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Evaluation of the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioners (ANTS-AP) system: A behavioural rating system to assess the non-technical skills used by staff assisting the anaesthetist | This study tested the reliability, validity and usability of a prototype behavioural rating system for the non-technical skills of assistants working with the anaesthetist. Anaesthetic nurses and operating department practitioners (n = 48) used the prototype Anaesthetic Non-technical Skills for Anaesthetic Practitioner... |
Transesophageal echocardiography in myocardial revascularization: II. Influence on intraoperative decision making | This study was conducted to determine how transesophageal echocardiography (TEE) guides intraoperative decision making during myocardial revascularization. Although its usefulness in influencing clinical decision making during cardiac valvular surgery is well documented, the clinical utility of TEE in patients undergoi... |
Absorption of carbon dioxide by dry soda lime decreases carbon monoxide formation from isoflurane degradation | This study was performed to determine whether the absorption of carbon dioxide (CO2) influences the formation of carbon monoxide (CO) from degradation of isoflurane in dry soda lime. Isoflurane (0.5%), CO2 (5%), a combination of the two in oxygen, and pure oxygen were separately passed through samples of 600 g of compl... |
Sevoflurane or halothane anesthesia: Can we tell the difference? | This study was performed to evaluate the ability of anesthesiologists to differentiate between sevoflurane, a newer, more expensive anesthetic, and halothane. A total of 113 assessments were made by 36 anesthesiologists on 58 children, aged 6 mo to 6 yr, scheduled for bilateral myringotomy and tube placement. All patie... |
A survey of anaesthetic charts | This survey reviews the structure and content of all anaesthetic record charts in use in the 40 hospitals of the Yorkshire Regional Health Authority in the light of previous recommendations. Twenty‐two different anaesthetic charts were used by 290 anaesthetists in this region. Some of the charts did not meet the ideal ... |
Thomas Drysdale Buchanan, MD, and the Birth of Academic Anesthesiology | Thomas Drysdale Buchanan, MD (1876-1940), founding president of the American Board of Anesthesiology, was the first person in the United States to hold the title "Professor of Anesthesiology" in a medical school faculty position dedicated exclusively to the specialty. An 1897 graduate of New York Medical College, Dr Bu... |
Thomas Linwood Bennett, MD: One of New York City's first prominent physician anesthetists | Thomas Linwood Bennett (1868-1932) was one of New York City's first prominent physician anesthetists. He was the first dedicated anesthetist at the Hospital for the Ruptured and Crippled, subsequently renamed Hospital for Special Surgery. He subsequently practiced at multiple institutions throughout New York City as on... |
Local anesthetic-induced cardiac toxicity: A survey of contemporary practice strategies among academic anesthesiology departments | Though new local anesthetics (LA), effective test-dosing, and new regional anesthetic techniques may have improved the safety of regional anesthesia, the optimal management plan for LA-induced cardiac toxicity remains uncertain. Accordingly, we evaluated current approaches to LA cardiotoxicity among academic anesthesio... |
Arterial oxygen saturation during induction of anaesthesia | Three groups of 10 ASA 1 patients were studied to determine the incidence of hypoxaemia (oxygen saturation ≤ 90%) using pulse oximetry during induction of ‘mask’ anaesthesia, and whether simple oxygenation techniques could prevent its occurrence. We also surveyed all anaesthetists in three major hospitals to ascertain ... |
Substance misuse amongst anaesthetists in the United Kingdom and Ireland: The results of a study commissioned by the Association of Anaesthetists of Great Britain and Ireland | Three hundred and four departments of anaesthesia in UK and Ireland were sent questionnaires about alcohol and drug abuse in anaesthetists over the preceding 10-year period. Information was sought on the nature and extent of substance problems, their presentation and management. The survey achieved a high response rate... |
Comparison of basic methods in clinical studies and in vitro tissue and cell culture studies reported in three anaesthesia journals | Tissue and cell culture (in vitro) studies reported in the 1997 issues of the British Journal of Anaesthesia, Anesthesia and Analgesia, and Anesthesiology were compared with groups of clinical studies selected at random from the same issues. Comparisons were of some basic aspects of study design and reporting that migh... |
The role of fibrinogen and fibrinogen concentrate in cardiac surgery: an international consensus statement from the Haemostasis and Transfusion Scientific Subcommittee of the European Association of Cardiothoracic Anaesthesiology | To date, data regarding the efficacy and safety of administering fibrinogen concentrate in cardiac surgery are limited. Studies are limited by their low sample size and large heterogeneity with regard to the patient population, by the timing of fibrinogen concentrate administration, and by the definition of transfusion... |
