Efficacy of paediatric anaesthetic trolleys: A call for a basic standard and layout.

BACKGROUND: Providing safe anaesthesia to children especially in emergency situations goes hand in hand with instant availability of appropriately sized equipment and monitoring. This is best achieved using a designated paediatric anaesthetic trolley containing essential equipment. Guidance for the contents of such trolleys is neither explicit nor standard. We used a survey and a qualitative enquiry to develop a checklist suitable for standardisation of contents and layout of paediatric anaesthetic trolleys. METHODS: We conducted an observational study of our current practice and paediatric anaesthetic trolleys in a tertiary care hospital. We also performed a qualitative enquiry from experienced paediatric anaesthetists and operating department practitioners.We developed an empirical checklist to ensure the minimum 'essential' equipment is available on these trolleys and implemented a standard layout to facilitate its use. RESULTS: We identified 11 areas in our hospital where anaesthesia is provided to children, each with a designated paediatric anaesthetic trolley. There were considerable deficiencies of items in all areas with no standard pattern or layout. Different types of trolleys contributed to the confusion. In addition, overstocking of inappropriate items hindered its efficient use. CONCLUSION: Standardising the contents and layout of the paediatric anaesthetic trolley is an essential pre-requisite for safer paediatric anaesthetic practice.

Arterial and end-tidal carbon dioxide difference in pediatric intensive care.

BACKGROUND AND AIM: Arterial carbon dioxide tension (PaCO2) is considered the gold standard for scrupulous monitoring in pediatric intensive care unit (PICU), but it is invasive, laborious, expensive, and intermittent. The study aims to explore when we can use end-tidal carbon dioxide tension (PETCO2) as a reliable, continuous, and noninvasive monitor of arterial CO2. MATERIALS AND METHODS: Concurrent PETCO2, fraction of inspired oxygen, PaCO2, and arterial oxygen tension values of clinically stable children on mechanical ventilation were recorded. Children with extra-pulmonary ventriculoatrial shunts were excluded. The PETCO2 and PaCO2 difference and its variability and reproducibility were studied. RESULTS: A total of 624 concurrent readings were obtained from 105 children (mean age [SD] 5.53 [5.43] years) requiring invasive bi-level positive airway pressure ventilation in the PICU. All had continuous PETCO2 monitoring and an arterial line for blood gas measurement. The mean (SD) number of concurrent readings obtained from each child, 4-6 h apart was 6.0 (4.05). The PETCO2 values were higher than PaCO2 in 142 observations (22.7%). The PaCO2-PETCO2 difference was individual admission specific (ANOVA, P < 0.001). The PaCO2-PETCO2 difference correlated positively with the alveolar-arterial oxygen tension [P(A-a)O2] difference (ρ = 0.381 P < 0.0001). There was a fixed bias between the PETCO2 and PaCO2 measuring methods, difference +0.66 KPa (95% confidence interval: +0.57 to +0.76). CONCLUSIONS: The PaCO2-PETCO2 difference was individual specific. It was not affected by the primary disorder leading to the ventilation.

Alcohol pharmacokinetics and risk-taking behaviour following exercise-induced dehydration.

This study investigated the influence of exercise-induced dehydration on alcohol pharmacokinetics, subjective ratings of impairment, and risk-taking behaviours. Twelve male volunteers participated in 3 experimental trials completed in a randomised cross over design separated by at least 7 days. In one trial, participants exercised to cause dehydration of ~2.5% body weight loss. For the other trials, participants were required to be in a rested and euhydrated state. A set volume of alcohol was then consumed in each trial and participants were monitored over a 4h period. Blood (BAC) and breath (BrAC) alcohol samples were collected throughout and analysed to calculate pharmacokinetic variables associated with the blood alcohol curve. Total urine production, estimates of BrAC, and subjective ratings of intoxication and impairment were also recorded throughout each trial. No difference was found in the pharmacokinetics of alcohol between any of the trial conditions. BrACs were higher than BACs for 2h following alcohol consumption, but lower at measures taken 3 and 4 h post ingestion. Participants' ratings of confusion and intoxication were significantly lower, and they were more willing to drive in the dehydration trial compared with one of the euhydration trials. These findings suggest that dehydration or other physiological changes associated with exercise may have an ability to influence the subjective effects of alcohol and increase the likelihood of risk-taking behaviours such as drink-driving. However, further research is required to examine the effects of alcohol under conditions of exercise-induced fluid loss in order to clarify these findings.

How a quality improvement initiative can be used to promote single sex accommodation.

The NHS is committed to delivering privacy and dignity to all patients. To this end, the Department of Health has implemented initiatives to eliminate mixed sex wards. Salford Royal Foundation Trust is committed to three guiding principles of clean, safe and personal care. In April 2008, the trust launched its quality improvement strategy, and the single sex project within this aims to ensure that 95% of patients are admitted directly to single sex accommodation. This initiative implemented a number of tests of change relating to workforce and culture, facilities and planning, and communication. To examine whether these tests had resulted in an improvement, outcome, process and balancing measures were designed. The outcome measures showed the trust reached a compliancerate of 93% of all patients admitted to three clinical areas.