Allan Cyna - Academia.edu (original) (raw)
Papers by Allan Cyna
Internal medicine journal, Jan 4, 2017
To determine the prevalence of psychological distress in Australian Junior Medical Officers (JMOs... more To determine the prevalence of psychological distress in Australian Junior Medical Officers (JMOs) and investigate the determinants associated with psychological distress over a three year (2014-2016) period. JMOs were surveyed using the 2014-2016 JMO Census (n = 220, 399, and 466 each year, response rate approximately 15%). Levels of psychological distress were assessed using the Kessler Psychological Distress Scale (K10). A K10≥ 25 was chosen to indicate high psychological distress and this determinant was compared to various demographic and work-related factors. Australian JMOs experience a high level of psychological distress (mean of 18.1, median 16.0). There were no differences in demographical variables such as age, sex, marital status, dependents and between PGY 1 and 2. Increasing hours worked per week was associated with a higher K10, with every hour worked increasing odds by 3%. Attitudinal items including feeling unwilling to study medicine again, feeling poorly trained,...
... Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA ... more ... Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA Dr Maire Shelly Adult Intensive ... Director of Clinical Training, Medical Education Unit, Caboolture Hospital, Caboolture, Queensland 4510, Australia Dr Suyin GM Tan Department of ...
Anaesthesia and intensive care, 1999
In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinica... more In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Examples of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some...
BJOG: An International Journal of Obstetrics & Gynaecology, 2013
To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is adde... more To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Randomised controlled clinical trial, conducted from December 2005 to December 2010. The largest tertiary referral centre for maternity care in South Australia. A cohort of 448 women at >34 weeks of gestation, with a singleton pregnancy and cephalic presentation, planning a vaginal birth. Exclusions were: the need for an interpreter; pre-existing pain; psychiatric illness; younger than 18 years; and previous experience of hypnosis for childbirth. All participants received usual care. The group of women termed Hypnosis + CD (hypnotherapist guided) were offered three antenatal live hypnosis sessions plus each session's corresponding audio CD for further practise, as well as a final fourth CD to listen to during labour. The group of women termed CD only (nurse administered) were played the same antenatal hypnosis CDs as group 1, but did not receive live hypnosis training. The control group participants were given no additional intervention or CDs. Use of pharmacological analgesia during labour and childbirth. No difference in the use of pharmacological analgesia during labour and childbirth was found comparing hypnosis + CD with control (81.2 versus 76.2%; relative risk, RR 1.07; 95% confidence interval, 95% CI 0.95-1.20), or comparing CD only with control (76.9 versus 76.2%, RR 1.01, 95% CI 0.89-1.15). Antenatal group hypnosis using the Hypnosis Antenatal Training for Childbirth (HATCh) intervention in late pregnancy does not reduce the use of pharmacological analgesia during labour and childbirth.
Anaesthesia, 1997
We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previo... more We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previously fit young man. Following induction of general anaesthesia, and prior to surgery, the patient received bilateral glossopharyngeal nerve blocks with 0.5% bupivacaine and adrenaline 1:200 000. The initial recovery was uneventful but persistent throat and neck pain developed at home which was diagnosed as a throat infection and possible hyperextension injury of the neck. It is impossible to say how much the dissection of chronically infected tonsils or the infiltration of local anaesthetic into or near a potentially infected area contributed to the development of cervical osteomyelitis. The absence of any other symptoms and signs, a normal blood count and cervical spine X-ray, and the rarity of cervical osteomyelitis, all contributed to a delay in diagnosis.
Cochrane Database of Systematic Reviews, 2011
... 7. Ghai B, Ram J, Makkar JK, Wig J, Kaushik S. A reply – Blind enough? ... Submental intubati... more ... 7. Ghai B, Ram J, Makkar JK, Wig J, Kaushik S. A reply – Blind enough? ... Submental intubation: A useful adjunct in panfacial trauma. Submental intubation: A useful adjunct in panfacial trauma Abhishek Vashishta, Sunil Sharma, Ankita Chugh, Dinesh Jain, Nishant Gupta, ... ...
