European journal of anaesthesiology
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Comparative Study
Attendance of the anaesthesiologist to the patient. National recommendations for standard of anaesthetic practice.
The national recommendations for standard of anaesthetic practice in six countries of the European Community are compared with respect to the attendance of the anaesthesiologist to the patient. These standards apply to anaesthesia, major regional anaesthesia and sedation administered by anaesthesiologists. The attendance to the patient varies from strict continuous presence of the anaesthesiologist to observation of the patient by a non-medical assistant and the anaesthesiologist taking care of another anaesthetized patient. Items which all standards should mention are defined.
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Although it is generally acknowledged that a pre-use checkout of the anaesthetic machine significantly improves patient safety, an evaluation of such procedures is uncommon. Previous studies have shown that anaesthetic personnel using different check routines are unable to detect the majority of pre-set technical malfunctions. We have shown that it is possible to develop an effective and time-saving check procedure by integrating seven simple steps into one continuous flow procedure, where the settings and results of one step are used in the following step to optimize step interaction. ⋯ A performance test was undertaken by activating four different malfunctions in an anaesthetic machine training simulator. Twelve of 17 nurse anaesthetists rapidly identified all faults, whereas five nurses missed one or two faults. Our study suggests that our check procedure (the seven point check) provides a time-saving method for effective pre-use control of the anaesthetic machine.
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Propofol has been reported to cause discolouration of urine and hair. A case of green discolouration of the liver is reported in a 56-year-old man after long-term sedation with propofol in the intensive care unit. After discontinuation of propofol the discolouration of the liver disappeared. This phenomenon is due to metabolism of propofol which may lead to a phenolic green chromophore which is conjugated in the liver and excreted in the urine.