Ability of anaesthetists to identify a marked lumbar interspace

Abstract

SummaryA computerised database of operating theatre activity was used to estimate the costs of regional and general anaesthesia for varicose vein and inguinal hernia surgery. Data retrieved for each procedure included the anaesthetic technique and drugs used, and the duration of anaesthesia, surgery and recovery. The costs of anaesthetic drugs and disposables, salary costs of the anaesthetic personnel and maintenance costs for anaesthetic equipment were considered. Drugs and disposables accounted for < 25% of the total cost of an anaesthetic. Anaesthetic times were 5 min longer for regional anaesthesia, but recovery times were 10 min shorter following regional anaesthesia for varicose vein surgery. Staff costs were dependent on the length of time each staff member spent with the patient. Although the number of cases was small, provision of a field block and sedation for inguinal hernia repair was considerably cheaper than other anaesthetic techniques.Keywords Anaesthetic costs: regional; general. Cost containment has become a priority in all areas of health care. Clinicians must work within tightly controlled budgets in spite of increasing demand for services, expectations of higher standards, and the introduction of new drugs and techniques. A common view is that anaesthetic costs are insignificant because they are a relatively small component of the total for each surgical episode. This is superficially true; the Audit Commission reported that anaesthetic services comprised only 3% of NHS trust expenditure [1]. However, this adds up to a large sum of money across the service. Anaesthesia for any surgical procedure involves a wide choice of drugs, techniques and monitoring procedures, each with very different cost implications. Selection of any particular method must be determined by the relative costs, as well as the clinical benefits, if the challenge of providing highquality care within limited resources is to be met.The cost of each anaesthetic is the sum of a number of components. Information about the price of drugs (the commonest focus for debate) is readily available, but choices based solely on drug acquisition costs ignore many other factors that contribute to the cost of an anaesthetic, including capital and recurrent expenditure on equipment, the prices of disposable equipment, and the salaries of the anaesthetist, anaesthetic assistant and recovery staff. Personnel costs are dependent on the time spent by the patient in the anaesthetic room, operating theatre and recovery area, each of which may be affected by the anaesthetic technique or drugs used. This study used data from a computerised database of operating theatre activity to compare the costs of general and regional anaesthesia for patients undergoing varicose vein and inguinal hernia surgery. Methods Data collectionThe Ninewells Hospital operating theatre management system was established in 1989 using the Financial Information Project (FIP) Galaxy Theatre System, a software package marketed by Sanderson GA Ltd (1±2 Venture Way, Aston Scien...

Locating the epidural space in obstetric patients—ultrasound a useful tool: Continuing Professional Development

“…A high frequency (7)(8)(9)(10)(11)(12)(13)(14)(15) MHz) linear transducer is preferred for peripheral nerve blocks and central venous cannulations where the structures to be visualized are located superficially. This transducer produces a high-resolution image; however, it has poor beam penetration.…”

“…11 Broadbent et al demonstrated that even experienced anesthesiologists estimate the intervertebral level inaccurately by palpation in 71% of cases; they tend to estimate the level as higher than the actual, and their estimate could be as many as four spaces higher. 12 Tuffier's line, an anatomical landmark widely used for this purpose, does not always bear a constant relationship to an individual vertebral level or the interspace. Particularly in pregnant women, Tuffier's line intersects the spine above L4-5 interspace level, and the median level of intersection is just below L2-3 level.…”

“…Another factor to consider is the inconsistent location of the tip of the conus medullaris with respect to the vertebral level, which lies below L1-2 in about 42% of adults. 12 With ultrasound imaging, intervertebral levels can be identified with more precision. Its accuracy has been shown to be about 76% compared with 30% accuracy with palpation.…”

“…ont démontré que, dans 71 % des cas, même des anesthésiologistes d'expérience estimaient de façon erronée le niveau intervertébral par palpation; en effet, ils ont tendance à estimer le niveau comme étant plus élevé qu'en réalité, et leurs estimations peuvent s'écarter du niveau réel jusqu'à quatre espaces plus haut. 12 La ligne de Tuffier, un repère anatomique communément utilisé à cette fin, ne correspond pas systématiquement à un niveau vertébral ou à un espace interépineux en particulier. C'est particulièrement le cas chez les femmes enceintes, où la ligne de Tuffier rejoint la colonne au-dessus du niveau intervertébral L4-5, et le niveau médian d'intersection se situe juste au-dessous du niveau L2-3.…”

“…Un autre facteur dont il faut tenir compte est l'emplacement changeant du cône médullaire par rapport au niveau vertébral, qui se situe au-dessous de L1-2 chez environ 42 % des adultes. 12 L'imagerie par ultrason permet d'identifier les niveaux intervertébraux avec davantage de précision. Il a été démontré que sa précision était d'environ 76 % par rapport à une précision de 30 % avec une méthode de palpation.…”