarean section. Adrenaline was used with either lignocaine or bupivacaine; few consultants used both solutions. Contraindications to the use of adrenaline in the nonuser group were in decreasing order of rank: neurological damage, pregnancy‐induced hypertension, stenotic valvular heart disease, sickle cell disease or trait and fetal distress. Overall, the contraindications related to the systemic absorption of adrenaline were most common. Copyright © 1992, Wiley Blackwell. All rights reserved |
Are you getting the message? A look at the communication between the Department of Health, manufacturers and anaesthetists | A questionnaire sent to 109 anaesthetists in the South West Region has revealed that there is a problem with dissemination of information relating to hazards with equipment. Thirty‐four per cent of consultants, and 67% of junior anaesthetists were only slightly or not at all confident that they see the Hazard Notices and Safety Action Bulletins relating to the equipment they use. The study has also demonstrated the large amount of new equipment coming into circulation and has highlighted deficiencies in the reading of equipment manuals. Some suggestions are made as to how the current system may be improved. Copyright © 1991, Wiley Blackwell. All rights reserved |
Anaesthetists' attitudes to teamwork and safety | A questionnaire survey was conducted with 222 anaesthetists from 11 Scottish hospitals to measure their attitudes towards human and organisational factors that can have an impact on effective team performance and consequently on patient safety. A customised version of the Operating Room Management Attitude Questionnaire (ORMAQ) was used. This measures attitudes to leadership, communication, teamwork, stress and fatigue, work values, human error and organisational climate. The respondents generally demonstrated positive attitudes towards the interpersonal aspects of their work, such as team behaviours and they recognised the importance of communication skills, such as assertiveness. However, the results suggest that some anaesthetists do not fully appreciate the debilitating effects of stress and fatigue on performance. Their responses were comparable with (and slightly more favourable than) those reported in previous ORMAQ surveys of anaesthetists and surgeons in other countries. |
Dissemination of fibreoptic airway endoscopy skills by means of a workshop utilizing models | A questionnaire was mailed to 182 attendees of four practical workshops on fibreoptic endoscopy. After the workshops, 35% of the attendees were able to introduce fibreoptic intubation into their clinical practice or improve their success rate. This suggests that a new psychomotor skill can be disseminated effectively to clinicians by a practical workshop that utilizes inanimate models, and is based on sound educational principles. © 1989 Oxford University Press. |
A national survey of ICU consultant working practices at weekends | A questionnaire was sent to all Intensive Care Society linkmen to investigate weekend working arrangements on Intensive Care Units (ICU) in the United Kingdom. In all, 87 responses revealed that the average consultant covering ICU at weekends works a 1 in 6 rota, is responsible for 10 beds, works 8-9 h a day and receives two calls at night. Of consultants, 54% cover anaesthesia as well as ICU, 55% work a 48 h or 72 h weekend and only one in five consultants currently have fixed sessional allocation for weekend working. 83% felt that they should not cover anaesthesia as well as ICU and there was no support for consultants to be resident at night. Applying the terms and conditions of the new consultant contract for England to this average consultant would result in 6.6 Programmed Activities for the weekend and 2 days of compensatory rest. © 2004 Blackwell Publishing Ltd. |
Training in intensive care: A questionnaire to trainees | A questionnaire was sent to senior registrars in General Medicine and Anaesthesia enquiring into the amount of training they received in Intensive Therapy and their attitudes to this in the light of their expectations for a consultant post. The results suggest that training is inadequate and that trainees are dissatisfied with the current situation. Copyright © 1983, Wiley Blackwell. All rights reserved |
Optimal shape of the laryngeal mask cuff: The influence of three deflation techniques | A randomised, single-blinded, controlled trial was conducted to determine if a new laryngeal mask deflation tool offered any advantages over manual or free deflation. Ten laryngeal mask airways were tested and the deflation tool provided a significantly superior and more consistent shape than either hand manipulation or the free deflation, but did not offer any benefits in terms of residual volume. The deflator tool should encourage, wider use of the standard recommended insertion technique. It can be used as a backup when manual deflation cannot provide the correct shape and may be useful for researchers studying laryngeal mask airway placement. |
Obstetric anaesthetic services in Scotland in 1982 | A recent survey of Scottish obstetric anaesthesia practice revealed that the majority of deliveries take place in the larger hospitals; these also have the highest epidural rates, both for relief of pain in labour and for Caesarean section. However, as epidural blockade is an essential part of modern obstetric practice, it is a matter of concern to achieve an equal standard in the medium‐sized hospitals, whilst accepting that special arrangements are required in the very small obstetric hospitals. Copyright © 1986, Wiley Blackwell. All rights reserved |
Rheology and anesthesiology | A review of blood rheology with special emphasis on its applications in anesthesiology is presented. The rheological behavior of blood is determined by 2 variables, non-Newtonian viscosity and yield stress. The physical significance of these quantities is discussed. Blood viscosity directly affects total peripheral resistance, and changes in the state of peripheral vessels cannot be accurately evaluated unless simultaneous measurements of blood viscosity are made. Blood viscosity also influences cardiac output, and elevations in hematocrit may reduce total O2 transport by increasing viscosity to the point that cardiac output decreases. The role of blood viscosity and blood yield stress in the pathogenesis of deep-vein thrombosis is mentioned, and the role of anesthesia in affecting viscosity by decreasing venous flow is discussed. Clinical examples of the role of blood rheology in neonatal respiratory distress and during open heart surgery are also given. |
Revised checklist for anaesthetic machines | A revised edition of the guidelines of the Association of Anaesthetists of Great Britain and Ireland, for the pre-operative check of anaesthetic machines, was published in March 1997. A checklist based on the revised guidelines was used for the routine pre-operative checks of anaesthetic machines over a 6-week period in a district general hospital. One hundred and thirty-two checklists were completed. These were analysed for the time taken to complete the check and for the faults found in the anaesthetic machines. The mean time taken to complete a check was 6.8 min and the mean time taken to complete two consecutive checks, in the anaesthetic room and operating theatre, was 12.7 min. Carbon dioxide cylinders were present on the machines in 99 checks (75%), contrary to Association guidelines. Other faults were found in 40 checks (30.3%). The most frequent cause of faults was the oxygen analyser, faults being found in 15 checks. Other frequent faults were due to empty vaporisers or spare gas cylinders and the emergency oxygen bypass control. |
