Chapter 13 Reports
Anaesthetic Guidelines
Guidelines of the Association of Anaesthetists of Great Britain and Ireland
Immediate Post-Anaesthetic Recovery 1993
Association of Anaesthetists of Great Britain and Ireland 1993
Association of Anaesthetists of Great Britain and Ireland, 1998
Recommendations
• A team-based approach to anaesthesia offers many advantages for the provision of a high-quality anaesthesia service.
• Pre-admission screening is a vital early component of pre-anaesthetic assessment. It reduces cancellations and promotes effective usage. It does not replace the need for the anaesthetist’s preoperative visit.
• Recovery areas must have trained staff available throughout all operating hours and until the last patient meets all the criteria for discharge.
Provision of Anaesthetic Services in Magnetic Resonance Units 2002
Summary
1. The continuous presence of a strong magnetic field, and restricted access to the patient, means that the provision of anaesthesia within MR units presents unique problems.
2. Whenever a new MR unit is planned, the possibility of managing sedated or anaesthetized patients should be considered.
3. In the planning process, adequate space should be made available for the provision of anaesthesia services.
5. The level of assistance for the anaesthetist must be equal to that expected in the operating theatre environment.
6. Immediate access from the scanning room to the anaesthetic preparation/resuscitation area is essential as in the event of an emergency, the patient must be removed from the magnetic field without delay.
8. The monitoring of patients in MR units during anaesthesia, sedation and recovery must comply with minimum monitoring standards.
9. It is essential that a remote monitoring facility is available to allow the anaesthetic team to remain outside the scanning room once the patient’s condition is stable.
10. Only personnel, who have received appropriate training and are fully conversant with the local protocols, are allowed to enter the controlled area unsupervised.
Recommendations
• Information about anaesthesia, preferably in the form of a patient-friendly leaflet, should be provided to patients undergoing elective surgery before they meet their anaesthetist.
• The anaesthetic room immediately before induction is not an acceptable place or time to provide elective patients with new information other than in exceptional circumstances.
• The amount and the nature of information that should be disclosed to the patient should be determined by the question: ‘What would this patient regard as relevant when coming to a decision about which of the available options to accept?’
• At the end of an explanation about a procedure, patients should be asked whether they have any questions; any such questions should be addressed fully and details recorded.
• Anaesthetists should record details of the elements of a discussion in the patient record, noting what risks, benefits and alternatives were explained.
• A separate formal consent form signed by the patient is not required for anaesthetic procedures that are done to facilitate another treatment or as part of an inter-related process.
• The Mental Capacity Act 2005 (MCA) allows patients without capacity to express their previously-determined wishes by means of an Advance Decision or by means of a proxy using a Lasting Power of Attorney.
• When planning to allow trainees or others to use an opportunity presented by a patient for training in practical procedures, the anaesthetist should make every effort to minimize risk and maximize benefits, and should consider alternative ways of achieving the same end. Specific consent for such procedures may or may not be required depending on the circumstances.
Good Practice in the Management of Continuous Epidural Analgesia in the Hospital Setting 2004
Royal College of Anaesthetists & Association of Anaesthetists of Great Britain & Ireland (www.aagbi.org/publications/guidelines/docs/epidanalg04.pdf)
OAA/AAGBI Guidelines for Obstetric Anaesthesia Services 2005
Association of Anaesthetics of Great Britain and Ireland and the Obstetric Anaesthetists Association. Revised Guidelines
Infection Control in Anaesthesia 2008
Summary
1. A named consultant in each department of anaesthesia should liaise with Trust Infection Control Teams and Occupational Health Departments to ensure that relevant specialist standards are established and monitored in all areas of anaesthetic practice.
2. Precautions against the transmission of infection between patient and anaesthetist or between patients should be a routine part of anaesthetic practice. In particular, anaesthetists must ensure that hand hygiene becomes an indispensable part of their clinical culture.
3. Anaesthetists must comply with local theatre infection control policies including the safe use and disposal of sharps.
4. Anaesthetic equipment is a potential vector for transmission of disease. Policies should be documented to ensure that nationally recommended decontamination practices are followed and audited for all reusable anaesthetic equipment.
5. Single use equipment should be utilized where appropriate but a sterile supplies department (SSD) should process reusable items.
6. An effective, new bacterial/viral breathing circuit filter should be used for every patient and a local policy developed for the re-use of breathing circuits in line with manufacturer’s instructions. The AAGBI recommends that anaesthetic departments should consider changing anaesthetic circuits on a daily basis in line with daily cleaning protocols.
National Institute for Health and Clinical Excellence Guidelines
Guidance on the Use of Ultrasound Locating Devices for Placing Central Venous Catheters 2002
(www.nice.org.uk/nicemedia/pdf/49_English_patient.pdf)
Summary
• 2-D imaging ultrasound guidance should be the preferred method when inserting of central venous catheter into the internal jugular vein in adults and children in ‘elective situations’.
• 2-D imaging ultrasound guidance should be considered in most clinical situations where CVC insertion is necessary, whether the situation is elective or an emergency
• Everyone who uses 2-D imaging ultrasound guidance to insert central venous catheters should have appropriate training to ensure they are competent to use the technique.
Atrial Fibrillation: the Management of Atrial Fibrillation 2006
(www.nice.org.uk/CG036NICEguideline)
Ultrasound-Guided Regional Nerve Block 2009
(www.nice.org.uk/Guidance/IPG285)
Ultrasound-Guided Catheterization of the Epidural Space 2008
(www.nice.org.uk/nicemedia/pdf/IPG249Guidance.pdf)
Intraoperative Nerve Monitoring During Thyroid Surgery 2008
(www.nice.org.uk/nicemedia/pdf/IPG255Guidance.pdf)
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