The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we p...The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal(IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, costeffective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.展开更多
This paper discusses some of the key aspects of human factors in anaesthesia for the improvement of patient safety. Medical errors have emerged as a serious issue in healthcare delivery. There has been new interest in...This paper discusses some of the key aspects of human factors in anaesthesia for the improvement of patient safety. Medical errors have emerged as a serious issue in healthcare delivery. There has been new interest in human factors as a means of reducing these errors. Human factors are important contributors to critical incidents and crises in anaesthesia. It has been shown that the prevalence of human factors in anaesthesia can be as high as 83%. Cognitive thinking process and biases involved are important in understanding human factors. Errors of cognition linked with human factors lead to anaesthetic errors and crisis. Multiple errors in the cognitive thinking process, known as "Cognitive dispositions to respond" have been identified leading to errors. These errors classified into latent or active can be easily identified in the clinical vignettes of serious medical errors. Application of the knowledge on human factors and use of cognitive de-biasing strategies can avoid human errors. These strategies could involve use of checklists, strategies to cope with stress and fatigue and the use of standard operating procedures. A safety culture and health care model designed to promote patient safety can compliment this further. Incorporation of these strategies strengthens the defence layers against the "Swiss Cheese" models, which exist in the health care industry.展开更多
文摘The practice of anesthesiology has always been governed by evidence-based medicine. The quick turnover rate of patients in the operating room and patient safety and satisfaction, have also further changed the way we practice anesthesia. The use of intrathecal(IT) opiates as an effective form of postoperative pain relief has been established for many years. Morphine was the first opioid used by IT route. In clinical practice, morphine is regarded as the gold standard, or benchmark, of analgesics used to relieve intense pain. Perhaps for this reason, IT morphine has been used for over 100 years for pain relief. IT morphine is one of the easiest, costeffective and reliable techniques for postoperative analgesia and technical failures are rare. And yet there is no consensus amongst anesthesiologists regarding the dose of IT morphine. Like all other methods of pain relief, IT morphine also has some side effects and some of them are serious though not very common. This review article looks into some of the key aspects of the use of IT morphine for post-operative analgesia and various doses for different procedures are discussed. This article also describes the side effects of IT morphine and how to treat and prevent them.
文摘This paper discusses some of the key aspects of human factors in anaesthesia for the improvement of patient safety. Medical errors have emerged as a serious issue in healthcare delivery. There has been new interest in human factors as a means of reducing these errors. Human factors are important contributors to critical incidents and crises in anaesthesia. It has been shown that the prevalence of human factors in anaesthesia can be as high as 83%. Cognitive thinking process and biases involved are important in understanding human factors. Errors of cognition linked with human factors lead to anaesthetic errors and crisis. Multiple errors in the cognitive thinking process, known as "Cognitive dispositions to respond" have been identified leading to errors. These errors classified into latent or active can be easily identified in the clinical vignettes of serious medical errors. Application of the knowledge on human factors and use of cognitive de-biasing strategies can avoid human errors. These strategies could involve use of checklists, strategies to cope with stress and fatigue and the use of standard operating procedures. A safety culture and health care model designed to promote patient safety can compliment this further. Incorporation of these strategies strengthens the defence layers against the "Swiss Cheese" models, which exist in the health care industry.
