No abstract

The Difficult Airway Society 2015 guidelines recommend and describe in detail a surgical cricothyroidotomy technique for the can't intubate, can't oxygenate (CICO) scenario, but this can be technically challenging for anaesthetists with no surgical training. Following a structured training session, 104 anaesthetists took part individually in a simulated can't intubate, can't oxygenate event using simulation and airway models to evaluate how well they could perform these front-of-neck access techniques. Main outcomes measures were: ability to correctly perform the technical steps; procedural time; and success rate. Outcomes were compared between palpable and impalpable cricothyroid membrane scenarios. Anaesthetists' technical abilities were good, as assessed by a video analysis checklist score. Mean (SD) procedural time was 44 (16) s and 65 (17) s for the palpable and impalpable cricothyroid membrane models, respectively (p ≤ 0.001). First-pass tracheal tube placement was obtained in 103 out of the 104 palpable cricothyroidotomies and in 101 out of the 104 impalpable cricothyroidotomies (p = 0.31). We conclude that anaesthetists can be trained to perform surgical front-of-neck access to an acceptable level of competence and speed when assessed using a simulator.

A survey of 35 hospitals in the United Kingdom has uncovered a wide variety of syringe drug labels. Use of different systems in different hospitals may result in wrong drug administrations, particularly when trainees move from one hospital to another. There is an urgent need to standardise the colour coding of syringe labels in the United Kingdom. Such standards are already in place in Australia, New Zealand and in the United States of America. This survey of syringe drug labels highlights the existing risks and recommendations for change are made.

No abstract

Anaesthetic facemasks are among the most commonly used airway devices. Many facemasks manufactured and sold in the UK still have mask hooks (Fig 1). Since the advent of the laryngeal masks and the second-generation supraglottic devices, the hooks and the harness are no longer in use in most European countries. A short survey in four hospitals in the West Midlands, UK, showed that the hooks on the anaesthetic face masks were removed by the anaesthetic team and discarded unused straight from the packaging. They felt that the hooks interfered with the ease and comfort of holding the mask.Three UK-based product managers of companies that manufacture masks were asked to clarify the position regarding the hooks. They were not surprised with our survey findings and were aware that the hooks were not used by anaesthetists in most of the UK and Europe. They had to manufacture them as standard because mask anaesthesia with the use of the head harness was still popular and practised in North America, which was a big market for their products. The logistics of supplying only to a European market without the hook was far costlier than the manufacture and supply of the hooks to all regions. The overall extra cost was less than 2% of the total value of the face mask.