Implications of equipment failure occurring during surgery.

INTRODUCTION: Few formal studies have been performed investigating the frequency of equipment failure during surgery. Surgeons are unable to operate without the plethora of instruments and equipment surrounding them in the operating theatre. As with any mechanical component, instruments and equipment are subject to time- and use-dependent degradation in their performance. Yet no formal requirements exist for the routine inspection or maintenance of instruments. Owing to this lack of information regarding equipment failure we undertook the first investigation of intraoperative equipment malfunction occurring during cardiac surgical procedures. METHODS: Over a 12-month period cardiac surgeons were required to report equipment malfunction during each procedure. Operating theatre equipment was divided into three categories broadly based on equipment portability and function: group 1, theatre infrastructure and components; group 2, large medical equipment; and group 3, surgical instruments. RESULTS: In a highly significant proportion of operations performed (92%) there was an issue with equipment. The most common issues occurred in group 3 with fine surgical instrument malfunctions; most commonly worn-out needle holders and blunt scissors. Theatre infrastructure and large medical equipment failures (groups 1 and 2) resulted in the cancellation of four cases. Some intraoperative instrument failures were potentially catastrophic. CONCLUSIONS: The incidence of equipment failure during cardiac surgery is unacceptably high. In some instances, cases were cancelled and revenue lost owing to equipment malfunction. A balance between the safety and quality of equipment and cost effectiveness is required. These findings suggest that surgical instruments warrant an annual compulsory inspection.

Retrosternal goitre assumed to be asthma causing asphyxia in pregnancy: case report and literature review.

The prevalence of asthma is high, but 'all that wheezes is not asthma'. We present the case of a 38-year-old pregnant woman who had acute severe ventilatory failure initially thought to be an exacerbation of asthma. This delayed the actual diagnosis of haemorrhagic enlargement of a goitre complicated by pre-eclampsia. We also perform a literature review of previous publications. This case highlights the goitrogenic effects of pregnancy and the associated risks of respiratory compromise.

Bronchogenic cyst imitating chronic asthma.

This case report demonstrates the dangers of assuming the accuracy of a neonatal diagnosis of asthma, that is not responsive to medical therapy, and highlights the value of CT imaging.