SummaryWe conducted a national postal survey of trauma anaesthetists in the UK to ascertain current practice for the peri-operative anaesthetic management in patients with fractured necks of femur. We received 155 replies from 218 questionnaires sent (71.1% response rate). Regional anaesthesia was preferred by 75.8% of respondents, with 95.5% of these employing a spinal technique. This was generally performed bad side down (45.7%) using ketamine (37.3%) and ⁄ or midazolam (41.2%) to aid positioning. In all, 31.4% used fentanyl in the intrathecal injectate, whereas only 5.9% used morphine. Paracetamol and morphine were the most commonly used postoperative analgesic regimens with non-steroidal anti-inflammatory drugs used by only 27.4%. Continuous epidural or nerve block infusions were used rarely. Of the anaesthetists, 50.6% would only request a preoperative echo if there were suspicious signs or symptoms in patients with a previously undiagnosed heart murmur. The peri-operative management of these patients can be readily improved.
SummaryComplications at extubation remain an important risk factor in anaesthesia. A postal survey was conducted on extubation practice amongst consultant anaesthetists in the United Kingdom and Ireland. The use of short acting drugs encourages anaesthetists to extubate the trachea at lighter levels of anaesthesia. The results show that oxygen (100%) is not routinely administered either before extubation or en route to the recovery area. A trend towards a head up or sitting position at extubation is emerging. However, further research into the use of these positions is required. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. The role of drugs such as propofol in decreasing the incidence of these complications needs further evaluation. Some of these results give concern for patient safety and for training. The importance of teaching and adherence to continued oxygenation until complete recovery is strongly emphasised. Nerve stimulators should be used continually as standard monitoring throughout the anaesthetic period when muscle-relaxing drugs are part of the anaesthetic technique. It has been shown that there are more adverse incidents associated with extubation than intubation and these are occurring not only during extubation itself, but also during the time spent in the recovery room [1][2][3][4][5]. The increased incidence of complications has been correlated with the pre-operative physical status, depth of anaesthesia at extubation, increasing age and gender with a male preponderance [2,6]. These complications remain consistent regardless of the type of operation [1].The problems associated with extubation may be broadly categorised into cardiovascular and respiratory complications. Cardiovascular complications include tachycardia, hypotensive and hypertensive episodes [7][8][9][10], which may be significant in patients with pre-existing ischaemic heart disease [11,12], pre-eclampsia [13] and in those undergoing neurological procedures [14]. Respiratory complications include local trauma, coughing, desaturation, breath-holding, masseter-spasm, laryngospasm, airway obstruction and aspiration [7,[15][16][17][18]].An on-line journal search revealed a lack of recent investigations or statistical data in these areas. This survey was performed with this in mind. The main aims of the survey were twofold. The first was to ascertain extubation practices with regard to the type of surgery, timing, position and techniques. The second was to estimate the incidence of problems associated with extubation and how these were treated.
MethodsA postal survey was conducted in May 2004. A total of 845 Consultant Anaesthetists were randomly selected from the membership database of the Association of Anaesthetists of Great Britain and Ireland (AAGBI). These anaesthetists were sent the questionnaire, which they were asked to complete and return anonymously in the stamped, addressed envelope provided. The questionnaire (Fig. 1) was a structured document with...
We describe an adult patient with gastric volvulus caused by a congenital diaphragmatic hernia. Anaesthetic management was complicated by cardiovascular instability, respiratory distress and unexpectedly difficult intubation.
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