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Abstracts of Papers
Table 2 Intubation data FAIC group, n=20 Intubation time, seconds Failed intubation First attempt Second attempt (after removal of MILS) C/L view (GlideScope) I II III IV Ease of intubation Mean ordinal score Visual analogue scale 2.3 45.5 (23.9) 2.0 28 (19.35) (P <0.01) 2 (10%) 17 (85%) 1 (5%) 6 (30%) 14 (70%) 2 (10%) 0 0 81.3 (12.2) GEB group, n=20 58.2 (7.2)

Method: We asked all anaesthetists to report on women with severe co-morbidities, severe pre-eclampsia or BMI >40. We reviewed the notes of these patients noting the medical issues, whether they had been seen at MAPP and when and how the anaesthetist became aware of admission. Results: From April to July 2010 35 women were highlighted of which 33 sets of notes were obtained. Thirteen of these had a BMI >40, of which 7 had a BMI >45. Fifteen had a significant comorbidity. Five had severe PET or cholestasis (affecting clotting). Conclusion: We are recognising the importance of anaesthetic involvement in the severely obese with all mothers with a BMI >45 being referred to MAPP and we were aware within one hour of admission of 6/7. Recommendations: We would like to be informed on admission of those with a BMI >40. Only 7/15 with severe co-morbidities were referred to MAPP although we were aware of 10/15 within one hour of admission. Is there enough information in the community about the problems anaesthetists should be made aware of? Letters from pre-assessment clinic are an important prompt to inform the anaesthetist of admission and are invaluable as information for that anaesthetist. Ensure all patients who have been referred to or seen in preassessment clinic are referred to anaesthetist on admission to LW.

Gum Elastic Bougie vs Frova Airway Intubating Catheter when using the Glidescope for difficult intubation

MILS=manual inline stabilisation. Data are presented as number (%) or mean (SEM). Ease of intubation measured by ordinal score 1 to 4 (1=easy, 4=very difficult) and a visual analogue scale 0 to 100 mm (0=easy, 100 mm=very difficult). Reference 1. Thiboutot F, Nicole PC, Trpanier CA, Turgeon AF, Lessard MR. Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anesth 2009; 56:412-418.

P. Sivalingam, G. Ariotti, C. Jowett. Princess Alexandra Hospital, Brisbane, Queensland, Australia. Video laryngoscopes such as the GlideScope can improve the view at laryngoscopy. GlideScope use is recommended with an intubating metallic stylet, however this has been associated with trauma. Use of a bougie for intubation is common in clinical anaesthesia. We investigated whether one type of bougie (the Gum Elastic Bougie [GEB]) would be superior to another (Frova Airway Intubating Catheter [FAIC]) when using the Glidescope with application of cervical spine manual inline stabilisation (i.e. a simulated difficult intubation scenario)1. Mean intubation time was 58.2 seconds in the GEB group vs 81.3 seconds in the FAIC group. On a visual analogue scale of difficulty (0 to 100 mm), intubation using the GEB was significantly easier than with the FAIC (P <0.01). There were no failed intubations with the GEB at first attempt compared to the FAIC group which had two incidences. The GEB appears superior to the FAIC when using the Glidescope for a simulated difficult intubation. Table 1 Patient data FAIC group, n=20 Male gender Age, year Weight, kg Body mass index, kg/m
2

An audit of the quality of recovery room handovers

N. Smith, K. McDonald. Wollongong Hospital, Wollongong, New South Wales, Australia. Handover between anaesthetists and nurses in recovery is an important process in continuity of patient care. We welcomed the recommendations for good recovery handover made recently by Smith and Mishra1, but wondered how often such ideal practice actually occurs. We work in a 300 bed major regional hospital in New South Wales, Australia. Our main recovery room receives approximately 11,000 postoperative patients per year from all surgical specialties except cardiothoracic and complex paediatric surgery. We performed an audit of recovery room handovers to investigate how often the recommended criteria for good practice are met in our institution. Both the anaesthesia and recovery nurse departments were informed of the audit and global consent from the respective managers was obtained. We aimed to observe 100 handovers and assess whether the criteria suggested by Smith and Mishra were met. One of us quietly observed handovers on five randomly selected days over a three week period and an eventual total of 101 handovers were observed. Our findings are presented in Table 1 (available in the online version). Numbers are given as raw figures, but correspond to equivalent percentages. As can be seen, a number of areas fall short of the recommended ideal practice. Some information that should clearly be given in all handovers was found in less than ideal numbers such as only 53% describing intraoperative fluids given, or only 72% with instructions about postoperative analgesia, or the low rates of asking for or giving permission for the anaesthetist to leave at the end of the
Anaesthesia and Intensive Care, Vol. 39, No. 4, July 2011

GEB group, n=20 11 (55%) 54.6 (18.1) 78.3 (14.4) 27.2 (4.0) 0/20 12/6/2/0

10 (50%) 50.7 (14.3) 81.1 (17.4) 28.2 (4.2) 1/19 8/8/4/0

ASA physical status, I/II Mallampati score with Glidescope and MILS C/L, I/II/III/IV

MILS=manual inline stabilisation. Data are presented as number (%), or mean (SD).