Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. System failure: an analysis of 2000 incident reports.
Although 70-80% of problems have some component of human error, its overall contribution to many problems may be small; studies of complex systems have revealed that up to 85% are primarily due to deficiencies in the lay-out and processes of the system. The anaesthetist has to operate in a complex system; many problems originate from deficiencies in this system. Information of relevance to system failure was extracted from the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS). ⋯ Level III involves interaction between AIMS and the major professional bodies and level IV interaction between AIMS, these bodies and a variety of national and international agencies. Over 100 topics were identified from the AIMS data for consideration at one or more of these levels. AIMS has the potential not only to play a vital practical role in the continued enhancement of the quality of anaesthetic practice, but also to provide a valuable resource for research at the increasingly important interface between human behaviour and complex systems.
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Which monitor? An analysis of 2000 incident reports.
The role of monitors in patients undergoing general anaesthesia was studied by analysing the first 2000 incidents reported to the Australian Incident Monitoring Study; 1256 (63%) were considered applicable to this study. In 52% of these a monitor detected the incident first; oximetry (27%) and capnography (24%) detected over half of the monitor detected incidents, the electrocardiograph 19%, blood pressure monitors 12%, a low pressure (circuit) alarm 8%, and the oxygen analyser 4%. Of the other monitors used, 5 first detected 1-2% of incidents, and the remaining 8 less than 0.5% each. ⋯ Other monitors, including the ECG, each increase the yield by by less than 0.5%. The international monitoring recommendations and those of the Australian and New Zealand College of Anaesthetists are thoroughly vindicated by the patterns revealed in this study. The priority sequence of monitor acquisition for those with limited resources should be stethoscope, sphygmomanometer, oxygen analyser if nitrous oxide is to be used, pulse oximeter, capnograph, high pressure alarm, and, if patients are to be mechanically ventilated, a low pressure alarm (or spirometer with alarm); an ECG, a defibrillator, a spirometer and a thermometer should be available.
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Anaesth Intensive Care · Oct 1993
The Australian Incident Monitoring Study. Recovery room incidents in the first 2000 incident reports.
Of the first 2000 incidents reported to the Australian Incident Monitoring Study 120 (6%) occurred in the recovery room after general, regional or local anaesthesia. Over two thirds (69%) of these involved the respiratory system, 19% were cardiovascular, 3% involved the central nervous system and 9% were miscellaneous in nature. These recovery room incidents were associated with significantly more adverse outcomes (56%) than incidents in the operating theatre (24%). ⋯ Over three quarters (77%) of all recovery incidents (and 88% of respiratory incidents) were detected clinically; the remainder were first detected by a monitor. A theoretical analysis showed that over 95% of respiratory events, had they been allowed to evolve, would have been detected by pulse oximetry before organ damage occurred, emphasising the potential importance of pulse oximetry in reducing adverse outcome from any complication in the recovery ward which might be "missed" by clinical observation. The findings of this study underline the importance of having an adequate number of trained recovery nursing staff supported by the availability of a pulse oximeter for each patient at least until the return of protective reflexes and the ability to maintain adequate arterial saturation has been established.
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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.