British journal of anaesthesia
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Current thinking about patient safety emphasizes the relationship between organizational factors, that is, latent risk factors (LRFs) and patient safety. This study explores the influence of the operating theatre (OT), intensive care unit (ICU), and disciplines on ratings of LRFs. If we have an understanding of the contribution made by these factors, we can identify significant points from which we can promote a safe environment. ⋯ As healthcare focuses its safety efforts towards system issues rather than towards the individual provider of care, attention has turned to organizational factors, known as LRFs. Understanding how LRFs affect safety should enable us to design more effective measures that will improve overall safety. Strategies for improving patient safety should be tailored specifically for various clinical areas and disciplines.
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There are few national figures on the incidence of failed tracheal intubation during general anaesthesia in obstetrics. Recent small studies have quoted a rate of one in 250 general anaesthetics (GAs). The aim of this UK national study was to estimate this rate and identify factors that may be predictors. ⋯ We received 57 completed reports (100% response). The incidence using a unit-based estimation approach was one in 224 (95% confidence interval 179-281). Univariate analyses showed the index cases to be significantly older, heavier, with higher BMI, with Mallampati score recorded and score >1. Multivariate analyses showed that age, BMI, and a recorded Mallampati score were significant independent predictors of failed tracheal intubation. The classical laryngeal mask airway was the most commonly used rescue airway (39/57 cases). There was one emergency surgical airway but no deaths or hypoxic brain injuries. Gastric aspiration occurred in four (8%) index cases. Index cases were more likely to have maternal morbidities (P=0.026) and many babies in both groups were admitted to the neonatal intensive care unit: 21 (37%) vs 29 (27%) (NS). Three babies died--all in the control group.
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The objective of this study was to test whether non-invasive assessment of respiratory stroke volume variation (ΔrespSV) by oesophageal Doppler monitoring (ODM) can predict fluid responsiveness during surgery in a mixed population. The predictive value of ΔrespSV was evaluated using a grey zone approach. ⋯ ΔrespSV predicted fluid responsiveness accurately during surgery over a ΔrespSV range between 14% and 15%. In contrast, FTc did not predict fluid responsiveness.