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Mookambika R, Kumar RVH, Areti A, Jaya V. Comparing the posture and comfort of anaesthesiologists during laryngoscopy and tracheal intubation in the head-elevated laryngoscopy position in supine position and with a 25° backup: A randomised clinical crossover trial. Indian J Anaesth 2024; 68:547-552. [PMID: 38903261 PMCID: PMC11186526 DOI: 10.4103/ija.ija_1130_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 06/22/2024] Open
Abstract
Background and Aims The head-elevated laryngoscopy position (HELP) and a 25° backup have been proposed to enhance glottic visualisation, yet concerns about ergonomic discomfort hinder their widespread adoption. This study compares the comfort and posture adopted by anaesthesiologists while performing laryngoscopy and tracheal intubation with patients in HELP while in a supine position or with 25° backup. Methods The study included 48 patients aged 18-60 years with normal airways and 12 experienced anaesthesiologists. Patients were randomised into two groups using permuted block randomisation. Anaesthesiologists performed laryngoscopy and intubation in supine HELP and 25° backup HELP positions. Anaesthesiologist's posture was determined by measuring the angles of neck, wrist, elbow, back and knee joints, which were compared using Student's t-test, and subjective comfort assessed on a Likert scale was compared using the Chi-square test. As mentioned by the anaesthesiologist, Cormack- Lehane grading was also noted and compared using a Chi-square test between groups, taking a P value <0.05 as significant. Results Both positions demonstrated comparable anaesthesiologist posture (P = 0.919) and comfort (P = 0.644). However, the 25° backup HELP positions significantly improved Cormack-Lehane grades, with 68% achieving grade 1 compared to 31% in the supine HELP group (P = 0.012). Haemodynamic stability and tracheal intubation time showed no significant differences between the groups (P = 0.475 and 0.117, respectively), and no complications were reported in either group. Conclusion Anaesthesiologists' posture and comfort during laryngoscopy and tracheal intubation are similar between supine and 25° backup in patients with easy airways.
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Affiliation(s)
- R Mookambika
- Department of Anaesthesia and Surgical Intensive Care Unit, MGM Healthcare, Chennai, Tamil Nadu, India
| | - R V Hemanth Kumar
- Department of Anaesthesia, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Puducherry, India
| | - Archana Areti
- Department of Anaesthesia, KMCH Institute of Health Sciences and Research, Coimbatore, Tamil Nadu, India
| | - V Jaya
- Department of Anaesthesia, JIPMER, Karaikal, Puducherry, India
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2
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Wong GSK, Cobain C, Pawa A. You don't know what you've got 'til it's gone: why anaesthetic rooms should stay. Anaesthesia 2024; 79:469-472. [PMID: 38214367 DOI: 10.1111/anae.16223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Affiliation(s)
- G S K Wong
- Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's St Thomas' NHS Foundation Trust, London, UK
| | - C Cobain
- Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's St Thomas' NHS Foundation Trust, London, UK
| | - A Pawa
- Department of Theatres, Anaesthesia and Peri-operative Medicine, Guy's St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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3
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Hansel J, Jones SJ. Anaesthetic rooms are no longer needed. Anaesthesia 2024; 79:465-468. [PMID: 38214405 DOI: 10.1111/anae.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Affiliation(s)
- J Hansel
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| | - S J Jones
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, UK
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4
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Koskas D, Vignais N. Physical Ergonomic Assessment in Cleaning Hospital Operating Rooms Based on Inertial Measurement Units. Bioengineering (Basel) 2024; 11:154. [PMID: 38391640 PMCID: PMC10886191 DOI: 10.3390/bioengineering11020154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Workers involved in hospital operating room cleaning face numerous constraints that may lead to musculoskeletal disorders. This study aimed to perform physical ergonomic assessments on hospital staff by combining a continuous assessment (RULA) based on inertial measurement units with video coding. Eight participants performed cleaning tasks while wearing IMUs and being video recorded. A subjective evaluation was performed through the Nordic questionnaire. Global RULA scores equaled 4.21 ± 1.15 and 4.19 ± 1.20 for the right and left sides, respectively, spending most of the time in the RULA range of 3-4 (right: 63.54 ± 31.59%; left: 64.33 ± 32.33%). Elbows and lower arms were the most exposed upper body areas with the highest percentages of time spent over a risky threshold (right: 86.69 ± 27.27%; left: 91.70 ± 29.07%). The subtask analysis identified 'operating table moving', 'stretcher moving', and 'trolley moving' as the riskiest subtasks. Thus, this method allowed an extensive ergonomic analysis, highlighting both risky anatomical areas and subtasks that need to be reconsidered.