A training programme for fibreoptic nasotracheal intubation. Use of model and live patients. | A scheme for teaching nasotracheal intubation with the aid of fibreoptic instruments on models and live patients is described and evaluated. Twelve trainees completed 74 out of 75 intubations successfully on sedated patients to the satisfaction of themselves, their patients and their instructors. Copyright © 1983, Wiley Blackwell. All rights reserved |
The microcomputer in self‐assessment for examinations in anaesthesia | A series of 30 multiple choice questions were modified for presentation on a microcomputer which was programmed to present them to the user and mark them. In a preliminary study, 15 trainee anaesthetists all agreed the system was satisfactory as an aid to preparation for the FFARCS. Copyright © 1981, Wiley Blackwell. All rights reserved |
Clinical automatic control of neuromuscular blockade | A simple feedback control technique has been used to automatically deliver pancuronium to anaesthetised surgical patients. The dosage rate is automatically adjusted at 10‐second intervals, according to the measured evoked, rectified, integrated electromyogram. When set to demand 80 percent blockade, in 40 patients. the controller maintained blockade at a steady mean level of 72.9 percent (consuming pancuronium at a mean rate of 0.47 μg/kg/minute). The main clinical practical problems involved protection against electrical noise and the need to spend time setting up the equipment. Copyright © 1986, Wiley Blackwell. All rights reserved |
The application of cricoid pressure: An assessment and a survey of its practice | A simple test rig was developed to assess the force applied during the application of cricoid pressure. Anaesthetists and paramedical personnel familiar with Sellick's manoeuvre were tested yielding results which indicate an unacceptably wide variation in performance in each group. The mean force was 46.4 N but 47% failed to reach a force of 44 N. In addition a survey was undertaken of trained anaesthetic staff to identify the current status of the manoeuvre. Of those sampled 78% routinely employed Sellick s manoeuvre and over 70% had experienced a problem with its application which exposed the patient to the risk of regurgitation. 1983 The Association of Anaesthetists of Great Britain and Ireland |
A simple air sampling technique for monitoring nitrous oxide pollution | A simple, inexpensive device for the continuous low-flow sampling of air was devised to permit monitoring of pollution by gaseous anaesthetics. The device consisted of a water-filled Perspex cylinder in which a double-walled flexible-film gas sample collection bag was suspended. Air samples could be aspirated into the collection bag at flow rates of as low as 1 ml min-1 by allowing the water to drain from the cylinder at a controlled rate. The maintenance of sample integrity with aspiration and storage of samples of nitrous oxide in air at concentrations of 1000, 100 and 30 v/v was examined using gas chromatography. The sample bags retained a mean 94% of the nitrous oxide in air samples containing nitrous oxide 25 p.p.m. over a 72-h storage period. © 1981 Macmillan Publishers Ltd. |
The effect of education, assessment and a standardised prescription on postoperative pain management | A study involving 2738 patients in 15 hospitals in the United Kingdom was undertaken to evaluate the effect of simple methods of pain assessment and management on postoperative pain. The study consisted of four parts: a survey of current practice in each hospital; a programme of education for staff and patients regarding pain and its management; the introduction of formal assessment and recording of pain and the use of a simple algorithm to allow more flexible, yet safe, provision of intermittent intramuscular opioid analgesia; and a repeat survey of practice. One hospital from each of the former health regions of England and Wales was selected for inclusion in the project. Hospitals included representatives of different size units (university, large and small district general hospitals). As a result of the study, there was an overall reduction in the percentage of patients who experienced moderate to severe pain at rest from 32% to 12%. The incidence of severe pain on movement decreased from 37% to 13% and moderate to severe pain on deep inspiration from 41% to 22%. Similar decreases were seen in the incidence of nausea and vomiting. There was also a slight reduction in the incidence of postoperative complications. This study shows that simple techniques for the management of postoperative pain are effective in reducing the incidence of pain both at rest and during movement and should form part of any acute pain management strategy. |
The determination of an effective cricoid pressure | A study of cricoid pressure was undertaken to relate the applied cricoid force with the resulting intraluminal cricopharyngeal (or oesophageal) pressure. The results indicate that whilst there was a wide range in normal adults a cricoid force of 44 N was judged to be effective in protecting the majority of adult patients from regurgitation. 1983 The Association of Anaesthetists of Great Britain and Ireland |
The anaesthetic machine-a study of function and design | A study of the time and motion of the anaesthetists' routine activities was made using conventional equipment. Films of manual and visual movements were studied in detail and the expectations of certain consultant anaesthetists regarding apparatus were recorded. Models of apparatus were used to test their acceptability. A modular system appeared preferable to a work station or to adaptation of present designs. More work and the construction of prototypes are indicated if the anaesthetic machine is to be modernized. © 1980 Macmillan Publishers Ltd. |
Provision of training in chronic pain management for specialst registrars in the United Kingdom | A study published in 1992 highlighted wide variations in the provision of training in pain management. In this survey, data were collected from both pain clinicians and Programme Directors of the Schools of Anaesthesia to see if there had been any changes in training patterns since the introduction of the Calman training scheme. There did not seem to be a uniform improvement in the provision of training in pain management for Specialist Registrars and many may reach their Certificate of Completion of Specialist Training without a basic knowledge of chronic pain. It is thought that at the present time there will be few Specialist Registrars with sufficient training to take up consultant posts in pain management unless they compete for the much sought after, and often not fully funded, pain fellowships outside their rotations. |
