Category Archives: clinical

To do or not to do?

Does it need to be done now? If deferred is the outcome likely to be different/better/worse/the same?

If surgically patient needs to be done but needs a level x bed and none available – if on balance the surgeons agree that, though not ideal and increased chance of mobility/mortality without higher level is recognised, if the outcome is still likely to be better than if deferring – proceed.

Single-breath vital capacity inhalation induction with high concentration Sevoflurane (SBVC – HC)

Single-breath vital capacity inhalation induction with high concentration sevoflurane (SBVC – HC)

 

Does exactly what it says on the tin.

 

Prime the circuit with 8% Sevo with >= 6 L /min O2 (+/- N2O).

Hold face mask against surface to build up Sevo.

Practice vital capacity breathing with patient.

Following forced expiration apply face mask and instruct to take vital capacity breath.

 

Induction complete in 50-60 sec.

 

http://bja.oxfordjournals.org/content/early/2012/09/16/bja.aes319.full.pdf

 

– PB @ LRI

 

What does an excellent anaesthetist look like?

J. Larsson et al (BJA, 2013) say he/she is:

  • structured, responsible and has a focused way of approaching tasks
  • clear and informative, briefing the team about the action plan before induction
  • humble to the complexity of anaesthesia, admitting own fallibility
  • patient centred, having personal contact with the patient before induction
  • fluent in practical work without losing overview
  • calm and clear in critical situation, being able to change to a strong leading style

 

A.F. Smith et al (BJA, 2011) found the most highly ranked attributes were:

  • ‘strives for excellence’
  • innovative/original
  • good communicator
  • teacher
  • clinical skills