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Affiliation(s)
- Daniel Koskas
- CIAMS, Université Paris-Saclay, 91405 Orsay, France
- CIAMS, Université d'Orléans, 45067 Orléans, France
| | - Nicolas Vignais
- CIAMS, Université Paris-Saclay, 91405 Orsay, France
- CIAMS, Université d'Orléans, 45067 Orléans, France
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5
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Fouad AM, Fahim AE, Bedewy AA, Al-Touny A, Al-Touny SA. Work-related musculoskeletal complaints and ergonomic risk factors among Egyptian anesthesiologists: a cross-sectional study. BMC Public Health 2024; 24:279. [PMID: 38263050 PMCID: PMC10807210 DOI: 10.1186/s12889-024-17757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Anesthesiologists are vulnerable to work-related musculoskeletal disorders (WMSDs) due to sustained repetitive movements and awkward postures. This study aimed to assess the prevalence of WMSDs among anesthesiologists and to evaluate its association with ergonomic risk factors. METHODS A convenience sample of 380 Egyptian anesthesiologists were invited to participate in this cross-sectional study through an electronic questionnaire. Data were collected from May to August 2022 and involved questions about participants' demographic, health, and work-related characteristics; the ergonomic risks and perceived hazards; and the musculoskeletal complaints during the past 12 months and 7 days - using Nordic Musculoskeletal Questionnaire (NMQ). Descriptive, bivariate, and multivariate statistical analyses were used to estimate the prevalence of MSD and identify its determinants in the studied sample. RESULTS A total of 215 anesthesiologists were included in this study, with a 56.8% response rate, 66% males with an average age of 38 (± 0.7) years. 21% were resident physicians, 47% were specialists, and 32% were consultants. The 12-month prevalence of MSD among anesthesiologists was 71.6% (95% CI: 65.6- 77.7%). Multivariate analysis showed that the main determinants of MSD among the studied sample were age of 45-years and older (OR: 3.22, 95% CI: 1.21-8.52, p = 0.018), regular physical exercise (OR: 0.25, 95% CI: 0.10-0.65, p = 0.005), insufficient rest time between procedures (OR: 2.25, 95% CI: 1.15-4.41, p = 0.018), and three or more awkward postures of the trunk (OR: 3.55, 95% CI: 1.43-8.82, p = 0.006). CONCLUSIONS The study highlights a high prevalence of WMSDs among Egyptian anesthesiologists, linked to advancing age, lack of regular exercise, insufficient rest between procedures, and frequent awkward postures. Addressing these ergonomic risk factors through targeted workplace interventions is crucial for promoting the overall well-being of anesthesiologists and ensuring the provision of safe anesthesia services.
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Affiliation(s)
- Ahmed Mahmoud Fouad
- Department of Public Health, Occupational & Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Ayman Ekram Fahim
- Department of Public Health, Occupational & Environmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed Abdelmohsen Bedewy
- Department of Anesthesiology & Critical Care, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Aiman Al-Touny
- Department of Anesthesiology & Critical Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Shimaa A Al-Touny
- Department of Anesthesiology & Critical Care, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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6
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Ntiamoah P, Machuzak M, Gildea TR, Mehta AC. Ergonomics of bronchoscopy: good advice or a pain in the neck? Eur Respir Rev 2023; 32:230139. [PMID: 37852660 PMCID: PMC10582918 DOI: 10.1183/16000617.0139-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023] Open
Abstract
Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, income potential and overall health. It is therefore imperative to provide comprehensive education to physicians regarding the significance of ergonomics in their work, especially considering the introduction of advanced diagnostic and therapeutic procedures. By implementing simple yet effective measures (e.g. maintaining neutral positions of the wrist, neck and shoulder; adjusting the height of tables and monitors; incorporating scheduled breaks; and engaging in regular exercises), the risk of injuries can be substantially reduced. Moreover, objective tools are readily available to assess ergonomic postures and estimate the likelihood of work-related musculoskeletal injuries. This review aims to evaluate the current literature on the impact of procedure-related musculoskeletal pain on practising pulmonologists and identify modifiable factors for future research.
