Ann Acad Med Singap
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Formal Quality Assurance programmes have been widely promoted and applied in anaesthesia departments in the United States of America. The rationale of three well-known programmes is examined. Although they may be of use as a method of examining one's own practice, there is little objective evidence to support the idea of measuring an anaesthesiologist's competence. There is also a danger that licensing authorities will misuse such spurious information.
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Although epidural and spinal blocks are well-accepted regional techniques in obstetrics, they have several disadvantages. Combined spinal-epidural (CSE) technique reduces or eliminates the risks of these disadvantages. The sequential CSE technique can reduce the incidence and severity of maternal hypotension. ⋯ Before any injection in the epidural catheter, its position should always be confirmed by aspiration test. The technique should be used only by those who are experienced in spinal and epidural blocks. CSE is an important addition to the armamentarium of the obstetric anaesthesiologist.
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Thirty-nine patients with 46 limbs at risk underwent arterial embolectomy. The overall mortality was 36% (14 patients). Seventeen limbs (37%) had a poor result. ⋯ The delay from onset of symptoms to the operation varied between a few hours to over a week and this was not related to the outcome. Thirteen percent of the arterial occlusions were in the upper limb. All of these were due to embolism and there was no mortality for this group with all affected arms achieving a good outcome.