Hepatitis-b virus infection in anaesthetists | To determine whether anaesthetists are at risk from developing hepatitis-B virus (HBV) infection from their patients, 95 anaesthetists working with black South Africans (who have a high prevalence of hepatitis-B antigenaemia) were questioned about attacks of viral hepatitis and their blood was tested for hepatitis-B (s... |
Improtance of components of the curriculum vitae in determining appointment to senior registrar posts | To evaluate the opinions of regional education advisers, academics and other consultants about features of the curriculum vitae, we undertook a small attitude survey. The response rate was 73%, which provided data from a total of 78 influential anaesthetists. The respondents’ attitude to each feature of the curriculum ... |
Prevalence of a training module for difficult airway management: A comparison between Japan and the United Kingdom | To examine the education of trainees with regard to difficult airway management, we sent a questionnaire to all 89 Japanese University Departments of Anaesthesia (to be answered by a person who was responsible for teaching trainees) and all 280 Royal College of Anaesthetists' Tutors in the UK. The presence or absence o... |
Surgeon-nurse anesthetist collaboration advanced surgery between 1889 and 1950 | To meet the need for qualified anesthetists, American surgeons recruited nurses to practice anesthesia during the Civil War and in the latter half of the 19th century. The success of this decision led them to collaborate with nurses more formally at the Mayo Clinic in Minnesota. During the 1890s, Alice Magaw refined th... |
Gender distribution of the American board of anesthesiology diplomates, examiners, and directors (1985-2015) | To understand the potential role of women in leadership positions, data from the American Board of Anesthesiology (ABA) were analyzed to explore the impact of women in the specialty of anesthesiology. The number of newly certified ABA diplomates, oral examiners, and directors from 1985 to 2015 was obtained from the ABA... |
A web-based system for teaching, assessment and examination of the undergraduate peri-operative medicine curriculum | Today's students are generally computer literate and have high expectations of university information technology resources. Most United Kingdom medical schools now provide networked computers for learning, research, communication and accessing the worldwide web. We have exploited these advances to augment and improve t... |
Tracheal intubation in a mannikin: Comparison of the belscope with the macintosh laryngoscope | Tracheal intubation carries a risk of accidental oesophageal intubation; this is increased with inexperienced trainees, and in patients with a difficult airway. The recent introduction of an angulated laryngoscope, the Belscope, may permit a better view of the vocal cords and increase the accuracy of orotracheal intuba... |
Tracheal intubation in a manikin: Comparison of supine and left lateral positions | Tracheal intubation in the left lateral position may be necessary in some circumstances. Using a manikin we demonstrated that anaesthetic trainees found tracheal intubation in the left lateral position was more difficult and took longer than in the supine position. However, the time to successful tracheal intubation de... |
Tracheal intubation following training with the GlideScope® compared to direct laryngoscopy | Tracheal intubation using direct laryngoscopy has a high failure rate when performed by untrained medical personnel. This study compares tracheal intubation following direct laryngoscopy by inexperienced medical students when initially trained by using either the GlideScope®, a video assisted laryngoscope, or a rigid (... |
The impact of trained assistance on error rates in anaesthesia: A simulation-based randomised controlled trial | Trained assistance for the anaesthetist appears likely to improve safety in anaesthesia. However, there are few objective data to support this assumption, and the requirement for a trained assistant is not universally enforced. We applied a simulation-based model developed in previous work to test the hypothesis that t... |
Influence of an anaesthetists on nurse-led, computer-based, pre-operative assessment | Trained nurses using a rule-based computer program can successfully carry out pre-anaesthesia screening. All medical problems and abnormal laboratory results need to be reviewed by an experienced anaesthetist. Following the introduction of this system, there was a reduction in the frequency of cancellations of patients... |
Anxiety levels in junior anaesthetists during early training | Trait anxiety levels (predisposition to anxiety) and personality profiles were recorded in four novice anaesthetists prior to the start of their training in anaesthesia. State anxiety (the extent of anxiety at the moment of testing) was also assessed before and afer the transition from accompanied to solo anaesthetic p... |
