Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Disruptive intraoperative behaviour has detrimental effects on clinicians, institutions, and patients. Abusive behaviour is an egregious form of disruptive behaviour that has a particular risk of detrimental consequences. The prevalence of abusive behaviour in the operating room (OR) is uncertain. We therefore examined the prevalence and frequency of exposure to abusive behaviour in a cohort of Canadian and US OR clinicians. ⋯ Both the number of clinicians who are exposed to abusive behaviour and the large number of reported events are concerning. Since these events can undermine team-work and affect patients, coworkers, and institutions, efforts are needed to further evaluate and manage the problem.
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Hyperbaric bupivacaine (0.75% in dextrose) is used for spinal obstetric anesthesia. Occasional clusters of anesthetic failures occur in this setting, not readily attributable to clinical factors. We hypothesized that cold temperature exposure is related to bupivacaine instability. ⋯ Canadian clinical practice and handling of hyperbaric bupivacaine is consistent. Most respondents indicated an interest in a formal reporting and collection process. Cold exposure did not degrade bupivacaine. A complex and possibly inconsistent reaction involving dextrose was identified that requires further analysis of a larger sample size to elucidate the mechanisms.
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Observational Study
Right upper lobe anatomy revisited: a computed tomography scan study.
The double lumen tube (DLT) has become the most popular way to isolate the lungs for thoracic surgery. The variable anatomy of the right main stem bronchus (RMSB) seems to be the main reason clinicians are unwilling to use the right-sided DLT (R-DLT). The factors that could compromise the adequate ventilation of the right lung are mostly the variable length of the RMSB and the misalignment of the lateral orifice of the R-DLT in regard to the right upper lobe bronchus (RULB). The objectives of this study were to validate an alternative method to estimate the RMSB length, and to determine the distribution of the angulation of the ostium of the RULB. ⋯ These anatomic observations provide a better understanding of the variable anatomy of the right bronchial tree and may guide thoracic anesthesiologists in the choice of the best lung isolation device for their patients.