Costs of replacement of anaesthetic equipment. Projected expenditure for clinical anaesthetic equipment in a teaching health district | A study was made of all the anaesthetic equipment in clinical use to substantiate estimates of the cost of its replacement on four hospital sites. The years during which replacement was likely to become necessary were estimated from the list compiled and an existing full inventory, together with costs at 1986 prices. The predicted costs for each year until 2000AD were derived. To these were added sums required to make good existing shortfalls and to introduce a moderate amount of equipment incorporating newer technology. The totals showed that the capital currently available in the health district is sufficient only for anaesthetic equipment and requires a substantial increase to replace medical apparatus belonging to all specialties already in routine clinical use. Health authorities must be given detailed projections of these costs. Copyright © 1988, Wiley Blackwell. All rights reserved |
The selection of a residency program: Prospective anesthesiologists compared to others | A study was undertaken to investigate factors important to senior medical students, particularly prospective anesthesiology residents, in selecting a residency program. A previously published questionnaire was used to determine whether previous findings could be replicated. One hundred ninety-seven senior medical students rated the importance of 22 items in their selection of a residency program. Factors were ranked nearly identically as in the previous study. Factors rated as most important were 'diversity of training experience' as well as 'house officer satisfaction,' whereas items about treating patients with the acquired immunodeficiency syndrome were rated as least important. There were gender differences that showed women assigned more importance to having a manageable case load, call schedules, and geographic location. Prospective anesthesiology residents perceived 'prestige' of the program, and the department as significantly more important than did prospective nonanesthesiology residents. The replication of results with regard to the overall ranking of factors demonstrates the reliability of the results. Resident selection committees need to focus on the issue of quality of training, the impression made by the interviewers, and include satisfied residents as part of the interview process. |
Practice patterns of anesthesiologists regarding situations in obstetric anesthesia where clinical management is controversial | A survey consisting of 47 questions, 40 regarding clinical practice and 7 regarding demographics, was mailed to 153 directors of obstetric anesthesia in academic practice and to 153 anesthesiologists in private practice. Questions relating to the following areas of practice were asked: 1) preoperative laboratory testing; 2) preeclampsia and possible coagulopathies; 3) epidural catheter placement in women with 'spinal problems'; and 4) use of epidural opioids and intravenous supplementation. Surveys were returned by 113 (74%) academic anesthesiologists and 94 (61%) private practice anesthesiologists. By univariate analysis, 14 questions showed a significant difference in response between those in academic and private practice, but only eight remained significant after accounting for the amount of clinical time currently devoted to obstetric anesthesia (>50% or ≤50%). These eight questions related to preoperative laboratory testing in the healthy parturient, preoperative laboratory testing in the preeclamptic patient, and the use of intravenous supplementation during a cesarean section with regional anesthesia. Although there were some differences in the responses between anesthesiologists in academic and private practice, overall the responses were similar. |
Syringe labels in anaesthetic induction rooms | A survey of 35 hospitals in the United Kingdom has uncovered a wide variety of syringe drug labels. Use of different systems in different hospitals may result in wrong drug administrations, particularly when trainees move from one hospital to another. There is an urgent need to standardise the colour coding of syringe labels in the United Kingdom. Such standards are already in place in Australia, New Zealand and in the United States of America. This survey of syringe drug labels highlights the existing risks and recommendations for change are made. |
Survey of laryngeal mask airway usage in 11,910 patients: Safety and efficacy for conventional and nonconventional usage | A survey of laryngeal mask airway (LMA) usage was conducted to provide general information about safety and efficacy with special emphasis on controversial issues such as positive pressure ventilation (PPV), prolonged anesthesia, and laparoscopic and nonlaparoscopic intraabdominal surgery. During the 2-yr study period, of the 39,824 patients who underwent general anesthesia, 11,910 (29.9%) patient airways were managed with the LMA. Forty- four percent underwent PPV. Placement was successful in 99.81%, and in 23 patients the LMA was abandoned in favor of the tracheal tube (TT). Use of the LMA for any intraabdominal procedure was considered nonconventional and occurred in 2222 (18.7%) patients. On 579 occasions procedures lasted >2 h. A total of 44 critical incidents were documented. Eighteen (0.15%) were related to the airway and none required intensive care management. There were 26 critical incidents not related to the airway which resulted in two admissions to the intensive care unit and one death. There were three cases of failed tracheal intubation managed with the LMA. This survey demonstrates that the LMA technique is safe and effective for both spontaneous and controlled ventilation. Use of the LMA for gynecologic laparoscopy, gynecologic laparotomy, and procedures >2 h also appears safe. |
Needlestick injuries in anaesthetists | A survey of needlestick injuries among 42 anaesthetists at this university hospital was carried out over a 3‐month period to ascertain the rate of occurrence and the extent to which a revised protocol for the management of such injuries was followed. There were nine reported incidents, of which six were with contaminated needles. Three were reported. Eight anaesthetists had not taken up immunisation against hepatitis B. The rationale behind the revised protocol, and possible reasons for poor compliance are discussed. Copyright © 1990, Wiley Blackwell. All rights reserved |
Drug recognition by nurses and anaesthetists | A survey of nurses and anaesthetists in a 500‐bed teaching hospital set out to discover how they located a drug container in order to read its label and verify its contents. Members of each group assessed the value of seven factors thought to help in this location and answered questions on personal errors in drug administration. The nurses found the expected position of the drug container in the trolley or cupboard to be the most important factor, followed by the size of the container. The anaesthetists placed the colour of the container as most important, followed by the manufacturer's distinctive container as their second best guide to drug location. This preference for colour and a distinctive container can be used to reduce the chance of confusing drugs locally. A scheme for colour‐coding ampoules in broad groups to reduce gross mistakes in the future is presented. Copyright © 1982, Wiley Blackwell. All rights reserved |
