Canadian Anaesthetists' Society journal
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Large-volume low-pressure cuffs have been introduced in an endeavour to reduce the incidence of tracheal mucosal damage. These cuffs when inflated to clinical seal develop folds, which together with low clinical seal pressure may not protect against aspiration. ⋯ The incidence of dye tracking past the large-volume cuffs studies was 100 per cent whereas no aspiration of dye was seen past the red rubber tubes. Increasing cuff pressure in the large-volume cuffs beyond clinical seal to 50 cm H2O did not obliterate the dye-filled cuff folds, despite wide variation in the thickness of the cuff material.
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Hospitals and anaesthetists in British Columbia were surveyed by means of questionnaires to assess patterns of obstetric anaesthesia practice, qualifications and numbers of obstetric anaesthesia personnel, hospital obstetric facilities and facilities and protocols for neonatal resuscitation. It was apparent that a large proportion of the obstetric anaesthesia service in this province was being provided by physicians who were not trained, nor certified, as anaesthesia specialists. Preanaesthetic assessment in the obstetric units differed in attitude and practice from the standards expected in the general operating rooms. ⋯ Post-anaesthetic recovery facilities in obstetric units were conspicuously deficient, even in the larger hospitals. The majority of community hospitals lacked written protocols for neonatal resuscitation; and the number of institutions reporting that the neonatal heart rates and temperatures were not routinely monitored is of concern. It is recommended that minimum standards for training in obstetric anaesthesia should be clearly defined; and provision should be made for revision and upgrading of knowledge and skills for physicians practicing anaesthesia in smaller community hospitals.