In the September 2008 BJA...
Epidural haematoma The rare but potentially disastrous complication of haematoma related to an epidural catheter is addressed in a survey of UK practice (Meikle et al., pages 400–4). This survey found improvements in the postoperative monitoring of epidurals, when compared with a similar unpublished survey from 2001, but there were still significant variations in standard protocols used. These include protocols for regular assessment of sensory/motor function and for the investigation of any patient with an ‘abnormal’ motor block. The need for clear workable protocols is emphasized in the accompanying Editorial (Bedforth et al., pages 291–3) which broadens the discussion to epidural haematomas and abscesses.Recovery room practice In the immediate postoperative period most patients are cared for in a recovery (PACU) area or ward by trained nursing staff. Smith and colleagues (pages 332–7) have studied the important area of the handover of care of the patient from the anaesthetist to the recovery staff. Their findings relating to the quality of information passed on, and the influence of working relationships makes interesting reading for all anaesthetists. A different aspect of recovery is covered in a study of the incidence and detection of delirium in the recovery room (Radtke et al., pages 338–43). In a comparison of three scoring systems, they found considerable variation (3–14%) in the ability of the scores to detect delirium.
Airways and ventilation One-lung ventilation for thoracic surgery is an anaesthetic challenge that is addressed in two studies in this month's BJA. A cadaver study of the use of a new double-lumen tube and bronchial blocker (Ghosh et al., pages 424–8) suggests it is potentially useful and worthy of clinical evaluation. The use of electrical impedance tomography to detect correct placement of a double-lumen tube is described by Steinman and colleagues (pages 411–18). While it was able to detect ventilation of each lung, it is not as yet accurate enough to replace fibreoptic bronchoscopy for detection of correct placement. In a comparison of spontaneous and positive-pressure ventilation with a LMA in patients with laryngo-tracheal stenosis (Nouraei et al., pages 419–23), positive pressure was found to provide more effective ventilation. Finally, a new single-use LMA with a gastric access port was evaluated against a reusable LMA with gastric port and found to perform similarly (Verghese and Ramaswamy, pages 405–10).
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Related articles in BJA:
- Detection and management of epidural haematomas related to anaesthesia in the UK: a national survey of current practice
- J. Meikle, S. Bird, J. J. Nightingale, and N. White
BJA 2008 101: 400-404.[Abstract] [Full Text] - Haematoma and abscess after epidural analgesia
- N. M. Bedforth, A. R. Aitkenhead, and J. G. Hardman
BJA 2008 101: 291-293.[Extract] [Full Text] - Interprofessional handover and patient safety in anaesthesia: observational study of handovers in the recovery room
- A. F. Smith, C. Pope, D. Goodwin, and M. Mort
BJA 2008 101: 332-337.[Abstract] [Full Text] - Comparison of three scores to screen for delirium in the recovery room
- F. M. Radtke, M. Franck, M. Schneider, A. Luetz, M. Seeling, A. Heinz, K. D. Wernecke, and C. D. Spies
BJA 2008 101: 338-343.[Abstract] [Full Text] - The Papworth BiVent tube: a feasibility study of a novel double-lumen endotracheal tube and bronchial blocker in human cadavers
- S. Ghosh, A. A. Klein, M. Prabhu, F. Falter, and J. E. Arrowsmith
BJA 2008 101: 424-428.[Abstract] [Full Text] - Electrical impedance tomography to confirm correct placement of double-lumen tube: a feasibility study
- D. Steinmann, C. A. Stahl, J. Minner, S. Schumann, T. Loop, A. Kirschbaum, H. J. Priebe, and J. Guttmann
BJA 2008 101: 411-418.[Abstract] [Full Text] - Physiological comparison of spontaneous and positive-pressure ventilation in laryngotracheal stenosis
- S. A. R. Nouraei, D. A. Giussani, D. J. Howard, G. S. Sandhu, C. Ferguson, and A. Patel
BJA 2008 101: 419-423.[Abstract] [Full Text] - LMA-SupremeTM—a new single-use LMATM with gastric access: a report on its clinical efficacy
- C. Verghese and B. Ramaswamy
BJA 2008 101: 405-410.[Abstract] [Full Text]
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