Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1998
Clinical TrialDepth of central venous catheter insertion in adults: an audit and assessment of a technique to improve tip position.
A technique of subclavian vein catheterization is described, tailored to the individual patient, to reduce the risk of right atrial placement with central venous catheter (CVC) insertion. Using data gathered retrospectively for Quality Improvement purposes, CVC tip location was assessed. The standard technique used in our cardiac anaesthesia unit at that time was to insert all CVCs to a depth of 15 cm from the skin. ⋯ The tailored method involved measuring the distance from the skin at which venepuncture occurred and using this distance to determine depth of CVC insertion. Using the tailored technique significantly decreases the frequency with which CVC tips enter the right atrium (P < 0.001). An advantage of the tailored technique is that the distance between the most proximal and the distal ports of multi-lumen CVCs is taken into consideration, reducing the risk of extravasation via the proximal port.
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Anaesth Intensive Care · Feb 1998
Case ReportsSpinal anaesthesia--the current trend towards narrow gauge atraumatic (pencil point) needles. Case reports and review.
Advances in manufacturing technology have led to the wider availability and affordability of narrow gauge atraumatic spinal needles. The use of these needles is the most effective method available for anaesthetists to reduce the incidence of post dural puncture headache. Their use in all circumstances however, may not be appropriate in light of the problems which may be associated. These problems are illustrated here by four case reports and a review of the literature.
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A survey carried out by the Australian Society of Anaesthetists explored gender issues in the personal and professional lives of anaesthetists. Issues highlighted include training and career paths, combining anaesthetic training with domestic responsibilities, personal relationships, pregnancy and childrearing, private practice, part-time work, parental leave, the single anaesthetist, doctor spouses, sexual harassment, and negative attitudes in colleagues. Particular problems were identified in the training years, in part-time work, in private practice, and in combining parental and domestic responsibilities with a career in anaesthesia. Strategies to address relevant issues are discussed, with reference to the increasing proportion of women in medicine and anaesthesia.
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Anaesth Intensive Care · Feb 1998
Case ReportsAirway management for an uncooperative patient with recessive dystrophic epidermolysis bullosa.
We describe a case of an unco-operative patient with recessive dystrophic epidermolysis bullosa in whom difficult tracheal intubation was anticipated and fibreoptic bronchoscope guided tracheal intubation was successfully achieved after induction of general anaesthesia. Other problems in airway management associated with this disorder are discussed.
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The formal project has been a requirement for the F. A. N. ⋯ A. diploma, which ideally should be taught before the Primary (30%) or in the Provisional Fellowship year (36%). Few respondents indicated a willingness to undertake a major commitment to research in the future (4%) but 46% wanted some contact with research and teaching as part of their normal work practice. A more structured teaching in research methodology, assessment of published work and presentation skills may be more suited to the longterm goals of the majority of clinical anaesthetists.