PubMed · 15756247
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Egidio Barbi, Irene Bruno, Alessandro Ventura. 2005. Widening sedation availability.. https://doi.org/10.1016/j.jpeds.2004.09.016
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BACKGROUND AND OBJECTIVE: Several new techniques and agents (e.g. ropivacaine) have been introduced in regional anaesthesia to improve patients outcome and safety. The beneficial effects on patient outcome are clear with these techniques, however, no information is available about their pattern and frequency of use in clinical practice. This study presents data concerning the current practice of regional anaesthesia in Germany. METHODS: A questionnaire was sent to every German anaesthesia department (n = 1381). Questions focused on the frequency and range of regional anaesthetic procedures employed, with attention also to the organizational structural of the individual institution. RESULTS: Six hundred and sixty-seven questionnaires were returned anonymously, representing a return rate of 48.3%. In hospitals with less than 200 beds, the number of regional anaesthetics was markedly higher compared to large hospitals with more than 400 beds. In contrast, small hospitals tended to provide only basic techniques of regional anaesthesia, whereas larger hospitals implemented more advanced techniques. Bupivacaine remains the most commonly used long-lasting local anaesthetic. Staff structure was also different in small departments - patient care was performed by board certified anaesthesiologists while residents were responsible for the patients in larger departments. CONCLUSIONS: In small hospitals a majority of board certified anaesthesiologists rely on basic regional anaesthesia techniques. In large departments some consultants provide the entire spectrum of regional anaesthesia, with the majority of cases transferred to the residents responsibility. These results indicate the strong need to improve residency programs with regard to regional anaesthesia.
PURPOSE: The Canadian Anesthesiologists' Society (CAS), the Ontario Preoperative Task Force (OPTF) and The Ottawa Hospital (TOH) have published guidelines detailing the indications for preoperative testing. The purpose of this study was to: (a) document compliance of testing practice at TOH-Civic Campus with published guidelines; and (b) determine the impact of preoperative testing on clinical management. METHODS: Following Research Ethics approval all patients undergoing elective surgery at TOH-Civic Campus in the first three months of 2004 were identified. One hundred charts from each month were randomly selected and analyzed retrospectively by a single reviewer. The ordering and results of four preoperative tests were characterized. The indication for preoperative testing was identified from preoperative notes and the source of non-compliant orders was identified. Compliance with the CAS, OPTF, and TOH guidelines was documented. Abnormal test results were analyzed for evidence of a subsequent change in clinical management. RESULTS: The charts of 294 of the 2,116 patients who underwent elective surgery at TOH-Civic Campus in the first three months of 2004 were reviewed. A total of 534 tests were ordered on 198 patients (67%). Non-compliance rates varied significantly (5-98%) depending on test and guideline analyzed. Results of 329 tests (61.6%) were normal. Management was changed by 14 of 534 tests ordered (2.6%). Surgery proceeded as scheduled in all cases. CONCLUSION: The majority of elective surgical patients undergo preoperative testing. Non-compliance with guidelines ranged from 5 to 98%. The results of most tests were normal and influenced management in only 2.6% of cases.
This survey was conducted in all 28 New Zealand District Health Boards with a response rate of 100%. The Clinical Directors of Departments of Anaesthesia were asked to quantify their current anaesthesia service delivery and to assess their workforce level. Over half of the District Health Boards reported understaffing, fifty percent occurring in hospitals of provincial cities or towns with an inability to attract specialist anaesthesia staff. Financial constraint was the other main reason for understaffing. With the information from the survey, an attempt was made to predict future New Zealand anaesthesia workforce requirements. A model for Australasia established by Baker in 1997 was used. In comparing this survey to previous studies, there is evidence that the nature and expectations of the anaesthesia workforce are changing as well as the work environment. Currently, there is no indication that anaesthesia specialist training numbers should be reduced. Close, ongoing monitoring and planning are essential to ensure future demands for anaesthesia services can be met.