EchoComTEE - A simulator for transoesophageal echocardiography | Transoesophageal echocardiography (TOE) requires extensive hands-on training, and it is for this purpose we have designed EchoComTEE, a simulator for TOE. It consists of a manikin and dummy probe; according to the position of the dummy probe (tracked by an electromagnetic sensor), two-dimensional (2D) images are calcul... |
Presence of protein deposits on 'cleaned' re-usable anaesthetic equipment | Twenty previously used and supposedly clean, sterilised laryngeal mask airwys, five bougies and five Magill forceps from the operating theatre, and 61 laryngoscope blades from different sites within a single hospital were randomly collected and stained with erythrosin B dye, which stains proteins if present on surfaces... |
Training in fibreoptic tracheal intubation in the north of england | Twenty-nine departments of anaesthesia in the North of England were questioned about the availability and teaching of fibreoptic tracheal intubation techniques. While 27 departments had both suitable equipment and trained consultant staff, only one offered formal teaching to all its junior anaesthetists. © 1992 British... |
Mood and cognitive functions in anaesthetists working in actively scavenged operating theatres | Twenty-two anaesthetists participated in a study to assess the influence of occupational exposure to anaesthetic agents on mood (arousal and stress) and cognitive functions. In a cross-over design, each anaesthetist worked one day in a reference facility (for example, intensive care) and another day in a scavenged oper... |
The effect of the anaesthetist's attire on patient attitudes: The influence of dress on patient perception of the anaesthetist's prestige | Two groups of adult patients (55 each) were visited pre‐operatively by an anaesthetist who was dressed either formally or casually. Their response to this visit, their opinions regarding anaesthetists and their knowledge of anaesthetic work were elicited afterwards by means of a questionnaire. Patients' satisfaction wi... |
The ‘Mini O2’ and ‘Healthdyne’ oxygen concentrators: Their performance and potential application | Two oxygen concentrators designed for home use, the ‘Healthdyne’ and the ‘Mini O2’, have been assessed with particular reference to their possible role in anaesthesia. Both were found to be a reliable source of oxygen enriched gas. Neither was fully capable of driving a gas powered ventilator satisfactorily, but both c... |
Psychometric comparisons of trainees and consultants in anaesthesia and psychiatry | Two psychometric tests were taken by trainees in anaesthesia and psychiatry, and by consultant practitioners in these specialties. The Cattell 16 Personality Factor Questionnaire measured primary and secondary aspects of personality. The Strong-Campbell Interest Inventory assessed interests, and compared the results wi... |
Perioperative considerations for evolving artificial pancreas devices | Type 1 diabetes mellitus is a lifelong condition. It requires intensive patient involvement including frequent glucose measurements and subcutaneous insulin dosing to provide optimal glycemic control to decrease short- and long-term complications of diabetes mellitus without causing hypoglycemia. Variations in insulin ... |
Anaesthetists and Dutch Elm Disease: A cautionary tale of undiagnosed tetanus with a moral | Undiagnosed tetanus can be a rare cause of acute intestinal obstruction followed by respiratory failure after surgery and general anaesthesia. The anaesthetist should always read the general practitioner's referring letter (so should the surgeon). Equally, the general practitioner's letter should record normal physiolo... |
Which countries publish in important anesthesia and critical care journals? | Using a MEDLINE-based analysis, we studied the national origin of articles published in important anesthesia, pain, critical care, and emergency medicine journals. All journals in English listed in the Science Citation Index (SCI) of Journal Citation Reports under the subheadings Anesthesiology (n = 17) and Emergency M... |
The educational value of using cumulative sum charts | Various workplace-based assessment tools are available, but none have been shown to improve performance in procedural skills. This study aimed to assess the impact of using one such tool, cumulative sum charts, on procedural skill ability. A single-blind randomised controlled trial was conducted on 82 final year medica... |
A measure of intraoperative attention to monitor displays | Vigilance is an important but difficult to measure attribute in anesthesia practitioners. We present a modified standard method to assess intraoperative vigilance toward electronic data displays. The response time to detect a simulated abnormal value on the physiologic monitor was measured. Eight anesthesia residents w... |
An analysis of the delivery of anaesthetic training sessions in the United Kingdom | We analysed data from the electronic rota system CLWRota, covering 2,689,962 anaesthetic sessions between 01/01/2014 and 31/12/2015, in 91 UK Trusts, in order to investigate trainees’ supervision. There were 8209 trainee attachments analysed, during which 618,695 sessions were undertaken by trainees. The number of supe... |
