ABSTRACT
Ultrasound is rapidly becoming an essential skill for all anaesthetists with an interest in regional anaesthesia. Using a single-blinded cross-over trial design, we assessed the accuracy and speed of simulated ultrasound-guided nerve blockade with the monitor either in direct line-of-sight or perpendicular to the line-of-sight. Thirty-one anaesthetists participated in the study. Times taken to reach the targets were similar 18.4 (14.6) s with the monitor 'in-line' and 22.4 (26.7) s with the monitor perpendicular to the target. Needle placement was significantly more accurate when anaesthetists had the monitor in front of them (29 acceptable) than to the side (22 acceptable). For anaesthetists with limited ultrasound experience, the accuracy, but not speed, of ultrasound guided regional anaesthesia can be improved by aligning the monitor in the line of sight of the operator.
Subject(s)
Nerve Block/methods , Ultrasonography, Interventional/instrumentation , Animals , Cattle , Clinical Competence , Cross-Over Studies , Humans , Phantoms, Imaging , Single-Blind Method , Time Factors , Ultrasonography, Interventional/methods , Ultrasonography, Interventional/standardsABSTRACT
Optimal airway management by the anaesthetist is particularly critical in neurosurgical patients. Standard intubation attempts may fail or have deleterious effects on cerebral dynamics so awake fibreoptic intubation is often the most suitable option for tracheal intubation. This review gives the neurosurgeon insight into why the anaesthetist may choose this method and what to expect if an awake fibreoptic intubation method is selected for the patient. The difficult airway is more frequently seen in hypophyseal and craniofacial surgery and in acute and chronic cervical spine pathology. Current practice and evidence for the use of the technique are reviewed and contraindications and complications discussed. A description of a typical awake fibreoptic intubation method is given with reference to the neurosurgical implications of local anaesthesia, sedation and the autonomic and neurophysiological responses that may occur.
Subject(s)
Fiber Optic Technology/methods , Intubation, Intratracheal/methods , Neurosurgery/instrumentation , Fiber Optic Technology/instrumentation , Humans , Intubation, Intratracheal/instrumentation , Neurosurgery/methods , WakefulnessABSTRACT
We determined how the quality of trial design and its reporting in scientific papers published in Anaesthesia has changed in the last 25 years. All articles between the years 1983-87 and 2003-07 were reviewed and classified according to methodology. Reporting and trial design of all prospective, comparative clinical interventional trials were compared between the two time periods using 12 criteria. Fewer articles now originate from the United Kingdom and Ireland than 25 years ago. Although fewer human interventional trials are now published in Anaesthesia, the quality of these trials has improved in terms of study design, bias control and proper disclosure. Significant improvements were observed in all criteria of trial design except for the declaration of non-primary adverse outcomes and the minimisation of the risk of type I errors. Further improvements could still be made with respect to sample size calculation, description of the method of randomisation, and blinding.
Subject(s)
Anesthesiology/standards , Clinical Trials as Topic/standards , Periodicals as Topic/standards , Research Design/standards , Anesthesiology/statistics & numerical data , Anesthesiology/trends , Bibliometrics , Clinical Trials as Topic/methods , Clinical Trials as Topic/trends , Humans , Periodicals as Topic/statistics & numerical data , Periodicals as Topic/trends , Publishing/standards , Publishing/statistics & numerical data , Publishing/trends , Research Design/trendsABSTRACT
During the 1990s, Aotearoa/New Zealand has experienced an alarming increase in youth suicide in the Maori and non-Maori populations. Among 23 Organization for Economic Cooperation and Development countries surveyed by the World Health Organization's (1995) World Health Statistics Annual, New Zealand ranks first for fatal suicidal behavior, in males 15-24 years of age, and third for fatal suicidal behavior in females. A United Nations Children's Fund (UNICEF, 1996) survey of 32 countries places New Zealand males as third highest for fatal suicidal behavior, and females as eighth highest in the age group 15-24 years. New Zealand has recently undergone a number of social and economic changes that have created dramatic social and cultural shifts. Given the rapidity of these changes, the shock on such a small country has been difficult to absorb. These shifts have placed tremendous pressures on families and service support systems, such as health and mental health services, to develop programs that are relevant and acceptable for a bicultural society. This article focuses on these changes and the effect they have had on cultural narratives of gender and suicidal behavior, the different cultural etiologies that underlie these statistics, and recommendations for intervention and prevention program development.
Subject(s)
Cultural Diversity , Gender Identity , Native Hawaiian or Other Pacific Islander/psychology , Psychology, Adolescent , Suicide/psychology , Adolescent , Adult , Attitude , Female , Humans , Male , New Zealand/epidemiology , Social Change , Socioeconomic Factors , Suicide/statistics & numerical dataABSTRACT
Three experiments were conducted to evaluate the effects of the luminance level of a pre-/post-exposure field and onset sequence of a post-exposure field on briefly exposed visual stimuli for 13 male and 13 female undergraduate college students. Results showed that identification of a briefly exposed informational test stimulus as well as masking effects (the minimum interval between an informational test stimulus and non-informational backward visual noise mask) were both influenced by the luminance of the pre-exposure field and onset sequence of the post-exposure field.
