PubMed · 14814378
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S C CULLEN. 1951. Anesthesiology and its relation to the basic sciences.. https://pubmed.ncbi.nlm.nih.gov/14814378/
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BACKGROUND AND OBJECTIVE: National Institute for Clinical Excellence guidance states that 2D imaging ultrasound guidance should be used when inserting internal jugular venous lines in adults and children in the elective situation and should be considered in most clinical circumstances requiring central venous catheter insertion. This survey explored the availability, training and use of ultrasound devices by consultant paediatric anaesthetists in the UK. METHODS: A questionnaire was distributed to UK members of the Association of Paediatric Anaesthetists of Great Britain and Ireland. RESULTS: There was a response rate of 63% and of those responding, 212 (81%) inserted paediatric central venous catheters. Ultrasound devices were available in the workplace of 216 (82%) and the average number of devices available per department was two. For elective paediatric theatre cases, 26% of paediatric anaesthetists with access to an ultrasound device always used it when inserting an internal jugular central venous line. The majority (74%) of respondents had received training in the use of 2D ultrasound. CONCLUSIONS: National Institute for Clinical Excellence guidance on the use of ultrasound locating devices for placing central venous catheters is not universally adhered to. Among the reasons for this are problems with availability of equipment, lack of training in the use of ultrasound and non-acceptance of the guidelines.
OBJECTIVES: To evaluate the results of Off Site preanaesthetic consult in Lorraine and to draw up a method for these pre-operative visits. STUDY DESIGN: Two surveys of the Lorraine-regional practice (from both the anaesthetists and surgeons from Lorraine) and one survey of patient satisfaction. PATIENTS AND METHOD: Questionnaires were sent by mail to all anaesthetists (n=270) and surgeons (n=339) in the Lorraine region. In the immediate postoperative period, specific questionnaires were sent by mail to selected patient groups (n=73 in each group), one group having and the other (control) not having Off Site preanaesthetic consult. RESULTS: Anaesthetists' survey: 48.4% of interviewed anaesthetists belonged to the pre-anaesthetic consult network. 81.2% of these anaesthetists performed Off Site pre-anaesthetic consult. The main recognized advantages were patient comfort (89.6%) and cost effectiveness (57.3%). 26.1% of anaesthetists who did not participate to the network were strongly opposed to this practice, while 60.9% were prepared to enter the network. Surgeons' survey: 15.6% of surgeons were not satisfied that anaesthetists in their institutions practiced the Off Site pre-anaesthetic consult. Patients' survey: no difference in satisfaction towards the quality of information delivered during the consultation (anaesthetic technique, analgesia and evaluation of the perioperative risk) nor in terms of perioperative anxiety. The average transportation distance spared by Off Site preanaesthetic Consult was 98 miles. CONCLUSION: Off Site preanaesthetic consult may have real benefits in terms of, patient satisfaction, comfort and cost-effectiveness. In the Lorraine region, a majority of anaesthetists has experience with this practice.
BACKGROUND: There is increasing concern about the ability of junior anaesthetists to manage the airway correctly and alarm that this may lead to adverse events. METHODS: We monitored the airway management skills of new-start anaesthetists in Scotland for 3 months. RESULTS: Experience with the laryngeal mask airway was satisfactory but there was wide variation in numbers of facemask and tracheal intubation cases. CONCLUSIONS: We recommend that facemask anaesthesia is given a high priority in the formative months and that a target number of intubations should be carried out before providing anaesthesia without direct supervision.