An analysis of retractions of papers authored by Scott Reuben, Joachim Boldt and Yoshitaka Fujii | We analysed how long it has taken for papers authored by Scott Reuben, Joachim Boldt and Yoshitaka Fujii to be retracted: investigations into these three anaesthetists have shown much of their research to be unethical or fraudulent. To date, 94% of their combined papers requiring retraction have been retracted; however... |
Concluding results from the first phase of the Zurich Unexpected Difficult Airway course based on exercise of technical skills | We analysed the results of the first phase of the Zurich Unexpected Difficult Airway course. Two hundred and twenty-eight staff members performed a total of 2712 standardised airway rescue procedures with four airway devices: SensaScope™, LMA Fastrach™, Laryngeal Tube and needle cricothyrodotomy. Four consecutive attem... |
The use of a visual aid to check anaesthetic machines: Is performance improved? | We asked 20 anaesthetists and seven operating department assistants to check three anaesthetic machines‘doctored’to contain errors of varying seriousness, and recorded their performances. Two weeks later we asked the same group to repeat the test. On the second occasion they followed a visual aid and filled in a questi... |
Residents' and program directors' attitudes toward research during anesthesiology training: A Canadian perspective | We assessed the attitudes of residents and program directors (PD) toward research training in Canadian anesthesiology residency programs. Questionnaires were sent to all 476 anesthesiology residents in Canada and a modified questionnaire was sent to the PD of each of the 16 anesthesiology programs between November 2003... |
Resuscitation skills of trainee anaesthetists | We assessed the basic and advanced cardiopulmonary resuscitation skills of 30 trainee anaesthetists in a simulated exercise. Only one person performed basic cardiopulmonary resuscitation as outlined in the 1992 European Resuscitation Council guidelines. The management of ventricular fibrillation and asystole were corre... |
Human cadavers preserved using Thiel's method for the teaching of fibreoptically-guided intubation of the trachea: a laboratory investigation | We assessed the suitability of human cadavers preserved using Thiel's method for teaching flexible fibreoptic tracheal intubation. Thirty-one anaesthetists unacquainted with this technique received didactic teaching followed by handling of the fibrescope on the Oxford teaching box. They then carried out fibreoptic intu... |
Predicting the size of a double-lumen endobronchial tube based on tracheal diameter | We assessed whether using the tracheal diameter to predict the correct size of the left double-lumen endobronchial tube (DLT) could be used for our generally smaller sized Asian patients. Sixty-six consecutive adult patients under anesthesia for elective surgery requiring the use of a DLT were studied. The size of the ... |
An ultrasound needle insertion guide in a porcine phantom model | We compared nerve blockade with and without the Infiniti™ needle guide in an ultrasound in-plane porcine simulation. We recruited 30 anaesthetists with varying blockade experience. Using the guide, the needle tip was more visible (for a median (IQR [range]) of 67 (56-100]) % of the time; and invisible for 2 (1-4 [0-19]... |
Accreditation Council for Graduate Medical Education competencies and the American Board of Anesthesiology Clinical Competence Committee: A comparison | We compared the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project to the long-standing requirement of the American Board of Anesthesiology for a Clinical Competence Committee Report. There are many similarities between these two systems of resident evaluation. However, the ACGME Outcome Proje... |
A comparison of fibreoptic-guided tracheal intubation through the Ambu®Aura-i™, the intubating laryngeal mask airway and the i-gel™: A manikin study | We compared the Aura-i™, intubating laryngeal mask airway and i-gel™ as conduits for fibreoptic-guided tracheal intubation in a manikin. Thirty anaesthetists each performed two tracheal intubations through each device, a total of 180 intubations. The median (IQR [range]) time to complete the first intubation was 40 (31... |
Regional anaesthesia for limb surgery - Before or after general anaesthesia: A survey of anaesthetists in the Oxford region | We conducted a postal survey of 221 anaesthetists in the Oxford region to determine their views and actual clinical practice regarding regional anaesthesia in adult patients undergoing limb surgery, when a combined regional and general anaesthetic was planned. Of the 162 respondents (73.3%), 142 (87.6%) regularly pract... |
The oesophageal and precordial stethoscope transducer as a monitoring and teaching aid | We describe a low cost, easy to construct monitoring and teaching aid for the oesophageal and precordial stethoscopes. It is constructed from two readily available 'state of the art’integrated circuits. The aid allows more than one observer simultaneously to hear heart and breath sounds, without being acoustically isol... |
