Anaesthetic assistants: their role in the development and resolution of anaesthetic incidents.

Trained anaesthetic assistants are considered essential for the safe conduct of anaesthesia. Data from 5837 AIMS (Anaesthetic Incident Monitoring Study) reports were evaluated for issues concerning anaesthetic assistants in the generation and resolution of anaesthetic incidents. "Inadequate assistance" as a contributing factor was identified in 187 reports, whilst "skilled assistance" which minimized the incident was present in 808 cases. One hundred and seventy-two reports specifically commented on anaesthetic assistants in the narrative section of the AIMS form. All surgical specialties were represented. In 147 of these reports the assistant actually contributed to or failed to assist with the incident. Although the majority of outcomes from the reports were uneventful, prolonged stay, awareness and ICU admission did ensue in a small number of cases. The most common incidents were related to problems with equipment, communication and inadequate staffing levels (number and/or skill mix). Results from this study have implications for anaesthetic assistant staffing levels and the orientation of course content.

Rapid inhalational induction of anaesthesia with isoflurane or halothane in humidified oxygen.

This study was designed to determine the relative speeds of induction and complication rates using either halothane or isoflurane for rapid inhalational induction of anaesthesia. Forty ASA physical status 1 and 2, unpremedicated patients presenting for day-care dental surgery received a rapid inhalational induction (RII) with either halothane 3.5% or isoflurane 5% in humidified oxygen. The carrier gas was humidified in order to limit airway irritation caused by the pungency of the volatile agents. Isoflurane produced a faster induction than halothane-121(50) (SD) sec vs 176(36) sec (P less than 0.01). Complication rates during induction (coughing, secretions, excessive movement and abandoned inductions) were similar for the two groups. The majority of patients in both the isoflurane group (17/20) and the halothane group (14/20) found the technique of RII to be acceptable. The incidences of headache, nausea and vomiting were low and not significantly different for the two groups. Isoflurane 5% in humidified oxygen is as acceptable for RII as halothane 3.5% and has a similar complication rate. Isoflurane may be used for RII in cases where it is deemed necessary to avoid halothane, or when a more rapid inhalational induction is required than is possible with halothane. The technique of RII with either agent in unpremedicated patients is well suited to day-care anesthesia.