Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Problems with ventilation: an analysis of 2000 incident reports.
A review of the first 2000 incidents reported to the Australian Incident Monitoring Study found 317 incidents which involved problems with ventilation. The major portion (47%) were disconnections; 61% of these were detected by a monitor. Monitor detection was by a low circuit pressure alarm in 37% but this alarm failed to warn of non-ventilation in 12 incidents (in 6 because it was not switched "on" and in 6 because of a failure to detect the disconnection). ⋯ The frequency of a complete failure to check an anaesthetic machine was greater when an induction room was involved than when only the operating theatre was the site of the incident. These incidents suggest that meticulous checking and monitoring for failure of ventilation, preferably using at least two separate, self-activating systems is highly desirable. The Australian and New Zealand College of Anaesthetists' policy on low circuit pressure alarms, oximetry and capnography is vindicated by these reports.
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. The oxygen analyser: applications and limitations--an analysis of 200 incident reports.
The first 2000 incidents reported to the Australian INcident Monitoring Study were analysed with respect to the role of the oxygen analyser; 27 (1%) were first detected by the oxygen analyser. All of these were amongst the 1256 incidents which occurred in association with general anaesthesia, of which 48% were "human detected" and 52% "monitor detected". The oxygen analyser was ranked 7th and detected 4% of these monitor detected incidents. ⋯ In a theoretical analysis of these 1256 incidents it was considered that the oxygen analyser, used on its own, would have detected 114 (9%), had they been allowed to evolve (3% before any potential for organ damage). In 4 incidents an oxygen analyser gave faulty readings, in 3 caused a leak and in one a total circuit obstruction; 5 incidents were not detected because the alarm had been disabled. Despite the advent of piped gas supplies, failure of gas delivery or delivery of a "wrong" gas mixture still occurs surprisingly frequently in current anaesthetic practice; hypoxic mixtures were supplied on 16 occasions, other "wrong" mixtures on 23 and the oxygen supply failed on 7 occasions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Blood pressure monitoring--applications and limitations: an analysis of 2000 incident reports.
Of the first 2000 incidents reported to the Australian Incident Monitoring Study, 1256 occurred in relation to general anaesthesia and 81 of the latter were first detected by blood pressure (BP) monitoring. A further 25 incidents not associated with general anaesthesia were first detected by blood pressure monitoring, giving a total of 106. In the monitor detection of incidents in relation to general anaesthesia, BP monitoring ranked fourth after oximetry, capnography and low pressure alarms. ⋯ The 10 cases of invasive monitoring failure were predominantly due to mains power loss, hardware breakage or operator error. In a theoretical analysis of the 1256 GA incidents, it was considered that on its own, BP monitoring would have detected 919 (73%), but in the vast majority, by the time this detection has occurred, potential organ damage could not be excluded. It is recommended that BP be measured at regular intervals dictated by clinical requirements (usually at least every five minutes).(ABSTRACT TRUNCATED AT 250 WORDS)
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Anaesth Intensive Care · Oct 1993
Randomized Controlled Trial Comparative Study Clinical TrialTowards optimal analgesia after caesarean section: comparison of epidural and intravenous patient-controlled opioid analgesia.
The provision of optimal analgesia after caesarean section remains a challenge as satisfactory pain relief must be combined with patient satisfaction, including the ability to care for the newborn. In a prospective study of 132 patients, we have compared epidural analgesia with intravenous patient-controlled analgesia (IVPCA) after either epidural or general anaesthesia. Different bolus doses of opioid (pethidine 10 mg and 20 mg) in the IVPCA group were also compared. Although epidural morphine provided the greatest efficacy (average pain score out of 10 was 1.8 v. 2.9-3.4 for the other groups), IVPCA, especially with a bolus dose of 20 mg, and especially after epidural anaesthesia, provided the greatest patient satisfaction with the least side-effects.
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Anaesth Intensive Care · Oct 1993
Comparative StudyThe Australian Incident Monitoring Study. Paediatric incidents in anaesthesia: an analysis of 2000 incident reports.
The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed to compare anaesthetic incidents in infants and children with those in adults. Of the 2000, 1790 (90%) involved adults, 151 (7%) children and 56 (3%) infants. Healthy children (ASA I) generated a greater proportion of incidents in this group than adults and infants, emphasizing the need for maintaining the same standards for children in this group as for infants and higher risk groups. ⋯ In the AIMS study procedures on the head and neck yielded proportionately more incidents in the infant/child group than in the adult group, as did incidents involving the respiratory and breathing circuit systems. Incidents in the child group were often detected clinically; however, there were no differences between the three age groups in the way monitors were used or performed; hence the same monitoring recommendations apply to all groups. Combined oximetry and capnography would have detected nearly 90% of all applicable problems in the AIMS study and could have prevented nearly 90% of the claims arising from inadequate ventilation in the US "closed claims" study.(ABSTRACT TRUNCATED AT 250 WORDS)