An advanced specialty training program in anesthesiology: A special educational fellowship designed to return community anesthesiologists to clinical practice | We describe a program for community anesthesiologists designed to evaluate clinical skills and provide additional training in the latest technologies in anesthesiology. This educational program was established for previously trained anesthesiologists who require additional training for either remedial purposes or becau... |
Reported significant observations during anaesthesia: A prospective analysis over an 18-month period | We describe a prospective analysis, in one hospital, of reported significant observations involving unsafe practices and working conditions during anaesthesia. Of the 549 significant observations reported voluntarily during a period of 18 months, 82% involved occurrences which were considered preventable and 27% could ... |
A homemade model for training in cricothyrotomy | We describe a simple, homemade model for teaching cricothyrotomy. It can easily be constructed from materials found in every anaesthetic room and is cheap, portable and usable several times before requiring replacement. We also describe evaluation of the model in a two-part study. First, 20 anaesthetic trainees, both w... |
Bernoulli cumulative sum (CUSUM) control charts for monitoring of anesthesiologists' performance in supervising anesthesia residents and nurse anesthetists | We describe our experiences in using Bernoulli cumulative sum (CUSUM) control charts for monitoring clinician performance. The supervision provided by each anesthesiologist is evaluated daily by the Certified Registered Nurse Anesthetists (CRNAs) and/or anesthesia residents with whom they work. Each of 9 items is evalu... |
A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure | We describe the development and laboratory assessment of a refined prototype tactile feedback device for the safe and accurate application of cricoid pressure. We recruited 20 operating department practitioners and compared their performance of cricoid pressure on a training simulator using both the device and a manual... |
Magnetic resonance spectroscopy of isoflurane kinetics in humans. Part II: Functional localization | We describe the first experiments to relate the cerebral kinetics of isoflurane (determined by fluorine magnetic resonance spectroscopy) to cerebral function. Using a surface receive coil we found two-compartment kinetics within the head with equilibrium half-times of 3.5 min and approximately 1 h with respect to expir... |
Incorporating simulation-based objective structured clinical examination into the Israeli national board examination in anesthesiology | We describe the unique process whereby simulation-based, objective structured clinical evaluation (OSCE) has been incorporated into the Israeli board examination in anesthesiology. Development of the examination included three steps: a) definition of clinical conditions that residents are required to handle competently... |
Anaesthesia services in developing countries: Defining the problems | We describe the use of a questionnaire to define the difficulties in providing anaesthesia in Uganda. The results show that 23% of anaesthetists have the facilities to deliver safe anaesthesia to an adult, 13% to deliver safe anaesthesia to a child and 6% to deliver safe anaesthesia for a Caesarean section. The questio... |
A comparison of traditional textbook and interactive computer learning of neuromuscular block | We designed an educational software package, RELAX, for teaching first- year anesthesiology residents about the pharmacology and clinical management of neuromuscular blockade. The software uses an interactive, problem based approach and moves the user through cases in an operating room environment. It can be run on per... |
Quality and reporting of trial design in scientific papers in Anaesthesia over 25 years | We determined how the quality of trial design and its reporting in scientific papers published in Anaesthesia has changed in the last 25 years. All articles between the years 1983-87 and 2003-07 were reviewed and classified according to methodology. Reporting and trial design of all prospective, comparative clinical in... |
Adaptive support ventilation with percutaneous dilatational tracheotomy: A clinical study | We determined the need for changes in minute ventilation with adaptive support ventilation after percutaneous dilatational tracheotomy under endoscopic guidance in 34 intensive care unit patients. During the procedure, minute ventilation was not changed; only maximum pressure limits were adjusted, if necessary. After i... |
A strategy for deciding operating room assignments for second-shift anesthetists | We developed a relief strategy for assigning second-shift anesthetists to late-running operating rooms. The strategy relies on a statistical method which analyzes historical case durations available from surgical services information systems to estimate the expected (mean) remaining hours in cases after they have begun... |
Validation of a pre-anaesthetic screening questionnaire | We developed a screening questionnaire to be used by nurses to decide which patients should see an anaesthetist for further evaluation before the day of surgery. Our objective was to measure the accuracy of responses to the questionnaire. Agreement between questionnaire responses and the anaesthetist's assessment was a... |
