Anesthesiology
-
Comparative Study
An evaluation of anesthesiologists' present checkout methods and the validity of the FDA checklist.
The United States Food and Drug Administration (FDA) published the Anesthesia Apparatus Checkout Recommendations (checklist) in order to improve the methods anesthesiologists use to check out anesthesia equipment. Whereas no published study of current checkout methods had been performed since the introduction of the FDA checklist, we compared anesthesiologists' current anesthesia equipment pre-use checkout methods with anesthesiologists' use of the FDA checklist. One hundred and eighty-eight anesthesiologists were tested to compare the number of prearranged anesthesia machine faults that could be detected with 1) their own checkout methods and 2) the FDA checklist. ⋯ For only one fault, malfunction of the oxygen/nitrous oxide ratio protection system, was there a statistically significant improvement (P less than 0.01) with the use of the FDA checklist. Anesthesiologists in residency training detected more faults (average 2.46/8, 30.8%) than did anesthesiologists who primarily practiced direct patient care (1.98/8, 23.9%) (P less than 0.01). Our data indicate that the mere introduction of the FDA checklist did not improve the ability of anesthesiologists to detect anesthesia machine faults.
-
The anatomic findings from cryomicrotome sections of 38 cadaver lumbar spines are reported. The technique produces high-resolution planar images of undisturbed epidural anatomy. Several observations differ from previous reports that used methods more prone to artifact. ⋯ The space anterior to the dura is filled with veins and is isolated from the rest of the epidural space by a membranous lateral extension of the posterior longitudinal ligament. This membrane and a midline posterior fat pedicle are the only observed potential barriers to the spread of epidural solutions. These findings may be important in understanding the mechanics and pharmacokinetics of solutions injected into the epidural space and in refining techniques for needle and catheter placement.
-
Recently there have been several reports of postoperative sepsis due to the intravenous injection of contaminated solutions of propofol (Diprivan). The mechanism by which this contamination occurred has not been identified. This study sought to determine whether bacterial contamination of the contents of glass ampules can be decreased by swabbing the neck of the vial with alcohol prior to opening. ⋯ The contents of all ampules that had been wiped with alcohol prior to being opened remained sterile (P less than 0.001 vs. non-alcohol-treated group for propofol ampules and P = 0.20 vs. non-alcohol-treated group for lidocaine ampules). These data suggest that bacterial contamination of propofol and lidocaine may occur as a result of opening glass ampules. Wiping the outside of the ampule with alcohol immediately prior to opening may decrease this risk.
-
To evaluate physiologic responses to mild perianesthetic hypothermia, we measured tympanic membrane and skin-surface temperatures, peripheral vasoconstriction, thermal comfort, and muscular activity in nine healthy male volunteers. Each volunteer participated on three separate days: 1) normothermic isoflurane anesthesia; 2) hypothermic isoflurane anesthesia (1.5 degrees C decrease in central temperature); and 3) hypothermia alone (1.5 degrees C decrease in central temperature) induced by iced saline infusion. Involuntary postanesthetic muscular activity was considered thermoregulatory when preceded by central hypothermia and peripheral cutaneous vasoconstriction. ⋯ Tonic waxing-and-waning was by far the most common pattern and resembled that produced by cold-induced shivering in unanesthetized volunteers; it appears to be thermoregulatory shivering triggered by hypothermia. Spontaneous clonus resembled flexion-induced clonus and pathologic clonus and did not occur during hypothermia alone; it may represent abnormal shivering or an anesthetic-induced modification of normal shivering. We conclude that among the three patterns of muscular activity, only the synchronous, tonic waxing-and-waning pattern can be attributed to normal thermoregulatory shivering.