Surgical time-out procedures: a single centre audit of standardised surgical communications.

OBJECTIVE: To assess deviation from a standardised structure of surgical time-out procedures in a multidisciplinary referral hospital. MATERIALS AND METHODS: An observational process audit was performed on a convenience sample of surgical cases. A fly-on-the-wall observer assessed surgical time-out procedures in real-time. Pre-induction and recovery checklists were not assessed. Observations were recorded on standardised reporting forms including a checklist and free text. Analysis was performed using a validated framework of four conceptual domains: the purpose, occasion, audience and content of the communication. Field notes were taken to allow retrospective verification of assessments. Observations were compared to a predefined standardised surgical time-out procedure structure. RESULTS: Twenty surgical time-out procedures were observed from a mixture of procedure types. Although all were performed at the specified time and place, only eight (40%) were considered to have fully achieved their purpose with potentially important sections of the communication being omitted in the others. Individuals were not ready for communication to begin in 14 (70%) and distractions occurred in 11 surgical time-out procedures (55%). In seven surgical time-out procedures (35%) superfluous information was communicated. CLINICAL SIGNIFICANCE: In a busy operating theatre environment, surgical time-out procedures may not be performed as they are intended. Communication during surgical time-out procedures should be audited to highlight opportunities for improvement.

Effect of intratesticular lidocaine on isoflurane requirements in dogs undergoing routine castration.

OBJECTIVES: To evaluate the isoflurane sparing effect of intratesticular lidocaine administration in dogs undergoing castration. METHODS: Thirty dogs received a standardised anaesthetic regimen including systemic analgesia with intramuscular buprenorphine at a dose of 0·02 mg/kg and intravenous carprofen at a dose of 4 mg/kg. Dogs were randomly assigned to a lidocaine group receiving 1 mg/kg lidocaine into each testis or a control group receiving no lidocaine. Baseline physiological parameters were measured after 10 minutes at an end-tidal isoflurane concentration of 1·3%. End-tidal isoflurane concentration was altered throughout surgery to maintain these parameters within 10% of baseline and recorded at five time points. T0 was baseline, T1 was the start of surgery, T2 to T3 were clamping of the testicular pedicles and T4 was skin closure. End-tidal isoflurane concentrations were compared using analysis of variance and Bonferroni tests. RESULTS: Fifteen healthy dogs were included in each study group. End-tidal isoflurane concentration was significantly lower in the lidocaine group compared to the control group at T2 (P<0·01), T3 (P<0·01) and T4 (P<0·01). CLINICAL SIGNIFICANCE: Intratesticular lidocaine reduces isoflurane requirements in dogs undergoing castration.

Progress toward the development of a safe and effective agent for treating reentrant cardiac arrhythmias: synthesis and evaluation of ibutilide analogues with enhanced metabolic stability and diminished proarrhythmic potential.

A series of ibutilide analogues with fluorine substituents on the heptyl side chain was prepared and evaluated for class III antiarrhythmic activity, metabolic stability, and proarrhythmic potential. It was found that fluorine substituents stabilized the side chain to metabolic oxidation. Many of the compounds also retained the ability to increase the refractoriness of cardiac tissue at both slow and fast pacing rates. The potential for producing polymorphic ventricular tachycardia in the rabbit model was dependent on the chirality of the benzylic carbon. The S-enantiomers generally had less proarrhythmic activity than the corresponding racemates. One compound from this series (45E, trecetilide fumarate) had excellent antiarrhythmic activity and metabolic stability and was devoid of proarrhythmic activity in the rabbit model. It was chosen for further development.