Anaesthesia
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All anaesthetic trainees must maintain a logbook. The recent extension of Specialist Registrar training from 4 to 5 years, granted by the Specialist Training Authority, is conditional upon a change to competency-based training. The Royal College of Anaesthetists defines competency as possession of the 'trinity' of knowledge, skills and attitudes. ⋯ Less than 50% regularly analysed their logbooks and for 67% of Specialist Registrars, no (or minimal) attention was paid to the logbook at assessments. Overwhelmingly, 97% did not believe that the current logbook assessed competency. The value of Training Portfolios is discussed.
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Multicenter Study Clinical Trial
The safety and efficacy of cisatracurium 0.15 mg.kg(-1) during nitrous oxide-opioid anaesthesia in infants and children.
We studied the neuromuscular and cardiovascular effects of a single, rapidly administered intravenous dose of cisatracurium 0.15 mg.kg(-1) in 27 infants (aged 1-23 months) and 24 children (aged 2-12.5 years). After midazolam premedication, anaesthesia was induced and maintained with thiopental and alfentanil in addition to nitrous oxide in oxygen. Neuromuscular function was monitored by evoked adductor pollicis electromyography. ⋯ Once neuromuscular function started to recover, the rate of recovery was similar in both age groups. Changes in blood pressure and heart rate after the administration of cisatracurium were negligible in both age groups. Cisatracurium, at a dose of 0.15 mg. kg(-1), was effective and well tolerated in infants and children.
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Spinal anaesthesia should not be performed above the L3/4 interspace if relying on surface anatomy to determine spinal level.
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