Postoperative pain control: A survey of current practice | A survey of postoperative analgesia in 195 anaesthetic departments in England and Wales was undertaken. The results showed that 64% of respondents were dissatisfied or very dissatisfied with the present situation. Large differences were demonstrated between what was regarded as the safest technique and what would form the ideal management of postoperative pain. Copyright © 1991, Wiley Blackwell. All rights reserved |
The neuroanaesthesia workforce in Great Britain and Ireland | A survey of the 36 units that provide a neuroanaesthesia service in Great Britain and Ireland was conducted. It shows the variation in the type of hospital, the number of whole-time equivalent neuroanaesthetists, the number of operating sessions and the number of neurosurgical beds per million of the catchment population of each unit. On-call commitment and arrangements for managing long cases are described. Current problems pertaining to neuroanaesthetic practice are mentioned. This survey will provide a basis for the planning of future neuroanaesthetic services, as the potential of expansion of neurosurgery and neuroradiology is realised. However, it is difficult to make accurate projections and hence advise on future workforce requirements in a climate of changing service delivery. Attention should be given to a number of workforce issues highlighted in this survey if recruitment into neuroanaesthesia is to be encouraged. |
Neuroanaesthetists' experience of workload-related issues and long-duration cases | A survey of the members of the Neuroanaesthesia Society of Great Britain and Ireland was conducted to examine issues arising from the management of long cases. Replies were received from 47% of neuroanaesthetists. The survey highlights that consultants are working for prolonged periods without adequate rest. This may compromise patient safety, job satisfaction and recruitment to the specialty. These pressures are likely to increase as the European Working Time Directive reduces the availability of trainees, and because of expansion in neurosurgery and neuroradiology. Similar concerns are likely to extend into other anaesthetic specialties with long-duration cases and may apply to our surgical colleagues. © 2005 Blackwell Publishing Ltd. |
Who uses transesophageal echocardiography in the operating room? | A survey was made of 155 anesthesiology residency programs in the United States to determine the patterns of use, responsibility for interpretation, and training of those responsible for intraoperative transesophageal echocardiography (TEE). Survey questions included numbers and types of cases for which TEE is used, who interprets TEE data and how they are trained, the extent of resident training in TEE, and beliefs about the utility of TEE. One hundred eight completed surveys were returned (70% response). Of those responding, 98 (91%) use intraoperative TEE. In 53 of those 98 institutions (54%), an anesthesiologist was primarily responsible for the interpretation of TEE data, whereas a cardiologist was responsible in the remainder. Approximately 35% of anesthesiologists using TEE had training in its use during residency or fellowship; the remainder were trained after finishing residency or fellowship. Forty-two percent of anesthesiologists who use TEE leave a formal interpretation on the chart apart from the anesthesia record, and 43% bill specifically for performing TEE. Although 69% of those responding thought that formal credentials should be required for anesthesiologists to use intraoperative TEE, only 32% reported that their institutions actually mandated this. 38% of those responding stated that they offer a dedicated TEE rotation to their residents, and 13% thought that their graduating residents were trained well enough to use TEE on their own. Among academic institutions responding, the use of intraoperative TEE is nearly universal, responsibility for its interpretation is split almost evenly between cardiologists and anesthesiologists, and there is a disparity between opinions and reality with regard to TEE credentialing for anesthesiologists. |
The attitudes of junior anaesthetists to research A survey | A survey was undertaken to investigate aspects of research work undertaken by junior anaesthetists. Two hundred and ninety‐five junior anaesthetists were surveyed. Forty‐seven percent of respondents were involved actively in research activities at the time of the survey, although 57% of senior house officers and registrars and 30% of senior registrars would not attempt to acquire publications except to improve their curriculum vitae. Few had received any formal training in research methods. The significance of these findings is discussed with regard to current training opportunities. Copyright © 1989, Wiley Blackwell. All rights reserved |
Teaching fibreoptic intubation: Effect of alfentanil on the haemodynamic response | A technique for teaching fibreoptic orotracheal intubation in patients under general anaesthesia is described and evaluated. A standard general anaesthetic was administered to 60 patients presenting for elective gynaecological surgery. Patients were randomly assigned to receive either alfentanil 10 μg. Kg−1 or a placebo, and to be intubated either by a consultant experienced in the use of the fibreoptic bronchoscope or by an inexperienced trainee under instruction. Heart rate, arterial pressure and oxygen saturation were monitored continuously. The time to achieve tracheal intubation in the trainee group was significantly prolonged (p < 0.001), but no patient developed arterial desaturation. The hypertensive response to fibreoptic intubation was suppresed in those patients who received alfentanil (p < 0.001). The increase in heart rate was not suppressed, but was attenuated when these patients were compared with those who had received the placebo (p < 0.001). Alfentanil 10μ.kg−1 minimises the haemodynamic response when teaching fibreoptic orotracheal intubation under general anaesthesia. Copyright © 1994, Wiley Blackwell. All rights reserved |
On line computer scheduling of anesthesiologists | A teleprocessed computer generated scheduling system is now in use in a large department of anesthesiology. Information typed into a cathode ray tube (CRT) terminal in the operating suite is processed and the activity schedule of all residents and attending anesthesiologists for the current day or any number of succeeding days is displayed and printed on command. Personal schedules of hourly assignments can be printed for any requested day. Feedback loops and manual override encourage man machine interaction. Weekend, holiday, and night call schedules are generated and vacation schedules controlled. Although there is no financial advantage over the previously used manual method, utility of the system and physician acceptance are excellent. Reproducible and reliable schedules are generated, relieving the department of dependence upon one or two knowledgeable scheduling officers. Since it immediately identifies all anesthesiologists available for clinical assignments any day or hour of the day, it is also a necessary initial operation in the eventual automatic production of the daily operating room surgical schedule by computer. |
