Anaesthesia
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Awareness remains a serious complication of general anaesthesia with potential adverse psychological sequelae. Even during seemingly adequate general anaesthesia, implicit memory may be retained along with the ability to subconsciously process auditory stimuli. ⋯ We shall discuss the structure of memory and the effects of increasing doses of general anaesthesia on cognitive processes. In addition methods of assessing the depth of anaesthesia will be reviewed.
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Clinical Trial Controlled Clinical Trial
Oxygenation of patients undergoing ophthalmic surgery under local anaesthesia.
The oxygenation of 30 patients undergoing elective ophthalmic surgery without sedation whilst breathing air was studied and was compared with two methods of oxygen supplementation. Arterial oxygen saturation, inspired and expired oxygen and carbon dioxide were analysed. The delivery of oxygen at 21.min-1 via nasal cannulae was shown to be superior to a method which directed oxygen from under the surgical drapes.
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A prospective interview-based survey on the incidence of postoperative nausea and vomiting in 1107 in-patients aged 4-86 years was conducted during a 3-month period. Nausea, emetic episodes and the need for anti-emetic medication were recorded for 24 h postoperatively. In the recovery room, the incidence of nausea and vomiting was 18% and 5%, respectively. ⋯ The highest incidence of emetic sequelae was observed in gynaecological patients; 52% of the 822 patients who received general anaesthesia and 38% of the 285 patients who received regional anaesthesia reported nausea. The most important predictive factors associated with an increased risk for nausea and vomiting were female gender, a previous history of postoperative sickness, a longer duration of surgery, nonsmoking and a history of motion sickness. Based on these five items, a simple score predicting the risk of nausea and vomiting was constructed with a moderately good discriminating power.
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Clinical Trial
Evaluation of thoracic epidural catheter position and migration using radio-opaque catheters.
Migration of thoracic epidural radio-opaque catheters was evaluated in 25 patients scheduled for thoracic surgery in the supine position (n = 5) or in the lateral position with lateral extension of the thoracic spine (n = 20). Chest radiography was performed daily for 3 days after operation. ⋯ The catheter tip position was unchanged in all patients operated upon in the supine position. In the group operated upon in the lateral position, the catheter tip retracted from day 1 to day 2 by an average of 0.69 cm (SD 1.08; p < 0.05); from day 2 to day 3 the average retraction was 0.35 cm (SD 0.67; p < 0.05).
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Critical incident reporting was introduced into the intensive care unit (ICU) as part of the development of a quality assurance programme within our department. Over a 3-year period 281 critical incidents were reported. Factors relating to causation, detection and prevention of critical incidents were sought. ⋯ Critical incident reporting was effective in revealing latent errors in our "system' and clarifying the role of human error in the generation of incidents. It has proven to be a useful technique to highlight problems previously undetected in our quality assurance programme. Improvements in quality of care following implementation of preventative strategies await further assessment.