Http Dx Doi Org 10 1080 00029157 2009 10401688, Sep 21, 2011
ABSTRACT
Birth Iss Perinat Care, 2008
Traditional epidural techniques have been associated with prolonged labour, use of oxytocin augme... more Traditional epidural techniques have been associated with prolonged labour, use of oxytocin augmentation, and increased incidence of instrumental vaginal delivery. The combined spinal-epidural (CSE) technique has been introduced in an attempt to reduce these adverse effects. CSE is believed to improve maternal mobility during labour and provide more rapid onset of analgesia than epidural analgesia. To assess the relative effects of combined spinal-epidural versus epidural analgesia during labour. The Cochrane Pregnancy and Childbirth Group Trials Register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to June 2002) and EMBASE (1974 to June 2002). All published randomised controlled trials involving a comparison of CSE with epidural analgesia initiated for women in the first stage of labour. Trials identified from searching were assessed for inclusion by the same two reviewers independently. Review Manager software was used for calculation of the treatment effect represented by odds ratios (OR) and weighted mean difference (WMD) using a fixed effects model with 95% confidence intervals (CI). Fourteen trials (2047 women) met our inclusion criteria. Of the 25 outcomes analysed from these studies CSE shows a reduced time from first injection to effective maternal analgesia WMD -5.50 minutes (95% CI -6.47 to -4.52; four trials), an increased incidence of maternal satisfaction OR 4.69 (95% CI 1.27 to 17.29; three trials), and an increased incidence of pruritus OR 2.79 (95% CI 1.87 to 4.18; nine trials). No difference was found between CSE and epidural techniques with regards to maternal mobility, rescue analgesia requirements, the incidence of post dural puncture headache (PDPH) or blood patch, hypotension, urinary retention, mode of delivery, or admission of the baby to the neonatal unit. There is no standard CSE or epidural technique. Compared with epidural, CSE provides faster onset of effective pain relief from the time of injection, and increases the incidence of maternal satisfaction. However, CSE women experience more itch. There is no difference between CSE and epidural techniques with respect to: the incidence of forceps delivery, maternal mobility, PDPH, caesarean section rates or admission of babies to the neonatal unit. It is not possible to draw any meaningful conclusions regarding rare complications such as nerve injury and meningitis.
Paediatric anaesthesia, 2015
The impact of communication within the perioperative period is an area of increasing research int... more The impact of communication within the perioperative period is an area of increasing research interest. Suggestions are phrases or actions that can lead to subconscious nonvolitional changes in patient perception, mood, and/or behavior. Statements functioning as suggestions may induce positive or negative perceptual responses and experiences. Children and anxious patients are particularly responsive to the effects of suggestion. We aimed to identify positively and negatively worded statements used during the provision of preoperative information by nursing staff in a tertiary referral center for pediatric care. Audio recordings of preoperative consultations between nurses, children, and their parents were made between February and May 2014. Two researchers independently reviewed the transcripts and identified positively and negatively worded suggestions. Examples of negative suggestions were, 'he is going to be sore for a week or two' or 'normal to feel a bit sick….'...
Anaesthesia and intensive care
Recall and information sources regarding the risks of regional anaesthesia in women having lower ... more Recall and information sources regarding the risks of regional anaesthesia in women having lower segment caesarean section have not been adequately assessed previously. We aimed to survey women's recall of their pre-anaesthesia risk discussion and determine where women, presenting for lower segment caesarean section under regional anaesthesia, obtain risk information. Following a small pilot survey, women's responses were recorded for "spontaneous" or "prompted" recalled risks, the information source and its reliability. One-hundred and fifty women were surveyed following caesarean section. Seventy women (46.7%) had an elective procedure and 80 (53.3%) had an emergency procedure. Overall, 142 women (94.6%) recalled at least four risks (44.6% spontaneously; 66% prompted). Of those women giving at least four spontaneous responses, 41 (58.6%) had elective and 26 (32.5%) had emergency lower segment caesarean section (P = 0.001). The majority of women stated that anaesthetists were the main, and most reliable, source of their information regarding risks of regional anaesthesia for caesarean section. This report identifies the risks associated with regional anaesthesia for caesarean section that women most frequently recall, namely headache, paralysis, nerve damage and inadequate block.