Virtual airway simulation to improve dexterity among novices performing fibreoptic intubation | We developed a virtual reality software application (iLarynx) using built-in accelerometer properties of the iPhone® or iPad® (Apple Inc., Cupertino, CA, USA) that mimics hand movements for the performance of fibreoptic skills. Twenty novice medical students were randomly assigned to virtual airway training with the iL... |
Difficult mask ventilation: Does it matter? | We discuss the relevance of finding a patient's lungs difficult to ventilate by facemask during the course of anaesthetic induction. In particular, we discuss the issue of whether it is advisable or unnecessary to check the ability to ventilate by facemask before administering a neuromuscular blocking agent. In the lig... |
Evaluation of a novel needle guide for ultrasound-guided phantom vessel cannulation | We evaluated a novel, sled-mounted needle guide for ultrasound-guided vessel cannulation. Fifty medical students were randomly assigned to use ultrasound with the sled (sled group, n = 23) or ultrasound without the sled (control group, n = 27) for vessel cannulation in a phantom. For each of 15 attempts we recorded can... |
Use of cognitive aids in a simulated anesthetic crisis | We evaluated empirically the extent to which the use of a cognitive aid during a high-fidelity simulation of a malignant hyperthermia (MH) event facilitated the correct and prompt treatment of MH. We reviewed the management of 48 simulated adult MH scenarios; 24 involving CA 1 and 24 involving CA 2 residents. In the CA... |
A comparison of the BURP and conventional and modified jaw thrust manoeuvres for orotracheal intubation using the Clarus Video System | We evaluated the effects of three airway manipulation manoeuvres: (a) conventional (single-handed chin lift); (b) backward, upward and right-sided pressure (BURP) manoeuvre; and (c) modified jaw thrust manoeuvre (two-handed aided by an assistant) on laryngeal view and intubation time using the Clarus Video System in 21... |
Evaluation of four airway training manikins as patient simulators for the insertion of eight types of supraglottic airway devices | We evaluated the performance of four currently available manikins: Airway Management Trainer TM (Ambu, UK), Airway Trainer TM (Laerdal, Norway), Airsim™ (Trucorp, Ireland), 'Bill 1'™ (VBM, Germany), with eight supraglottic airway devices: Airway Management Device™, Cobra Perilaryngeal Airway, Combitube™, i-Gel, Larynge... |
Evaluation of four airway training manikins as patient simulators for the insertion of single use laryngeal mask airways | We evaluated the performance of four manikins: Airsim™, Bill 1™ , Airway Management Trainer™ and Airway Trainer™, as simulators for insertion of single-use laryngeal mask airways and the reusable LMA Classic™. Sixteen volunteer anaesthetists inserted each laryngeal mask airway into each manikin twice. Insertions were s... |
Unilateral anesthesia does not affect the incidence of urinary retention after low-dose spinal anesthesia for knee surgery | We evaluated whether unilateral low-dose spinal anesthesia may reduce the likelihood of postoperative urinary retention. Forty patients scheduled for knee arthroscopy randomly received bilateral (n = 20) or unilateral (n = 20) spinal anesthesia with 6-mg hyperbaric bupivacaine 0.5%. The incidence of urinary retention (... |
Use of acronyms in anaesthetic and associated investigations: appropriate or unnecessary? – the UOAIAAAIAOU Study | We examined the prevalence of novel acronyms in the titles of anaesthetic and related studies and the response of anaesthetists to them. We separately analysed trainee-led research projects in the UK supported by the Research and Audit Federation of Trainees (RAFT), and a 10-year cohort of papers identified using the P... |
A high flow semi-open system for preoxygenation an evaluation | We have compared an alternative breathing system for preoxygenation comprising a Hudson face mask with high oxygen inflow (48 litre min-1) and a Mapleson A breathing system (100 ml kg-1 min-1). The study consisted of two parts: the first involved adult volunteers (10 male, seven female) and the second part used a lung ... |
Teaching fibreoptic nasotracheal intubation with and without closed circuit television | We have compared the progress of anaesthetists taught fibreoptic nasotracheal intubation with the aid of a closed circuit television (CCTV) system with that of anaesthetists taught by traditional methods. Twenty anaesthetists were allocated randomly to either the video or traditional training group. A graduated trainin... |
Learning fibreoptic skills in ear, nose and throat clinics | We have compared the progress of anaesthetists taught fibreoptic techniques on awake patients in ear, nose and throat clinics with that of anaesthetists taught by traditional methods. Twelve anaesthetists participated in the study and were randomly allocated to the ear, nose and throat group or to the traditional train... |
