SummaryWe performed a national postal survey exploring anaesthetists' practice in rapid sequence induction. All respondents used pre-oxygenation, although the technique employed, and its reliability, varied. Thiopental and succinylcholine, given after waiting for signs of loss of consciousness, were the most widely used drugs for rapid sequence induction. Propofol and rocuronium were used by more than a third of respondents, and most respondents (75%) also routinely administered an opioid. Cricoid pressure was used universally but the practice of its application varied widely. The commonest aids used if intubation was difficult were the gum elastic bougie, the long laryngoscope blade and the laryngeal mask. After failed intubation, approximately half of respondents would maintain the supine position. Failure to intubate at rapid sequence intubation had been seen by 45% of respondents but harm was uncommon. In contrast, 28% had seen regurgitation, which frequently led to considerable harm and to three deaths. In spite of this, practice of a failed intubation drill was uncommon (15%) and anaesthetic assistants were rarely known to practice application of cricoid pressure. Consultants were less likely than trainees to use rocuronium as a muscle relaxant, and more likely to choose morphine if administering an opioid. They were less likely to practice a failed intubation drill. Other aspects of practice varied little between grades. This survey suggests that many anaesthetists do not follow best practice when performing a rapid sequence induction.
Computerised dynamic posturography (CDP) can be used as an early marker of recovery to street fitness in patients undergoing ambulatory surgery. We studied three groups of patients undergoing nasal surgery. The goal of this study was to determine whether recovery, as assessed by CDP, is more rapid in patients having nasal surgery under sedation coupled with local anaesthesia or those having surgery under general anaesthesia. We further assessed the acceptability of sedation accompanied by local anaesthesia. A control group was included to determine if there is a learning curve to posturography. There was no difference between the two study groups in terms of balance. Balance was not significantly impaired at 3 h postoperative testing.
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