A time and motion study of the anaesthetist's intraoperative time | A time and motion study was made of anaesthetists during 32 surgical procedures. Thirteen activities performed by the anaesthetist were defined for the study. Time and event data were recorded electronically and analysed by digital computer. Activity and link analysis techniques were used to analyse the data. Only 25% of intraoperative time was spent observing the physiological state of the patient. Seventy-five percent was spent in secondary or indirect activities. Direct observation of the patient was least in the middle of the procedure when the anaesthetist was performing secondary activities. Prudent use of personnel, machines, or both, to perform activities not requiring full medical knowledge and training should increase the anaesthetist's ability to focus full attention on the state of the patient and may improve patient care. © 1988 British Journal of Anaesthesia. |
The prevalence of serological markers for hepatitis B virus infection amongst anaesthetists in the Oxford region | A total of 125 anaesthetists from nine hospitals within the Oxford region were surveyed to study the prevalence of serological markers for hepatitis B virus (HBV) infection. No anaesthetists were positive for Hepatitis B Surface Antigen (HBsAg) and only four (3.2%) were positive for HBsAg antibody (anti‐HBsAg). This result is in marked contrast to other studies and suggests that anaesthetists in the United Kingdom do not constitute a high risk population. The reasons for this are discussed. Copyright © 1987, Wiley Blackwell. All rights reserved |
Diabetes mellitus and anaesthesia: A survey of the peri‐operative management of the patient with diabetes mellitus | A variety of methods are currently available for the management of the diabetic patient in the peri‐operative period. A questionnaire about current clinical practice was sent to all anaesthetists in the Oxford region. The majority reported that minor surgery in both insulin treated and noninsulin treated diabetic patients warranted no intervention other than avoidance of meals and medication before surgery, and that, for major surgery, a glucose‐insulin‐potassium infusion should be used. Fifty one out of 71 respondents in the junior staff grades preferred this latter approach for intermediate surgical procedures in insulin treated patients compared with 27 out of 69 of the consultant staff. Most anaesthetists aimed for blood glucose levels of 7–13 mmolilitre in the peri‐operative period. The literature is also reviewed. Copyright © 1988, Wiley Blackwell. All rights reserved |
Prevention and management of intra-operative pain during caesarean section under neuraxial anaesthesia: a technical and interpersonal approach | A woman who experiences pain during caesarean section under neuraxial anaesthesia is at risk of adverse psychological sequelae. Litigation arising from pain during caesarean section under neuraxial anaesthesia has replaced accidental awareness under general anaesthesia as the most common successful medicolegal claim against obstetric anaesthetists. Generic guidelines on caesarean section exist, but they do not provide specific recommendations for this area of anaesthetic practice. This guidance aims to offer pragmatic advice to support anaesthetists in caring for women during caesarean section. It emphasises the importance of non-technical skills, offers advice on best practice and aims to encourage standardisation. The guidance results from a collaborative effort by anaesthetists, psychologists and patients and has been developed to support clinicians and promote standardisation of practice in this area. © 2022 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists. |
The contributions of A. W. Hofmann | A. W. Hofmann broadly influenced anesthesiology through his seminal work on amine structures and synthetic amine drugs. Many drugs in addition to atracurium should invoke his memory. |
Challenging lung isolation secondary to aberrant tracheobronchial anatomy | Aberrant tracheobronchial anatomy is reported at an incidence of approximately 10% and most frequently involves the segmental and subsegmental bronchi. The most relevant abnormality to the practice of anesthesiology is the presence of a tracheal bronchus. Although typically an asymptomatic finding during bronchoscopy, a tracheal bronchus has important implications for airway management and lung isolation. Coexisting abnormalities may further complicate lung isolation. We describe a patient with a tracheal bronchus, coexisting with a left-shifted carina and apically retracted left mainstem bronchus, presenting for right extrapleural pneumonectomy. Attempts to place a left-sided double-lumen endotracheal tube were unsuccessful. We discuss our solution, review the literature, and present potential solutions for lung isolation in patients with a tracheal bronchus. Copyright © 2011 International Anesthesia Research Society. |
Peer review interrater concordance of scientific abstracts: A study of anesthesiology subspecialty and component societies | Abstracts presented at anesthesiology subspeciality and component society meetings are chosen by peer review. We assessed this process by examining selection criteria and determining interrater concordance. For the societies studied, the level of reviewer agreement ranged from poor to moderate, i.e., slightly better than by chance alone. We hypothesize that having clearer evaluation criteria, scoring systems with interval scales, and assessment based on quality can strengthen the peer review process. ©2006 by the International Anesthesia Research Society. |
The impact of longer-than-average anesthesia times on the billing of academic anesthesiology departments | Academic anesthesiology departments provide clinical services for surgical procedures that have longer-than-average surgical times and correspondingly increased anesthesia times. We examined the financial impact of these longer times in three ways: 1) the estimated loss in revenue if billing were done on a flat-fee system by using industry-averaged anesthesia times; 2) the estimation of incremental operating room (OR) sites necessitated by longer anesthesia times; and 3) the estimated potential gain in billed units if the hours of productivity of current anesthesia time were applied to surgical cases of average duration. Health Care Financing Administration average times per anesthesia procedure code were used as industry averages. Billing data were collected from four academic anesthesiology departments for 1 yr. Each claim billed with ASA units was included except for obstetric anesthesia care. All clinical sites that do not bill with ASA units were excluded. Base units were