Anaesthesia
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Comparative Study
Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques.
In a randomised crossover trial, we compared a wire-guided cricothyrotomy technique (Minitrach) with a catheter-over-needle technique (Quicktrach). Performance time, ease of method, accuracy in placement and complication rate were compared. Ten anaesthesiology and 10 ENT residents performed cricothyrotomies with both techniques on prepared pig larynxes. ⋯ There was one complication in the catheter-over-needle group compared to five in the wire-guided group. We conclude that the wire-guided minitracheotomy kit is unsuitable for emergency cricothyrotomies performed by inexperienced practitioners. On the other hand, the catheter-over-needle technique appears to be quick, safe and reliable.
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We describe a simple, homemade model for teaching cricothyrotomy. It can easily be constructed from materials found in every anaesthetic room and is cheap, portable and usable several times before requiring replacement. We also describe evaluation of the model in a two-part study. ⋯ In the second part, both models were rated well, with similar scores. The homemade model is an easily assembled alternative to more expensive models. Both experienced and inexperienced trainees find practising on such models useful.
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Case Reports
Ultrasound guidance for a lateral approach to the sciatic nerve in the popliteal fossa.
Descriptions of the use of ultrasound for nerve location have focused on upper limb blocks. We present a case in which ultrasound imaging was used for a lateral approach to the sciatic nerve in the popliteal fossa. ⋯ Under direct ultrasound guidance, we placed a block needle close to the tibial nerve and confirmed its position with nerve stimulation. Injected local anaesthetic was seen on ultrasound as it spread around both tibial and common peroneal nerves.
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A questionnaire was sent to all Intensive Care Society linkmen to investigate weekend working arrangements on Intensive Care Units (ICU) in the United Kingdom. In all, 87 responses revealed that the average consultant covering ICU at weekends works a 1 in 6 rota, is responsible for 10 beds, works 8-9 h a day and receives two calls at night. Of consultants, 54% cover anaesthesia as well as ICU, 55% work a 48 h or 72 h weekend and only one in five consultants currently have fixed sessional allocation for weekend working. 83% felt that they should not cover anaesthesia as well as ICU and there was no support for consultants to be resident at night. Applying the terms and conditions of the new consultant contract for England to this average consultant would result in 6.6 Programmed Activities for the weekend and 2 days of compensatory rest.