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Patient Safety

This category contains 20 posts

Don’t Understand Balloon Pumps – don’t bother

Alas – another intervention bites the dust. For decades the intra-aortic balloon pump has been heralded as the great savior of the patient with cardiogenic shock. If you have always found these devices confusing (when to use, when to wean, what difference 1:1 versus 1:2 augmentation etc), then worry not: they are heading to the … Continue reading

Regional or General Anaesthhesia for Hip Fracture

A 78 year old female patient is brought to the operating room with a fractured hip. She tells you that she wants to “go asleep” for the operation. How do you advise her? Two papers in July’s Anesthesiology have shed light on this issue. Both studies mine large databases and so care must be taken … Continue reading

EuSOS study published – and it’s not pretty!

46,539 patients from all over Europe were recruited to the The European Surgical Outcomes Study over 7 days in April 2011 (read here). Day cases, cardiac and neurosurgical patients were excluded. The overall mortality rate was 4% (nearly 1 in 20 patients). 8% of patients were admitted to ICU or HDU at some stage – … Continue reading

Hydroxy Ethyl Starches – are we nearing the end of the road?

When the VISEP study was published in 2008,1 proponents of colloid based resuscitation (myself included) argued that, since the study was conducted using old generation pentastarches, the data were not generalizable to all hydroxyl-ethyl fluids.2 Indeed there was an emerging body of evidence supporting the safety of newer, lower molecular weight starches; particularly those composed … Continue reading

Recovery from neuromuscular blockade

residual blockade Lesson unlearned

Ultrasound for central venous access

The ASA has published its guidelines for central venous access (see link below).  I am regularly amused by the slavish credence given by trainees to use of ultrasound as ‘mandatory’ for central  venous access.  Why I ask?  That ‘s what the NICE guideline says, they reply.  Do you work in the NHS I ask? Yes … Continue reading

NAP4 report on airway catastrophes

Have you had a highly challenging airway situation in the ICU or the emergency department?  Did it lead to a major adverse event?  If so you are not alone, as the NAP4 report demonstrates: http://www.rcoa.ac.uk/index.asp?PageID=1089 Although there is no denominator, and a direct comparison with operating theatre events was not a purpose of the report, … Continue reading

Agitation and Pain in the Recovery Room (tutorial)

Problem: A 43 year old male returns from the operating room following cholecystectomy. The operation had been originally planned using the laparoscopic approach. However it became necessary to convert to an open procedure. Intraoperatively the patient received fentanyl 300mic/g, propofol, vecuronium, oxygen and desflurane and cefazolin. At the end of surgery, neuromuscular blockade (sustained tetanus … Continue reading

Perioperative Visual Loss

Nothing terrifies an anaesthetist as much as the prospect of a patient waking up blind. It happens, but very infrequently. Who is at risk? What surgeries? What are the risk factors? Is there anything we can do to prevent and treat visual loss? Perioperartive visual loss is associated with posterior ischemic optic neuropathy (ION), anterior ION, … Continue reading

Local Anaesthesia Toxicity (tutorial)

Patrick Neligan, Consultant in Anaesthesia & Intensive Care, Galway University Hospitals (c) Clinical Scenario A 37 year old female undergoes bilateral mammoplasty. The procedure is performed under general anaesthesia. Prior to incision the wound was infiltrated with 20ml of 1% lignocaine, on each side. Intraoperatively the patient’s temperature was 37.5 degrees celcius, heart rate was 100 … Continue reading