Anaesthesia and intensive care
Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior t... more Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior to administering regional analgesia in labour. We surveyed consultant members of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric anaesthesia, in order to identify and compare which risks of regional analgesia they report discussing with women prior to and during labour. We also asked about obstetric anaesthetists' beliefs about informed consent, the type of consent obtained and its documentation. Of 542 questionnaires distributed, 291 responses (54%) were suitable for analysis. The five most commonly discussed risks were post dural puncture headache, block failure, permanent neurological injury, temporary leg weakness and hypotension. Obstetric anaesthetists reported discussing a mean of 8.0 (SD 3.8) and 10 (SD 3.8) risks in the labour and antenatal settings respectively. Nearly 20% of respondents did not rank post dural puncture headache among their top five most important risks for discussion. Seventy percent of respondents indicated that they believe active labour inhibits a woman's ability to give 'fully informed consent'. Over 80% of respondents obtain verbal consent and 57 (20%) have no record of the consent or its discussion. Obstetric anaesthetists reported making a considerable effort to inform patients of risks prior to the provision of regional analgesia in labour. Verbal consent may be appropriate for labouring women, using standardized forms that serve as a reminder of the risks, and a record of the discussion. Consensus is required as to what are the levels of risk from regional analgesia in labour.
Anaesthesia and intensive care
We aimed to identify and categorise advanced communication skills used by experienced consultant ... more We aimed to identify and categorise advanced communication skills used by experienced consultant paediatric anaesthetists to facilitate the induction of paediatric anaesthesia. The communication techniques were both verbal and non-verbal. Communications with potentially negative effects were also noted. Eighty-three inductions were observed over a three-month period. The 12 anaesthetists observed were all senior consultants at a tertiary referral paediatric centre. The mean age of patients was 6.1 years SD+/-4.8. There were 53 males (63.9%) and 30 females (36.1%). A first anaesthetic was administered to 43 patients (56%) and sedative premedication to six (8%). Inhalational inductions were observed in 59 patients (71%). The remainder received an intravenous induction. Anaesthesia was induced in the operating room on 68 occasions (82%), in the induction room on 11 (13%) and in the radiology department on 4(5%). The most common communication techniques used were: voice change in 60 (72%); distraction in 49 (59%); direct commands in 39 (47%); repetition in 34 (41%); imagery in 21 (25%) and focused attention 21 (25%). Other techniques used were seeding of ideas, utilisation, non-verbal cues, double-binds, story-telling, indirect suggestion, dissociation and reversed effect. Sabotage by parents or staff such as inadvertent negative suggestions, was observed on 14 occasions (17%). Paediatric anaesthetists utilise a wide range of communication techniques in a highly flexible manner when inducing anaesthesia in children. Many of these communications can be characterised as hypnotherapeutic. Our observations suggest that formal structured training in communication skills and further research is warranted.
Anaesthesia and intensive care
Immediate management of inadvertent dural puncture during insertion of an epidural needle during ... more Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. Following dural puncture, 265 respondents (64%) indicated that they "would usually remove the Tuohy needle and resite". The most common reason for this decision was concern regarding the safety of intrathecal catheters (ITC) (n = 236, 89%), in particular, the risk of misuse (n = 182, 70%). The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
Anaesthesia and intensive care
Internal medicine journal, Jan 4, 2017
To determine the prevalence of psychological distress in Australian Junior Medical Officers (JMOs... more To determine the prevalence of psychological distress in Australian Junior Medical Officers (JMOs) and investigate the determinants associated with psychological distress over a three year (2014-2016) period. JMOs were surveyed using the 2014-2016 JMO Census (n = 220, 399, and 466 each year, response rate approximately 15%). Levels of psychological distress were assessed using the Kessler Psychological Distress Scale (K10). A K10≥ 25 was chosen to indicate high psychological distress and this determinant was compared to various demographic and work-related factors. Australian JMOs experience a high level of psychological distress (mean of 18.1, median 16.0). There were no differences in demographical variables such as age, sex, marital status, dependents and between PGY 1 and 2. Increasing hours worked per week was associated with a higher K10, with every hour worked increasing odds by 3%. Attitudinal items including feeling unwilling to study medicine again, feeling poorly trained,...
... Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA ... more ... Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA Dr Maire Shelly Adult Intensive ... Director of Clinical Training, Medical Education Unit, Caboolture Hospital, Caboolture, Queensland 4510, Australia Dr Suyin GM Tan Department of ...
Anaesthesia and intensive care, 1999
In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinica... more In order to develop a minimal obstetric anaesthesia dataset based on current Australasian clinical audit best practice, we carried out a postal survey of 69 Australasian anaesthetic departments covering an obstetric service. We asked about data being collected, specifically concerning the high risk obstetric patient, epidural analgesia and postoperative anaesthetic review. Examples of any data collection forms were requested. Of the 66 responses, 35 departments (53%) were not collecting any audit data. Twenty-six of the 31 departments (84%) performing obstetric anaesthesia audit responded to our follow-up telephone survey. Eighteen departments believed that there had been an improvement in patient care as a result of their audit and 13 felt that the benefits outweighed the costs involved. However, only six departments (9%) had performed an audit cycle. The importance of feedback to patients or hospital staff and the incidence of post dural puncture headache (PDPH) were cited by some...
BJOG: An International Journal of Obstetrics & Gynaecology, 2013
To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is adde... more To determine the use of pharmacologic analgesia during childbirth when antenatal hypnosis is added to standard care. Randomised controlled clinical trial, conducted from December 2005 to December 2010. The largest tertiary referral centre for maternity care in South Australia. A cohort of 448 women at >34 weeks of gestation, with a singleton pregnancy and cephalic presentation, planning a vaginal birth. Exclusions were: the need for an interpreter; pre-existing pain; psychiatric illness; younger than 18 years; and previous experience of hypnosis for childbirth. All participants received usual care. The group of women termed Hypnosis + CD (hypnotherapist guided) were offered three antenatal live hypnosis sessions plus each session's corresponding audio CD for further practise, as well as a final fourth CD to listen to during labour. The group of women termed CD only (nurse administered) were played the same antenatal hypnosis CDs as group 1, but did not receive live hypnosis training. The control group participants were given no additional intervention or CDs. Use of pharmacological analgesia during labour and childbirth. No difference in the use of pharmacological analgesia during labour and childbirth was found comparing hypnosis + CD with control (81.2 versus 76.2%; relative risk, RR 1.07; 95% confidence interval, 95% CI 0.95-1.20), or comparing CD only with control (76.9 versus 76.2%, RR 1.01, 95% CI 0.89-1.15). Antenatal group hypnosis using the Hypnosis Antenatal Training for Childbirth (HATCh) intervention in late pregnancy does not reduce the use of pharmacological analgesia during labour and childbirth.
Anaesthesia, 1997
We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previo... more We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previously fit young man. Following induction of general anaesthesia, and prior to surgery, the patient received bilateral glossopharyngeal nerve blocks with 0.5% bupivacaine and adrenaline 1:200 000. The initial recovery was uneventful but persistent throat and neck pain developed at home which was diagnosed as a throat infection and possible hyperextension injury of the neck. It is impossible to say how much the dissection of chronically infected tonsils or the infiltration of local anaesthetic into or near a potentially infected area contributed to the development of cervical osteomyelitis. The absence of any other symptoms and signs, a normal blood count and cervical spine X-ray, and the rarity of cervical osteomyelitis, all contributed to a delay in diagnosis.
Cochrane Database of Systematic Reviews, 2011
... 7. Ghai B, Ram J, Makkar JK, Wig J, Kaushik S. A reply – Blind enough? ... Submental intubati... more ... 7. Ghai B, Ram J, Makkar JK, Wig J, Kaushik S. A reply – Blind enough? ... Submental intubation: A useful adjunct in panfacial trauma. Submental intubation: A useful adjunct in panfacial trauma Abhishek Vashishta, Sunil Sharma, Ankita Chugh, Dinesh Jain, Nishant Gupta, ... ...
