Anaesthesia and intensive care
-
Anaesth Intensive Care · Nov 2009
ReviewThe rise of simulation in technical skills teaching and the implications for training novices in anaesthesia.
Changes in work practices have led to a decline in the opportunities for anaesthetic trainees to learn technical procedures in supervised practice. Efforts to mitigate medical error and other changes have coincided with the development of alternative training methods so that it is increasingly difficult to justify the traditional model of teaching technical procedures. The range of simulators available for training in technical procedures in anaesthesia continues to expand. ⋯ Using the available simulation equipment and educational tools, trainees can be prepared to begin supervised practice having demonstrated adequate procedural knowledge and expertise in simulation. With the use of simulated patients there is also the opportunity to integrate non-technical skills as well where appropriate. This review summarises the justification for the use of simulation in technical skills training in anaesthesia and the educational theory that supports its use, and outlines one of the available frameworks that can be used to aid its application.
-
Anaesth Intensive Care · Nov 2009
Clinical TrialDerivation and prospective testing of a two-step sevoflurane-O2-N2O low fresh gas flow sequence.
Simple vaporiser setting (F(D)) and fresh gas flow (FGF) sequences make the practice of low-flow anaesthesia not only possible but also easy to achieve. We sought to derive a sevoflurane F(D) sequence that maintains the end-expired sevoflurane concentration (F(A)sevo) at 1.3% using the fewest possible number of F(D) adjustments with a previously described O2-N2O FGF sequence that allows early FGF reduction to 0.7 l min(-1). In 18 ASA physical status I to IH patients, F(D) was determined to maintain F(A)sevo at 1.3% with 2 l min(-1) O2 and 4 l min(-1) N2O FGF for three minutes, and with 0.3 and 0.4 l min(-1) thereafter. ⋯ When prospectively tested, median (25th; 75th percentile) performance error was 0.8 (-2.9; 5.9)%, absolute performance error 6.7 (3.3; 10.6)%, divergence 18.2 (-5.6; 27.4)%.h(-1) and wobble 4.4 (1.7; 8.1) %. In one patient, FGF had to be temporarily increased for four minutes. One O2/N2O rotameter FGF setting change from 6 to 0.7 l min(-1) at three minutes and two sevoflurane F(D) changes at three and 15 minutes maintained predictable anaesthetic gas concentrations during the first 45 minutes in all but one patient in our study.
-
Anaesth Intensive Care · Nov 2009
Case ReportsA failure of M-Entropy to correctly detect burst suppression leading to sevoflurane overdosage.
Electroencephalogram depth of anaesthesia monitors are increasingly being used, with the aim of reducing awareness during anaesthesia. Most literature concentrates on the ability of these monitors to predict when a patient is likely to be aware. This case report highlights the opposite problem, where the monitor (M-Entropy) indicated an awake state but the patient was in fact deeply anaesthetised. If the anaesthetist is unable to interpret the raw electroencephalogram and understand the limitations of the monitor being used, excessive doses of anaesthetic may be given with potentially serious consequences.
-
Anaesth Intensive Care · Nov 2009
Comparative StudyCricothyroidotomy: comparison of three different techniques on a porcine airway.
We compared three different cricothyroidotomy techniques on a cadaveric porcine airway model to determine the most rapid, successful and safe method in emergency situations. In this observational comparative bench-test, surgical or scalpel cricothyroidotomy (ST), Cook Melker Cricothyrotomy Kit (CM) and Portex Cricothyroidotomy Kit (PCK) were evaluated. After a familiarisation program, four operators performed five procedures using each of the techniques. ⋯ There were no significant anatomical variations in the pig larynxes. We conclude that the CM technique is safe, rapid and has a significantly higher success rate in achieving an artificial airway in this airway model. Overall, all the participants in our study preferred to use this kit in an emergency situation.
-
Anaesth Intensive Care · Nov 2009
Repeated intrathecal administration of ropivacaine causes neurotoxicity in rats.
Previous studies suggest that ropivacaine causes the least neurotoxicity among local anaesthetics. Most data derive from a single injection of ropivacaine into the subarachnoid space. The histological changes and behavioural effects of repeated intrathecal administration have yet to be studied. ⋯ As expected, the recovery time to normal ambulation was prolonged as the ropivacaine concentration was increased. Ropivacaine can induce neurotoxicity and trigger apoptosis in a dose-dependent manner after repeated intrathecal administration. Although the clinical safety profile of ropivacaine appears favourable compared with other local anaesthetics, it is possible our findings have clinical significance.