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Affiliation(s)
- Prince Ntiamoah
- Department of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Michael Machuzak
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas R Gildea
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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7
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Bailey CR, Shorrock S, Fong K. Human factors and ergonomics. Br J Hosp Med (Lond) 2023; 84:1-4. [PMID: 37364878 DOI: 10.12968/hmed.2023.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Human factors and ergonomics in healthcare is an important discipline that considers both the physical and mental characteristics of healthcare workers, as well as the complex interactions within which organisations exist.
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Affiliation(s)
- Craig R Bailey
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steve Shorrock
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Queensland, Australia
| | - Kevin Fong
- Department of Anaesthesia, University College London Hospitals NHS Trust, London, UK
- Department of Science, Technology, Engineering and Public Policy, University College London, London, UK
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8
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Kelly FE, Frerk C, Bailey CR, Cook TM, Ferguson K, Flin R, Fong K, Groom P, John C, Lang AR, Meek T, Miller KL, Richmond L, Sevdalis N, Stacey MR. Human factors in anaesthesia: a narrative review. Anaesthesia 2023; 78:479-490. [PMID: 36630729 DOI: 10.1111/anae.15920] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/12/2023]
Abstract
Healthcare relies on high levels of human performance, as described by the 'human as the hero' concept. However, human performance varies and is recognised to fall in high-pressure situations, meaning that it is not a reliable method of ensuring safety. Other safety-critical industries embed human factors principles into all aspects of their organisations to improve safety and reduce reliance on exceptional human performance; there is potential to do the same in anaesthesia. Human factors is a broad-based scientific discipline which aims to make it as easy as possible for workers to do things correctly. The human factors strategies most likely to be effective are those which 'design out' the chance of an error or adverse event occurring. When errors or adverse events do happen, barriers are in place to trap them and reduce the risk of progression to patient and/or worker harm. If errors or adverse events are not trapped by these barriers, mitigations are in place to minimise the consequences. Non-technical skills form an important part of human factors barriers and mitigation strategies and include: situation awareness; decision-making; task management; and team working. Human factors principles are not a substitute for proper investment and appropriate staffing levels. Although applying human factors science has the potential to save money in the long term, its proper implementation may require investment before reward can be reaped. This narrative review describes what is known about human factors in anaesthesia to date.
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Affiliation(s)
- F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C Frerk
- Department of Anaesthesia and Critical Care, Northampton General Hospital, Northampton, UK.,College of Life Sciences/Leicester Medical School, University of Leicester, UK
| | - C R Bailey
- Department of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, Bristol University, Bristol, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Flin
- School of Psychology, Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | - K Fong
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Science, Technology, Engineering and Public Policy, University College London, UK
| | - P Groom
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C John
- Department of Anaesthesia, University College Hospital's NHS Foundation Trust, London, UK
| | - A R Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, UK
| | - T Meek
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - K L Miller
- Department of Anaesthesia, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Richmond
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - N Sevdalis
- Centre for Implementation Science, King's College London, UK
| | - M R Stacey
- Department of Anaesthetics, Intensive Care and Pain Medicine, University Hospital of Wales, Cardiff, UK
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9
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Kelly FE, Frerk C, Bailey CR, Cook TM, Ferguson K, Flin R, Fong K, Groom P, John C, Lang AR, Meek T, Miller KL, Richmond L, Sevdalis N, Stacey MR. Implementing human factors in anaesthesia: guidance for clinicians, departments and hospitals: Guidelines from the Difficult Airway Society and the Association of Anaesthetists: Guidelines from the Difficult Airway Society and the Association of Anaesthetists. Anaesthesia 2023; 78:458-478. [PMID: 36630725 DOI: 10.1111/anae.15941] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/12/2023]
Abstract
Human factors is an evidence-based scientific discipline used in safety critical industries to improve safety and worker well-being. The implementation of human factors strategies in anaesthesia has the potential to reduce the reliance on exceptional personal and team performance to provide safe and high-quality patient care. To encourage the adoption of human factors science in anaesthesia, the Difficult Airway Society and the Association of Anaesthetists established a Working Party, including anaesthetists and operating theatre team members with human factors expertise and/or interest, plus a human factors scientist, an industrial psychologist and an experimental psychologist/implementation scientist. A three-stage Delphi process was used to formulate a set of 12 recommendations: these are described using a 'hierarchy of controls' model and classified into design, barriers, mitigations and education and training strategies. Although most anaesthetic knowledge of human factors concerns non-technical skills, such as teamwork and communication, human factors is a broad-based scientific discipline with many other additional aspects that are just as important. Indeed, the human factors strategies most likely to have the greatest impact are those related to the design of safe working environments, equipment and systems. While our recommendations are primarily provided for anaesthetists and the teams they work with, there are likely to be lessons for others working in healthcare beyond the speciality of anaesthesia.