Http Dx Doi Org 10 1080 00029157 2009 10401688, Sep 21, 2011
ABSTRACT
Birth Iss Perinat Care, 2008
Traditional epidural techniques have been associated with prolonged labour, use of oxytocin augme... more Traditional epidural techniques have been associated with prolonged labour, use of oxytocin augmentation, and increased incidence of instrumental vaginal delivery. The combined spinal-epidural (CSE) technique has been introduced in an attempt to reduce these adverse effects. CSE is believed to improve maternal mobility during labour and provide more rapid onset of analgesia than epidural analgesia. To assess the relative effects of combined spinal-epidural versus epidural analgesia during labour. The Cochrane Pregnancy and Childbirth Group Trials Register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to June 2002) and EMBASE (1974 to June 2002). All published randomised controlled trials involving a comparison of CSE with epidural analgesia initiated for women in the first stage of labour. Trials identified from searching were assessed for inclusion by the same two reviewers independently. Review Manager software was used for calculation of the treatment effect represented by odds ratios (OR) and weighted mean difference (WMD) using a fixed effects model with 95% confidence intervals (CI). Fourteen trials (2047 women) met our inclusion criteria. Of the 25 outcomes analysed from these studies CSE shows a reduced time from first injection to effective maternal analgesia WMD -5.50 minutes (95% CI -6.47 to -4.52; four trials), an increased incidence of maternal satisfaction OR 4.69 (95% CI 1.27 to 17.29; three trials), and an increased incidence of pruritus OR 2.79 (95% CI 1.87 to 4.18; nine trials). No difference was found between CSE and epidural techniques with regards to maternal mobility, rescue analgesia requirements, the incidence of post dural puncture headache (PDPH) or blood patch, hypotension, urinary retention, mode of delivery, or admission of the baby to the neonatal unit. There is no standard CSE or epidural technique. Compared with epidural, CSE provides faster onset of effective pain relief from the time of injection, and increases the incidence of maternal satisfaction. However, CSE women experience more itch. There is no difference between CSE and epidural techniques with respect to: the incidence of forceps delivery, maternal mobility, PDPH, caesarean section rates or admission of babies to the neonatal unit. It is not possible to draw any meaningful conclusions regarding rare complications such as nerve injury and meningitis.
Paediatric anaesthesia, 2015
The impact of communication within the perioperative period is an area of increasing research int... more The impact of communication within the perioperative period is an area of increasing research interest. Suggestions are phrases or actions that can lead to subconscious nonvolitional changes in patient perception, mood, and/or behavior. Statements functioning as suggestions may induce positive or negative perceptual responses and experiences. Children and anxious patients are particularly responsive to the effects of suggestion. We aimed to identify positively and negatively worded statements used during the provision of preoperative information by nursing staff in a tertiary referral center for pediatric care. Audio recordings of preoperative consultations between nurses, children, and their parents were made between February and May 2014. Two researchers independently reviewed the transcripts and identified positively and negatively worded suggestions. Examples of negative suggestions were, 'he is going to be sore for a week or two' or 'normal to feel a bit sick….'...
Anaesthesia and intensive care
Recall and information sources regarding the risks of regional anaesthesia in women having lower ... more Recall and information sources regarding the risks of regional anaesthesia in women having lower segment caesarean section have not been adequately assessed previously. We aimed to survey women's recall of their pre-anaesthesia risk discussion and determine where women, presenting for lower segment caesarean section under regional anaesthesia, obtain risk information. Following a small pilot survey, women's responses were recorded for "spontaneous" or "prompted" recalled risks, the information source and its reliability. One-hundred and fifty women were surveyed following caesarean section. Seventy women (46.7%) had an elective procedure and 80 (53.3%) had an emergency procedure. Overall, 142 women (94.6%) recalled at least four risks (44.6% spontaneously; 66% prompted). Of those women giving at least four spontaneous responses, 41 (58.6%) had elective and 26 (32.5%) had emergency lower segment caesarean section (P = 0.001). The majority of women stated that anaesthetists were the main, and most reliable, source of their information regarding risks of regional anaesthesia for caesarean section. This report identifies the risks associated with regional anaesthesia for caesarean section that women most frequently recall, namely headache, paralysis, nerve damage and inadequate block.