The occupational hazard of human immunodeficiency virus and hepatitis B virus infection: I. Perceived risks and preventive measures adopted by anaesthetists: a postal survey | We have conducted a postal survey of members of the Association of Anaesthetists to ascertain perceived risks and preventive measures adopted with regard to the occupational hazard of Human Immunodeficiency Virus and Hepatitis B Virus infection. Despite recognition of the infection risk and the adoption of appropriate ... |
The desflurane (tec 6) vaporizer: Design, design considerations and performance evaluation | We have described the design and design considerations of the desflurane Tec 6 "vaporizer" and have tested its performance characteristics. The vaporizer differs from previous vaporizers designed for anaesthesia in that electromechanical rather than mechanical controls accommodate the different physical characteristics... |
Dose-response studies of the interaction between mivacurium and suxamethonium | We have determined the effect of pretreatment with mivacurium on the potency of suxamethonium and the effect of prior administration of suxamethonium on the potency of mivacurium. We studied 100 ASA I or II patients during thiopentone-fentanyl-nitrous oxide-isoflurane anaesthesia. Neuromuscular block was recorded as th... |
Minimum alveolar concentration of sevoflurane in elderly patients | We have determined the minimum alveolar concentration (MAC) for sevoflurane in elderly patients (mean age 71.4yr). MAC was found to be 1.48 (SEM 0.08) %, which is smaller than the values for children and adults. The magnitude of the change in MAC with age is similar to that for halothane and isoflurane. The calculated ... |
Pitfalls in reporting sample size calculation in randomized controlled trials published in leading anaesthesia journals: A systematic review | We have evaluated the pitfalls in reporting sample size calculation in randomized controlled trials (RCTs) published in the 10 highest impact factor anaesthesia journals. Superiority RCTs published in 2013 were identified and checked for the basic components required for sample size calculation and replication. The dif... |
Bacterial retention properties of heat and moisture exchange filters | We have examined the properties of six heat and moisture exchange filters (HMEF) to ascertain their resistance to liquid flow and their ability to retain a challenge bacterium, Pseudomonas diminuta, from aqueous and nebulized suspensions. Only one HMEF, the Pall Ultipor was able to withstand a significantly greater pre... |
Inhalational anaesthesia in developing countries: Part I. The problems and a proposed solution | We have examined the requirements for inhalational anaesthesia in the developing countries with particular reference to the problems posed by difficulties in the supply of compressed gases. A scheme is proposed to circumvent these difficulties without loss of the quality of anaesthesia other than foregoing the use of n... |
First-time coronary artery bypass grafting: The anaesthetist as a risk factor | We have investigated the contribution of the anaesthetist and surgeon to outcome after 1301 consecutive coronary artery bypass grafting operations (first operation). The mean+ 1 so aspartate amino transferase concentration on the day after surgery (AST-D1) was 134 u litre-1 (or. after logarithmic transformation, 94 u l... |
The laryngeal mask airway as an aid to training in fibreoptic nasotracheal endoscopy | We have investigated the extent to which the laryngeal mask airway when used as an aid to fibreoptic nasotracheal video-endoscopy training, could reduce endoscopy apnoeic time in anaesthetised, paralysed oral surgery patients. Twenty anaesthetic trainees were randomly allocated to the laryngeal mask airway or control g... |
Inhalational anaesthesia in developing countries: Part II. Review of existing apparatus | We have reviewed the availability of apparatus which permits the maximum use to be made of available supplies and services in developing countries. In particular we have stressed the use of electrically operated air compressors and oxygen concentrators to drive sophisticated anaesthetic apparatus which is not dependent... |
The effect of a model-based predictive display on the control of end-tidal sevoflurane concentrations during low-flow anesthesia | We have shown that a multicompartment model accurately predicts end-tidal (ET) sevoflurane (sevo) and isoflurane concentrations. The model has been adapted to use real-time fresh gas flow and vaporizer settings to display a 10-min prediction of ET sevo concentrations. In this study, we evaluated the effect of the predi... |
Effectiveness and sequelae of very low-dose suxamethonium for nasal intubation | We have studied the effectiveness and sequelae of low-dose suxamethonium in 60 day-case oral surgery patients requiring nasal intubation. Anaesthesia was induced with propofol and alfentanil; 60 patients were allocated randomly to three groups of 20 patients and received no suxamethonium, suxamethonium 0.25 mg kg-1 or ... |
Learning fibreoptic endoscopy: Nasotracheal or orotracheal intubations first? | We have studied the extent to which learning fibreoptic nasotracheal endoscopy first helped anaesthetists to learn fibreoptic orotracheal endoscopy later, and vice versa. After preliminary training on a bronchial tree model, 30 anaesthetic trainees were randomly allocated to the nasal first/oral second group, who perfo... |