determined for each anesthesia procedure code. The mean commercial conversion factor (US$45 per ASA unit) for reimbursement was used to estimate the impact in dollar amounts. In all four groups, anesthesia times exceeded the Health Care Financing Administration average. The loss per group in billed ASA units if a flat-fee billing system were used ranged from 18,194 to 31,079 units per group, representing a 5% to 15% decrease (estimated billing decrease of US$818,719 to US$1,398,536 per group). The number of excess OR sites necessitated by longer surgical and anesthesia times ranged from 1.95 to 4.57 OR sites per group. The potential gain in billed units if the hours of productivity of current anesthesia time were applied to surgical cases of average duration was estimated to be from 13,273 to 21,368 ASA units. Longer-than-average anesthesia and surgical times result in extra hours or additional OR sites to be staffed and loss of potential reimbursement for the four academic anesthesiology departments. A flat-fee system would adversely affect academic anesthesiology departments. |
Variability in determination of point of needle insertion in peripheral nerve blocks: A comparison of experienced and inexperienced anaesthetists | Accurate identification of surface landmarks is essential for the successful performance of peripheral nerve blocks. The variability between experienced and inexperienced practitioners in identifying anatomical landmarks has not been studied previously. Anaesthetists were asked to identify the point of needle insertion for posterior lumbar plexus and sciatic nerve blocks on a volunteer using a standard textbook description. The chosen point for needle insertion was described in terms of X and Y co-ordinates, measured in millimetres, from a zero reference point marked on a volunteer's back. Fifteen experienced and 22 inexperienced anaesthetists took part in the study. The lumbar plexus block mean [range] values for the X, Y co-ordinates were 80 [62-108], 66 [46-86] and 92 [49-150], 62 [0-131] in the experienced and inexperienced groups, respectively. The sciatic nerve block X, Y co-ordinates were 77 [62-99], 70 [49-89] and 68 [29-116], 62 [26-93] in the experienced and inexperienced groups, respectively. The variance for the point of needle insertion was significantly greater in the inexperienced group (p < 0.01) for both the lumbar plexus and sciatic nerve blocks. We conclude that with increasing experience, there is decreased variability in determining the point of needle insertion using anatomical landmarks. |
The perioperative management of ascending aortic dissection | Acute aortic syndromes are a distinct group of pathologies involving the wall of the aorta that present acutely and can be potentially fatal unless treated in a timely fashion. The syndrome is dominated by aortic dissections, which comprise ≥95% of all such presentations. Those involving the ascending aorta are particularly lethal and require specific and early surgical treatment compared to dissections involving other parts of the aorta. The surgical repair of an ascending aortic dissection presents multiple challenges to the anesthesiologist. Thoughtful management throughout the perioperative period is critical for minimizing the significant morbidity and mortality associated with this condition. In this narrative review, we provide an overview of the perioperative management of patients presenting for the surgical repair of an ascending aortic dissection. Preoperative discussion focuses on assessment, hemodynamic management, and risk stratification. The intraoperative section includes an overview of anesthetic management, transesophageal echocardiographic assessment, and coagulopathy, as well as surgical considerations that may influence anesthetic management. Copyright © 2018 International Anesthesia Research Society. |
Keeping an Open Mind about Open Notes: Sharing Anesthesia Records with Patients | ADDENDUM: Please note that in the interim since this paper was accepted for publication, new governmental regulations, pertinent to the topic, have been approved for implementation. The reader is thus directed to this online addendum for additional relevant information: http://links.lww.com/AA/E44. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
Book review | Adverse Reactions to Anaesthetic Drugs. Volume 8. Monographs in Anaesthesiology Edited by J.A. Thornton. Copyright © 1982, Wiley Blackwell. All rights reserved |
Timing of reversal with respect to three nerve stimulator end-points from cisatracurium-induced neuromuscular block | After elective ear surgery with cisatracurium neuromuscular blockade, 48 adults were randomly assigned to receive neostigmine: (a) at appearance of the fourth twitch of a 'train-of-four'; (b) at loss of fade to train-of-four; or (c) at loss of fade to double-burst stimulation, all monitored using a TOF-Watch SX® on one arm. For each of these conditions, the recovery from train-of-four (TOF) ratio was measured in parallel objectively using a TOF-Watch SX placed on the contralateral arm. The median (IQR [range]) time from administration of reversal to a train-of-four ratio ≥ 0.9 was 11 (9-15.5 [2-28]) min, 8 (4-13.5 [1-25]) min and 7 (4-10 [2-15]) min in the three groups, respectively. This recovery time was significantly shorter when reversal was given at loss of fade to double-burst stimulation (c), than when given at the appearance of the fourth twitch (a), p = 0.046. However, the total time to extubation may be unaffected as it takes longer for fade to be lost after double-burst stimulation than for four twitches subjectively to appear. © 2015 The Association of Anaesthetists of Great Britain and Ireland. |
Adverse events and risk factors associated with the sedation of children by nonanesthesiologists | After implementation of hospital-wide monitoring standards, a quality assurance (QA) tool was prospectively completed for 1140 children (aged 2.96 ± 3.7 yr) sedated for procedures by nonanesthesiologists. The tool captured data regarding demographics, medications used, adequacy of sedation, monitoring, adverse events, and requirement for escalated care. The medical records of children who experienced adverse events are reviewed. Most (99%) children were monitored with pulse oximetry. Chloral hydrate was the most frequently used sedative (74.9% of cases). Of the children, 239 (20.1%) experienced adverse events related to sedation, including inadequate sedation in 150 (13.2%) and decrease in oxygen saturation in 63 (5.5%). Five of these children experienced airway obstruction and two became apneic. No adverse event resulted in long-term sequelae. Of the 854 children who received chloral hydrate, 46 (5.4%) experienced decreased oxygen saturation (≤90% of baseline). Children experienced desaturation after the use of chloral hydrate had received the recommended doses of chloral hydrate (38-83 mg/kg). ASA physical status III or IV and age <1 yr were predictors of increased risk of sedation-related adverse events. These data underscore the importance of appropriate monitoring that includes pulse oximetry to permit early detection of adverse events. Implications: This quality assurance study highlights the risks associated with the sedation of children and emphasizes the importance of appropriate monitoring by trained personnel. Children with underlying medical conditions and those who are very young are at increased risk of adverse events, which indicates that a greater degree of vigilance may be required in these patients. |
