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Biomedical subjects

S L Dain

Publications and source records attributed to S L Dain.

4 recordsLinked to original sources
PubMed2001

Anesthesia standards for facilities and equipment.

PURPOSE: This article will define standards, how they are developed and applied and how they impact on the day to day practice of clinicians. SOURCE: CSA-International, International Electrotechnical Committee (IEC), Organization for International Standardization (ISO). PRINCIPAL FINDINGS: The safety record of the practice of anesthesia has improved over the past 20 yr. This has been brought about by the increase in the knowledge base of physiology and pharmacology, improvements in anesthetic drugs and other medications and through the use of better equipment. However, the introduction of new equipment and the building of new health care facilities has also introduced risks to patient safety. These risks have been created by oversights in design, mistakes in equipment manufacture or facility construction and the need to produce a usable product for the price the health care system can afford. After the anesthetic disasters of the 1960s and 1970s, the need for minimum standards for safety in the design and construction of healthcare facilities and medical equipment were recognized. Canadian anesthesiologists were at the forefront in the development of these standards, and still today members of the Canadian Anesthesiologist's Society are key contributors to the development of both National and International standards. CONCLUSION: Equipment and facility standards have helped improve patient safety over the past 20 yr. However, anesthesiologists need to encourage their governmental regulatory bodies to encourage manufacturer compliance with specific standards.

Anesthesiology↗
PubMed1999

Anesthesia for intranasal surgery: a comparison between tracheal intubation and the flexible reinforced laryngeal mask airway.

UNLABELLED: The purpose of the study was to assess the suitability and safety of the flexible reinforced laryngeal mask airway (FRLMA) for intranasal surgery (INS) anesthesia. A secondary objective was to compare the incidence of complications of removal of the FRLMA with tracheal extubation in awake and anesthetized patients. One hundred fourteen ASA physical status I and II patients requiring INS were randomly assigned into three groups: Group I = FRLMA, Group II = endotracheal tube (ET) extubated awake, and Group II = ET extubated deeply anesthetized. In Group I, the incidence of coughing and oxyhemoglobin desaturation at removal was significantly reduced compared with that in Groups II and III (P < 0.05). There were no episodes of postremoval laryngospasm in Group I; in Group III, the incidence was 19% (P < 0.05), whereas in Group II, it was 6% (not significantly different). The number of patients with oxyhemoglobin desaturation < or = 92% on admission to the postanesthesia care unit was 0% in Group I, 26% in Group II (P < 0.05), and 16% in Group III (not significantly different). At bronchoscopy, the incidence of blood visible in the airway was low and similar among the three groups (3%, 6%, and 3%, respectively). There were no significant differences in the incidence of airway complications between Groups II and III. IMPLICATIONS: We compared airway management for intranasal surgery anesthesia using a new device, the flexible reinforced laryngeal mask airway, with the current standard of tracheal intubation. The study demonstrates that the flexible reinforced laryngeal mask airway can provide a safe, protected airway with a smoother emergence from anesthesia than tracheal intubation.

Adult↗
PubMed1987

The epidural test dose in obstetrics: is it necessary?

One must distinguish between what is medically safe and what is legally safe. The authors have the impression that in order to be "legally safe" one must perform a test dose. This is despite the fact that it has not been conclusively shown that the use of test doses improve the safety margin of epidural anaesthesia, when administered by a competent person, with the proper resuscitative equipment immediately available. Until a controlled study is performed, test doses should be done for continuous epidural anaesthesia with the understanding that they are neither 100 per cent sensitive nor specific in preventing complications. It is however one more manoeuvre that may be useful in recognizing some of the patients with accidental subarachnoid placement of epidural catheters. The literature suggests that lidocaine 1.5 per cent in dextrose 7.5 per cent should be the test dose of choice in obstetric epidural anaesthesia in an amount known to produce spinal anaesthesia (30-50 mg). The use of epinephrine in test doses in unpremedicated healthy women in active labour is neither sensitive nor specific in signalling intravascular injection, and it may also be detrimental to fetal wellbeing. Epinephrine 15 micrograms as a test dose for intravenous injection appears to create more problems than it solves.

Anesthesia, Epidural↗