1. An implementation program targeted at non-physician, anaesthesia assistants improves the quality of laryngeal mask anaesthesia
- Author
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Bernd Oliver Rose, Ellie Walker, and Isabelle Reed
- Subjects
BMJ Quality Improvement Programme ,Adverse outcomes ,business.industry ,General Medicine ,Perioperative ,law.invention ,Laryngeal mask airway ,law ,Anesthesia ,Ventilation (architecture) ,Medicine ,Observational study ,General anaesthesia ,Airway ,business ,Surgical patients - Abstract
The laryngeal mask airway (LMA) is used to facilitate adequate ventilation in the majority of procedures requiring general anaesthesia in the UK. Excessive LMA cuff pressure and/or volume, generated by injection of air to form an adequate seal within the upper airway, has been associated with pharyngolaryngeal morbidity, an indicator of quality in anaesthetic practice. However, measurement of LMA cuff pressure to limit excessive cuff pressure is not routine practice, despite trial data showing this reduces adverse outcomes. Our aim was to reduce morbidity from the LMA through the implementation of an educational and interventional program targeted at anaesthetic nurses and operating department assistants (ODA), to alter their physician colleagues’ practice. LMA cuff pressure measurements were made, and postoperative outcomes recorded, in an observational cohort of surgical patients over an initial 2-month period. These results, including patient morbidity and the evidence for LMA cuff pressure measurement, were presented to anaesthesia providers and their assistants. An implementation plan to adjust pressures within recommended levels was then undertaken by anaesthesia assistants. In 90 patients, >95% of LMA pressures were beyond the recommended level; higher volumes of injected air correlated with excess pressure (r=0.58; p
- Published
- 2013
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