Artifactual increase in journal self-citation | After submission of a manuscript to a peer-reviewed anesthesia journal, several authors were asked to cite additional references from the journal to which they submitted. We hypothesized that there were differences among the anesthesiology journals in both the total number of self-citations and the proportion of self-citations to the total number of references in each manuscript for the years 2005 and 2010. METHODS: We conducted a review of a sample of manuscripts from 2005 and 2010 to examine the number and rate of self-citations. As a secondary analysis, we reviewed impact factor (IF), rate of self-referencing, and contribution of self-citations to IF in the population of manuscripts published in 8 anesthesia journals between 2000 and 2009 using the ISI Journal Citation Reports. RESULTS: The number (P < 0.0001) and rate (P < 0.0001) of self-citations among the different journals were significantly different in 2005, with similar results for 2010 in the number (P < 0.0001) and rate (P = 0.0002) of self-citations. The mean range of number of self-citations ranged from 0.45 (95% confidence interval [CI], 0.06 to 0.84) to 3.95 (95% CI, 2.2 to 5.7) in 2005 and from 0.25 (95% CI, -0.05 to 0.55) to 4.5 (95% CI, 2.2 to 6.9) in 2010. On a per-journal basis, no difference in the number of self-citations was noted between 2005 and 2010. Analysis of the ISI Journal Citation Reports from 2000 to 2009 suggested a general decline in the contribution of self-cites to the IF over time for the aggregate journals (Spearman correlation coefficient (Rs) -0.25 (95% CI, -0.45 to -0.03), P = 0.02), with the exception of the journal in question (Rs = 0.59 (95% CI, -0.1 to 0.88), P = 0.05). Positive correlations were found between self-cited rate and IF (Rs 0.52, 95% CI, 0.34 to 0.66, P < 0.0001), percentage of self-cites to years used in IF calculation and IF (Rs 0.41, 95% CI, 0.21 to 0.58, P < 0.0001), and δ-IF and IF (Rs 0.89, 95% CI, 0.84 to 0.93, P < 0.0001). CONCLUSION: Although the number and rate of self-citations differed among anesthesia journals, the contribution of self-citation to IF has declined over time for most anesthesia journals. These results suggest periodic reassessment may be important to ensure that the publication process remains transparent and impartial to bias. Copyright © 2011 International Anesthesia Research Society. |
Estimating the time needed for induction of anaesthesia and its importance in balancing anaesthetists' and surgeons' waiting times around the start of surgery | After the anaesthetist has induced anaesthesia, it is desirable that the surgeon is present and ready to start surgery, otherwise the team needs to wait for the surgeon. From another perspective, however, the surgeon does not necessarily wish to be present from the start of induction, since that process can take a variable time and the surgeon might be otherwise occupied in productive activity rather than waiting for the patient to be ready. Waiting times in the morning can therefore be a source of constant friction between anaesthetists and surgeons. In this prospective study we used the data from 718 first cases of the day, during a 4-week study period at two university hospitals, to develop a simple spreadsheet-based method to analyse the interaction of anaesthesia and surgical start time, anaesthesia technique and the probability of waiting time for anaesthetist or surgeon, respectively. This method can be used to determine the best surgical or anaesthesia start time for each case, so that the waiting time for anaesthetists and surgeons can be minimised. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland. |
Airway challenges in critical care | Airway management in the intensive care unit is more problematic than during anaesthesia. In general, critically ill patients have less physiological reserve and complications are more common, both during the initial airway intervention (which includes risks associated with induction of anaesthesia), and later once the airway has been secured. Despite these known risks, those managing the airway of a critically ill patient, particularly out of hours, may be relatively inexperienced. Solutions to these challenging airway problems include: recognition of those patients with a potential airway problem; implementation of a plan to deal with their airway; immediate availability of a difficult airway trolley; use of capnography for every airway intervention and continuously in all ventilator-dependent patients; and appropriate training of all intensive care unit staff including use of simulation. © 2011 The Association of Anaesthetists of Great Britain and Ireland. |
Non-operating room emergency airway management and endotracheal intubation practices: A survey of anesthesiology program directors | Airway management in the operating room is the responsibility of anesthesiologists, although a variety of personnel may be responsible for airway management outside the operating room. We conducted a survey of anesthesia program directors regarding emergency airway management practices at their institutions. A questionnaire was sent to anesthesia program directors listed in the Graduate Medical Education Directory for 1995-1996. Of the 153 programs surveyed, 134 (88%) responded. In 45% of institutions, intubations in the emergency ward (EW) were performed by emergency medical physicians, 32% by anesthesiology personnel, and 19% by both. Most intubations performed on the hospital ward were performed by anesthesiologists. Neuromuscular blocking drugs and sedative/hypnotics were used 90% and 95% of the time, respectively, by emergency medical physicians in hospitals in which they managed the airway independently. Our data serve as a snapshot of current practices. EW physicians are prominently involved in airway management in the emergency room both independently and with anesthesiologists. Airway management in trauma patients remains the domain of anesthesiologists. Anesthesiologists are most represented in airway management on hospital floors. |
Evaluation of four airway training manikins as simulators for inserting the LMA Classic™ | Airway manikins have traditionally been used for teaching mask ventilation and tracheal intubation. There is an increasing need to use manikins for training in procedures such as insertion of the laryngeal mask airway. We have assessed four new airway training manikins (latest versions of the Airway Trainer™ (Laerdal, Norway), Airway Management Trainer™ (Ambu, UK), 'Bill 1'™ (VBM, Germany) and Airsim™ (Trucorp, Ireland)) as simulators for insertion of the LMA Classic™ laryngeal mask airway. Twenty volunteer anaesthetists inserted a size-4 laryngeal mask airway five times into each of the four manikins, in random order. Each insertion was assessed using objective and subjective tests. Subjective assessment varied widely but overall assessment indicated that the Airway Management Trainer was the poorest simulator for insertion of the laryngeal mask airway. The 'Bill 1' and Airsim manikins performed best as simulators for insertion of the laryngeal mask airway, although realistic ventilation with 'Bill 1' was not possible. © 2006 The Authors Journal compilation 2006 The Association of Anaesthetists of Great Britain and Ireland. |