Airway research: The current status and future directions | We highlight the areas we think important for future development of the subspeciality. The ultimate goal is to improve patient care and safety and to do this, we need to identify how and where episodes of harm arise. Simply continuing with current practice does not represent the best path towards our ultimate goal; obj... |
On-call stress among finnish anaesthetists | We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. The anaesthetists had the greatest on-call workload among ... |
Attitudes of patients and anaesthetists to informed consent for specialist airway techniques | We investigated the attitudes of 96 patients and 163 anaesthetists to the need for obtaining informed consent before specialist airway techniques. Participants were asked to score six questions using a numerical scale, as to whether they thought consent was necessary before specific procedures, particularly in relation... |
Correlating obstetric epidural anaesthesia performance and psychomotor aptitude | We investigated the correlation between the scores attained on computerised psychometric tests, measuring psychomotor and information processing aptitudes, and learning obstetric epidural anaesthesia. Ten anaesthetic trainees performed an adaptive tracking task (ADTRACK 3) and one information management task (MAZE) fro... |
Cricoid pressure: Knowledge and performance amongst anaesthetic assistants | We investigated the cricoid pressure technique of 135 anaesthetic assistants attending the annual conference of the British Association of Operating Department Assistants in May 1997. Their knowledge and training were assessed using a structured interview. Technique was assessed using a simulator measuring applied forc... |
Annie, Annie! Are You Okay?: Faces behind the Resusci Anne Cardiopulmonary Resuscitation Simulator | We investigated the history of Resusci Anne, the well-known cardiopulmonary resuscitation (CPR) simulation trainer. The creation of Resusci Anne began with Peter J. Safar, an accomplished anesthesiologist who experimented with resuscitation of respiration and cardiac function. He collaborated with Asmund S. Laerdal, wh... |
Influence of anaesthesia resident training on the duration of three common surgical operations | We investigated the influence of resident training on anaesthesia workflow of three standard procedures - laparoscopic cholecystectomy, diagnostic gynaecological laparoscopy and transurethral prostate gland resection (TURP) - comparing 259 non-emergency resident vs 341 consultant cases from 20 German hospitals. Each ho... |
Survey of change in practice following simulation-based training in crisis management | We investigated the long-term effects on clinical practice of a simulation-based course in anaesthesia crisis management. A questionnaire was posted to all anaesthetists who had attended a course in the preceding year. The response rate was 69% (66/96). The crisis management course was valued highly by respondents, who... |
Forces generated by Macintosh and GlideScope® laryngoscopes in four airway-training manikins | We measured forces generated by Macintosh and GlideScope® laryngoscope blades during airway intubation by 16 participants in four manikins: Laerdal® SimMan; TruCorp AirSim™ Advance; Laerdal® Airway Management Trainer; and Ambu® Airway Man. Both laryngoscopes generated the least force in the Laerdal Airway Management Tr... |
An observational study of practice during transfer of patients from anaesthetic room to operating theatre | We observed practice during transfer of 80 patients from anaesthetic room to operating theatre, to determine the duration of apnoea and the time without monitoring during the transfer process. Median (IQR [range]) time from disconnection of the breathing system in the anaesthetic room to the first breath in theatre was... |
Lecture practices in United States anesthesiology residencies | We obtained data on lecture practices from 100 of the 110 university-affiliated anesthesiology residency programs certified in the United States in 1988. Of these residency programs, 36% had a majority of their lectures before the operating room schedule began, 57% had no lectures at all in this early time slot, and 78... |
Valuing the work performed by anesthesiology residents and the financial impact on teaching hospitals in the United States of a reduced anesthesia residency program size | We performed a financial analysis at a large university tertiary care hospital to determine the incremental cost of replacing its anesthesiology residents with alternative dependent providers (i.e., certified registered nurse anesthetists in the operating room, advanced practice nurses and physician assistants outside ... |
The effect of a drug and supply cost feedback system on the use of intraoperative resources by anesthesiologists | We performed a randomized, prospective study to evaluate the use of a written feedback system in reducing the intraoperative costs of drugs and supplies used by anesthesiologists. Over 6 mo, 27 anesthesiology residents were randomized to feedback and control groups for their rotations in neurosurgical anesthesia. We re... |
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