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Affiliation(s)
- F E Kelly
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - C Frerk
- Department of Anaesthesia and Critical Care, Northampton General Hospital, Northampton, UK.,University of Leicester, College of Life Sciences/Leicester Medical School, Leicester, UK
| | - C R Bailey
- Department of Anaesthetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,Bristol University, Bristol, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Flin
- Aberdeen Business School, Robert Gordon University, Aberdeen, UK
| | - K Fong
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Science, Technology, Engineering and Public Policy, University College London, UK
| | - P Groom
- Department of Anaesthesia, Liverpool University Hospitals NHS Foundation Trust, Aintree, Liverpool, UK
| | - C John
- University College Hospital's NHS Foundation Trust, London, UK
| | - A R Lang
- Human Factors Research Group, Faculty of Engineering, University of Nottingham, UK
| | - T Meek
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - K L Miller
- Department of Paediatric Anaesthesia, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - L Richmond
- Department of Anaesthesia, Swansea Bay University Health Board, Swansea, UK
| | - N Sevdalis
- Centre for Implementation Science, King's College London, UK
| | - M R Stacey
- Department of Anaesthetics, Intensive Care and Pain Medicine, University Hospital of Wales, Cardiff, UK
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10
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Davies M, Clyburn P, Barker P, Flatt N, Noble N, Swart M, Redfern N, Davidson R, Fleming R, Stacey K, Richards C. Age and the anaesthetist: considerations for the individual anaesthetist and workforce planning: Guidelines about the ageing anaesthetic workforce from the Association of Anaesthetists: Guidelines for the ageing anaesthetic workforce from the Association of Anaesthetists. Anaesthesia 2022; 77:1259-1267. [PMID: 36173018 DOI: 10.1111/anae.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
There is clear evidence of a growing workforce gap and this is compounded by demographic data that show the current workforce is ageing. Within the current workforce, more doctors are taking voluntary early retirement and the loss of these experienced clinicians from departments can have wide-ranging effects. Older doctors are at risk of age-related health problems (e.g. sight, musculoskeletal, menopause) and are more susceptible to the effects of fatigue, which may increase the risk of error and or complaint. The purpose of this working party and advocacy campaign was to address concerns over the number of consultants retiring at the earliest opportunity and whether a different approach could extend the working career of consultant anaesthetists and SAS doctors. This could be viewed as 'pacing your career'. The earlier this is considered in a clinician's career the greater the potential mitigation on individuals.
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Affiliation(s)
- M Davies
- Department of Anaesthesia, North West Anglia NHS Trust, Peterborough, UK
| | - P Clyburn
- University Hospital of Wales, Cardiff, UK
| | - P Barker
- Department of Anaesthesia, Norfolk and Norwich NHS Trust, Norwich, UK
| | - N Flatt
- British Medical Association Representative, London, UK
| | - N Noble
- Aneurin Bevan University Health Board, Gwent, UK
| | - M Swart
- Department of Anaesthesia, Torbay and South Devon NHS Trust, Devon, UK
| | - N Redfern
- Department of Anaesthesia, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - R Davidson
- Bradford Teaching Hospitals NHS Trust, Bradford, UK
| | - R Fleming
- Department of Anaesthesia, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK
| | - K Stacey
- Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - C Richards
- Association of Anaesthetists, London, UK
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11
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Mallikarjuna S, Ramakumar N, Gupta B, Chakraborty S. Mobius Airo TruCT Scanner in the Operating Room: An Ergonomic Challenge to Neuroanesthesiologist. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1744401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Swathi Mallikarjuna
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nirupa Ramakumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhavna Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Siddharth Chakraborty
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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12
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Pandit JJ, Young P, Davies M. Why does oesophageal intubation still go unrecognised? Lessons for prevention from the coroner's court. Anaesthesia 2021; 77:123-128. [PMID: 34855200 DOI: 10.1111/anae.15634] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 12/16/2022]
Affiliation(s)
- J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,University of Oxford, Oxford, UK
| | - P Young
- Department of Anaesthesia, Queen Elizabeth Hospital, Kings Lynn, UK
| | - M Davies
- Department of Anaesthesia, Peterborough City Hospital, Peterborough, UK
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