Safer epidural and spinal connectors.

Inadvertent cross-connection of epidural local anaesthetic delivery systems with intravenous lines can cause significant morbidity and even death. Inadvertent intrathecal injection of toxic intravenous drugs has already led to many deaths. If epidural and spinal systems had the standard Luer lock connection reversed the problem would be prevented. The practical implications of this idea are explored. Patient safety would be enhanced if this system were adopted.

Organisational failures in urgent and emergency surgery. A potential peri-operative risk factor.

Medical error is an important cause of morbidity and mortality. Organisational failure in the pre-operative period has been associated with catastrophic outcome. Little information is available regarding peri-operative organisational problems. The incidence and nature of organisational failure before urgent and emergency surgery in a district general hospital was studied prospectively in 159 cases over a 30-day period. Organisational failure affected more than half of the cases overall, but varied in both its incidence and its complexity between surgical disciplines. Various causative factors were identified, e.g. 8% of cases were subject to delay due to clinical emergencies. The median [range] time required to rectify the problems was 115 [5-750] min. A consultant anaesthetist and surgeon were present in 30 and 20% of cases, respectively. Difficulty with the preparation of patients for emergency surgery is an important but underevaluated cause of medical error that may put patients at risk.

Oxygen desaturation after dental anaesthesia.

The incidence of oxygen desaturation (less than 91%) was measured by pulse oximetry during recovery from outpatient dental anaesthesia in 120 ASA grade I and II children. Alternate cases were given supplementary oxygen 5 litre min-1 by mask. Eighteen of 60 children (30%) given air and 14 of 60 (23%) given oxygen exhibited desaturation (P greater than 0.05). Desaturation was more likely to occur if the child was cared for during recovery by locum rather than permanent nursing staff: 22 of 64 (34%) compared with 10 of 56 (18%) (P less than 0.05). It is concluded that significant desaturation is common after brief dental anaesthesia, that the incidence of desaturation is not reduced significantly by supplementary oxygen and that careful supervision of patients by experienced recovery room staff is necessary after dental anaesthesia.

Support when gas exchange fails--ECMO, ECCO2R and IVOX.

The principles and problems of extracorporeal respiratory support (extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal) are reviewed. The recent development of intravenous oxygenation (IVOX) is noted and compared with existing forms of extracorporeal support.