Anaesthesia and intensive care
Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior t... more Anaesthetists are legally obliged to obtain consent and inform patients of material risks prior to administering regional analgesia in labour. We surveyed consultant members of the Australian and New Zealand College of Anaesthetists with a special interest in obstetric anaesthesia, in order to identify and compare which risks of regional analgesia they report discussing with women prior to and during labour. We also asked about obstetric anaesthetists' beliefs about informed consent, the type of consent obtained and its documentation. Of 542 questionnaires distributed, 291 responses (54%) were suitable for analysis. The five most commonly discussed risks were post dural puncture headache, block failure, permanent neurological injury, temporary leg weakness and hypotension. Obstetric anaesthetists reported discussing a mean of 8.0 (SD 3.8) and 10 (SD 3.8) risks in the labour and antenatal settings respectively. Nearly 20% of respondents did not rank post dural puncture headache among their top five most important risks for discussion. Seventy percent of respondents indicated that they believe active labour inhibits a woman's ability to give 'fully informed consent'. Over 80% of respondents obtain verbal consent and 57 (20%) have no record of the consent or its discussion. Obstetric anaesthetists reported making a considerable effort to inform patients of risks prior to the provision of regional analgesia in labour. Verbal consent may be appropriate for labouring women, using standardized forms that serve as a reminder of the risks, and a record of the discussion. Consensus is required as to what are the levels of risk from regional analgesia in labour.
Anaesthesia and intensive care
We aimed to identify and categorise advanced communication skills used by experienced consultant ... more We aimed to identify and categorise advanced communication skills used by experienced consultant paediatric anaesthetists to facilitate the induction of paediatric anaesthesia. The communication techniques were both verbal and non-verbal. Communications with potentially negative effects were also noted. Eighty-three inductions were observed over a three-month period. The 12 anaesthetists observed were all senior consultants at a tertiary referral paediatric centre. The mean age of patients was 6.1 years SD+/-4.8. There were 53 males (63.9%) and 30 females (36.1%). A first anaesthetic was administered to 43 patients (56%) and sedative premedication to six (8%). Inhalational inductions were observed in 59 patients (71%). The remainder received an intravenous induction. Anaesthesia was induced in the operating room on 68 occasions (82%), in the induction room on 11 (13%) and in the radiology department on 4(5%). The most common communication techniques used were: voice change in 60 (72%); distraction in 49 (59%); direct commands in 39 (47%); repetition in 34 (41%); imagery in 21 (25%) and focused attention 21 (25%). Other techniques used were seeding of ideas, utilisation, non-verbal cues, double-binds, story-telling, indirect suggestion, dissociation and reversed effect. Sabotage by parents or staff such as inadvertent negative suggestions, was observed on 14 occasions (17%). Paediatric anaesthetists utilise a wide range of communication techniques in a highly flexible manner when inducing anaesthesia in children. Many of these communications can be characterised as hypnotherapeutic. Our observations suggest that formal structured training in communication skills and further research is warranted.
Anaesthesia and intensive care
Immediate management of inadvertent dural puncture during insertion of an epidural needle during ... more Immediate management of inadvertent dural puncture during insertion of an epidural needle during labour is controversial and evidence to guide clinical practice is limited. We surveyed Australian obstetric anaesthetists by anonymous postal questionnaire. Of the 671 surveys sent, 417 (62%) were returned. Following dural puncture, 265 respondents (64%) indicated that they "would usually remove the Tuohy needle and resite". The most common reason for this decision was concern regarding the safety of intrathecal catheters (ITC) (n = 236, 89%), in particular, the risk of misuse (n = 182, 70%). The most frequently reported reason for "usually inserting an ITC" was that this reduced the incidence (n = 120, 84%) and severity (n = 110, 77%) of post dural puncture headache. Increased frequency of ITC insertion was reported by respondents who practised more frequent sessions of obstetric anaesthesia, had fewer years of experience as a consultant anaesthetist and worked in a public hospital. The more widespread use of ITCs seems to be limited by safety concerns.
Anaesthesia and intensive care