The effect of audible alarms on anaesthesiologists' response times to adverse events in a simulated anaesthesia environment: A randomised trial | Alarms are ubiquitous in anaesthetic practice, but their net effect on anaesthesiologists' performance and patient safety is debated. In this study, 27 anaesthesiologists performed two simulation sessions in random order; one session was programmed to include an alarm condition, with a standard, frequent, clearly audible alarm sound. During these sessions, adverse events were simulated and anaesthesiologists' response times to these events were recorded. Perceived workload was assessed with the NASA Task Load Index. Response times to adverse events and perceived workload were similar in both groups. Pooled response times to atrial fibrillation and desaturation were fast, with a median (range [IQR]) of 8 (4-14 [1-41]) s and 9 (6-16 [1-44]) s, respectively. Pooled response times to an ST segment elevation on the ECG and an obstructed intravenous line were significantly slower, with median (IQR[range]) times of 34 (21-76[4-300]) s and 227 (95-399 [2-600]) s, respectively (p < 0.001). This study shows that in a simulated anaesthesia environment, response times to adverse events are similar in the absence or presence of an audible alarm, and that response times to various critical events differ. © 2014 The Association of Anaesthetists of Great Britain and Ireland. |
The anaesthetic logbook - A survey | All anaesthetic trainees must maintain a logbook. The recent extension of Specialist Registrar training from 4 to 5 years, granted by the Specialist Training Authority, is conditional upon a change to competency-based training. The Royal College of Anaesthetists defines competency as possession of the 'trinity' of knowledge, skills and attitudes. This raises the question of whether the present logbook is of value in recording training. I surveyed a national cohort of trainees to investigate the current logbook: how it is being used, its value and its shortcomings. All respondents kept logbooks, but 81% and 69% experienced problems recording subspecialty experience in Intensive Care and Pain, respectively. Less than 50% regularly analysed their logbooks and for 67% of Specialist Registrars, no (or minimal) attention was paid to the logbook at assessments. Overwhelmingly, 97% did not believe that the current logbook assessed competency. The value of Training Portfolios is discussed. |
Francis Percival de Caux (1892–1965): An anaesthetist at odds with social convention and the law | All doctors practice medicine within the confines of what is termed ‘acceptable practice’. This acceptable practice is delineated by medical ethics, the actions of one's colleagues, social custom, and the laws of the country. Failure to conform to any or all of these constraints may result in professional ostracism or even loss of liberty. The life and work of Frances Percival de Caux clearly shows these effects in their most damaging manner. Copyright © 1991, Wiley Blackwell. All rights reserved |
Hospitalization for miscarriage and delivery outcome among Swedish nurses working in operating rooms 1973-1978 | All infants born in 1973-1978 to nurses working in anesthesiology or as operating room nurses were identified from a nationwide registry of all births in Sweden, a registry of hospitalized spontaneous and legally induced abortions that covers 70% of Sweden, and a nurse registry (n = 1323). For comparison, a group was formed that consisted of nurses working in medical wards (n = 1382). Delivery outcome was also compared with the estimate expected from nationwide figures. No statistically significant differences were seen, but infants of the anesthesiology/operating room nurses had a slightly higher perinatal death rate and a slightly higher rate of preterm births and low birth weights than infants in the comparison group and the nationwide average. On the other hand, the malformation rate was lower in the infants of anesthesiology/operating room nurses than in the control group or nationwide average. A case-control study within the group of anesthesiology/operating room nurses was performed. Questionnaires were sent to 75 nurses (25 cases whose infants died or had serious malformations; 50 controls whose infants were normal); 74 responded. The only difference in working conditions for cases and controls was that the cases had worked after the twenty-eighth week of pregnancy more often than the controls. However, this finding was restricted to nurses whose infants were malformed, and work after the twenty-eighth week cannot affect malformation rate. Work in anesthesiology or operating rooms had no effect on the incidence of hospitalization for miscarriage, perinatal deaths, or malformations detected in the neonatal period. |
SHO training in anaesthetics. How good is it? | All senior house officer posts in the Yorkshire Deanery have been assessed against five parameters. Posts in anaesthesia were among the best with excellent consultant support, good exposure to clinical practice and well-structured education and training. Anaesthetic poses were almost unique in satisfying the 'New Deal' on junior doctors hours though intensity of work was something of a problem for the on-call senior house officer. Appraisal is a new educational tool which is bring used to a greater degree in anaesthetics than in any other specialty. The deficiencies found in anaesthetic posts could be corrected by the universal use of appraisal and solving the recruitment problems that have compromised the delivery of good training in some districts. |
Beyond Ether Day: Betsey Magoun, the Forgotten Patient | Although the analgesic effects of ether were conclusively established during a series of public demonstrations of anesthesia at Massachusetts General Hospital in 1846, ether anesthesia was neither immediately nor universally introduced into practice. Betsey Magoun, the fourth patient undergoing surgery under anesthesia at the hospital, suffered life-threatening hypoxia and respiratory complications. Severe intraoperative problems witnessed by large audience may have contributed to the cautious introduction of anesthesia into routine practice. Ether inhalation was not commonly used until more effective methods of induction and maintenance of anesthesia were discovered. © 2023 Lippincott Williams and Wilkins. All rights reserved. |
CS gas—implications for the anaesthetist | Although the use of CS gas is illegal in the UK, an occasional patient exposed to its effects may be seen. We report the problems experienced with the anaesthetic management of such a patient. Copyright © 1993, Wiley Blackwell. All rights reserved |
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