Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Multicenter Study Clinical Trial
The Canadian four-centre study of anaesthetic outcomes: I. Description of methods and populations.
The objectives of this study were first to develop and institute a methodology for the study of anaesthetic outcome for parallel use in four teaching hospitals in Canada and second, to compare rates of morbidity and mortality associated with anaesthesia between the four centres. The basic design of the study was occurrence screening with anaesthetists entering data on patient demographics, anaesthetic and surgical factors. Research nurses reviewed anaesthetic records and hospital charts and interviewed patients postoperatively. ⋯ There were major differences found across the hospitals, particularly with regard to volume, patient case-mix, anaesthetic drugs and monitoring used. The use of parallel training, repeated consultations and use of rounds and inservices contributed to the reliability and validity of the data collection. We conclude that outcome surveillance can be instituted in different hospital Departments of Anaesthesia with sufficient confidence to form the basis of comparison of anaesthetic outcome.
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Unanticipated difficulties continue to occur in airway management. While newer systems of evaluation show some promise, the problem of poor predictive value limits their usefulness. ⋯ The anaesthetist should have a clear "fall back" plan of which of these techniques to use in emergency or urgent situations. Published algorithms may aid in the selection of appropriate techniques, but the anaesthetist must also develop dexterity with the particular technique chosen.
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The practice of obstetric anaesthesia can be highly rewarding. The clinician prepared with an understanding of maternal-fetal physiology (obstetric requirements), systemic narcotics, and regional anaesthesia can be highly effective at relieving pain and bringing about a successful delivery. While alternative techniques should always be considered, particularly those that stress childbirth education, continuous lumbar analgesia remains the most flexible and satisfactory approach. While there is new equipment (fine needles and smaller catheters) on the horizon, it remains to be demonstrated if they can match the success and safety record of present lumbar epidural practice.