SummaryIn aviation, the sterile cockpit rule prohibits non-essential activities during critical phases of flight, takeoff and landing, phases analogous to induction of, and emergence from, anaesthesia. We studied distraction during 30 anaesthetic inductions, maintenances and emergences. Mean (SD) noise during emergence (58.3 (6.2) dB) was higher than during induction (46.4 (4.3) dB) and maintenance (52 (4.5) dB; p < 0.001). Sudden loud noises, greater than 70 dB, occurred more frequently at emergence (occurring 34 times) than at induction (occurring nine times) or maintenance (occurring 13 times). (93%) emergences. These data demonstrate increased distraction during emergence compared with other phases of anaesthesia. Recognising and minimising distraction should improve patient safety. Applying aviation's sterile cockpit rule may be a useful addition to our clinical practice.
There is a significant increase in EtCO(2) in children undergoing thoracoscopy, which is higher than during laparoscopy. Changes in EtCO(2) are larger in smaller children undergoing single-lung ventilation. Thoracoscopy may preserve intraoperative thermoregulation.
Peripheral nerve blocks offer many potential advantages over opioid-based anaesthesia and analgesia for upper limb surgery.• The peripheral nerves of the upper limb are superficial and identified by a linear, high-frequency ultrasound transducer.
Ultrasound-guided peripheral nerve blocks of the upper limbPatient selectionSuccessful regional anaesthesia for upper limb surgery is reliant on appropriate patient selection. PNBs are advantageous in patients undergoing extensive surgery and those prone to PONV, at risk of postoperative respiratory depression or intolerant of opioids. Primary patient exclusions are patient refusal, infection
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