Morning conferences for anaesthesiologists - to be or not to be?

BACKGROUND: The main objectives of this study were to clarify the contents of and attitudes to morning conferences for physicians at Swedish departments of anaesthesiology and intensive care medicine. METHODS: A prospective cross-sectional three-part study was carried out. Heads of departments responded to a national survey on the structure and content of morning conferences. A questionnaire on attitudes to and general contents of morning conferences was filled out by anaesthesiologists in the Scania region in southern Sweden. Furthermore, telephone interviews were made with anaesthesiologists on primary night call in the Scania region to obtain information on whether their needs to report had been met and on how the conferences had actually been carried out and attended by the physicians. RESULTS: Information was obtained from 52 departmental heads (80%), 113 anaesthesiologists (53%), and 83 physicians on primary call (92%). Issues most frequently brought up were reports from physicians on night call, discussions of clinical matters, issues of staffing, and organizational matters. Daily morning conferences were strongly favoured for intercollegial solidarity and contacts, and were mainly and regularly used for reports from physicians on night call. At 95% of them, physicians on night call considered themselves to have been allowed to report what they wanted or needed to. CONCLUSIONS: Daily morning conferences enable regular exchange of information and professional experience, and are considered by Swedish anaesthesiologists to be most valuable for intercollegial solidarity and contacts. Before changes are being made in frequency or duration of morning conferences, their actual structure and content should be carefully evaluated and critically challenged to fit specific needs of that individual department

Management of Inadvertent Arterial Catheterisation Associated with Central Venous Access Procedures

OBJECTIVE: This study aims to describe the clinical management of inadvertent arterial catheterisation after attempted central venous catheterisation. METHODS: Patients referred for surgical or endovascular management for inadvertent arterial catheterisation during a 5-year period were identified from an endovascular database, providing prospective information on techniques and outcome. The corresponding patient records and radiographic reports were analysed retrospectively. RESULTS: Eleven inadvertent arterial (four common carotid, six subclavian and one femoral) catheterisations had been carried out in 10 patients. Risk factors were obesity (n=2), short neck (n=1) and emergency procedure (n=4). All central venous access procedures but one had been made using external landmark techniques. The techniques used were stent-graft placement (n=6), percutaneous suture device (n=2), external compression after angiography (n=1), balloon occlusion and open repair (n=1) and open repair after failure of percutaneous suture device (n=1). There were no procedure-related complications within a median follow-up period of 16 months. CONCLUSIONS: Inadvertent arterial catheterisation during central venous cannulation is associated with obesity, emergency puncture and lack of ultrasonic guidance and should be suspected on retrograde/pulsatile catheter flow or local haematoma. If arterial catheterisation is recognised, the catheter should be left in place and the patient be referred for percutaneous/endovascular or surgical management

Pulmonary sequestration--a review of 8 cases treated with lobectomy

To access Publisher full text version of this article. Please click on the hyperlink in Additional LinkBACKGROUND AND AIMS: Pulmonary sequestration (PS) is a rare congenital malformation where non-functioning lung tissue is separated from the bronchial tree and vascularised with an aberrant artery from the systemic circulation. The aim of this report was to study all patients who were treated for PS at Lund University Hospital between 1994 and 2004, with emphasis on clinical presentation of the disease and evaluate the results of surgical treatment. MATERIAL AND METHODS: 8 cases were identified, 7 females and one male, with a mean age of 7.3 years (range 25 days -17 years) at the time of diagnosis. RESULTS: Out of 8 patients, seven presented with respiratory symptoms and two with congestive heart failure. Five patients had other congenitial malformations; including scimitar syndrome and congenital heart disease. All the patients underwent a successful lobectomy. There were no major postoperative complications. At a medium follow-up of 77 months all of the fully treated children were doing well. CONCLUSION: Respiratory and cardiovascular symptoms are the most common symptoms related to PS. The wide range of clinical symptoms may cause diagnostic problems, especially in children and young adults with concomitant congenital heart disease. Therefore PS should be considered as a differential diagnosis in children with unexplained respiratory symptoms or with signs of congestive heart failure. In patients with PS, lobectomy seems to be a good therapeutic option

Clinical guidelines on central venous catheterisation

Safe and reliable venous access is mandatory in modern health care, but central venous catheters (CVCs) are associated with significant morbidity and mortality, This paper describes current Swedish guidelines for clinical management of CVCs The guidelines supply updated recommendations that may be useful in other countries as well. Literature retrieval in the Cochrane and Pubmed databases, of papers written in English or Swedish and pertaining to CVC management, was done by members of a task force of the Swedish Society of Anaesthesiology and Intensive Care Medicine. Consensus meetings were held throughout the review process to allow all parts of the guidelines to be embraced by all contributors. All of the content was carefully scored according to criteria by the Oxford Centre for Evidence-Based Medicine. We aimed at producing useful and reliable guidelines on bleeding diathesis, vascular approach, ultrasonic guidance, catheter tip positioning, prevention and management of associated trauma and infection, and specific training and follow-up. A structured patient history focused on bleeding should be taken prior to insertion of a CVCs. The right internal jugular vein should primarily be chosen for insertion of a wide-bore CVC. Catheter tip positioning in the right atrium or lower third of the superior caval vein should be verified for long-term use. Ultrasonic guidance should be used for catheterisation by the internal jugular or femoral veins and may also be used for insertion via the subclavian veins or the veins of the upper limb. The operator inserting a CVC should wear cap, mask, and sterile gown and gloves. For long-term intravenous access, tunnelled CVC or subcutaneous venous ports are preferred. Intravenous position of the catheter tip should be verified by clinical or radiological methods after insertion and before each use. Simulator-assisted training of CVC insertion should precede bedside training in patients. Units inserting and managing CVC should have quality assertion programmes for implementation and follow-up of routines, teaching, training and clinical outcome. Clinical guidelines on a wide range of relevant topics have been introduced, based on extensive literature retrieval, to facilitate effective and safe management of CVCs