1
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Abstract
Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.
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Affiliation(s)
- E Plunkett
- Department of Anaesthesia, University Hospitals Birmingham, Birmingham, UK
| | - A Costello
- Department of Anaesthesia, Milton Keynes University Hospitals, Milton Keynes, UK
| | - S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College London, London, UK
| | - K Hawton
- Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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2
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Collins K, Yentis SM. Epidurals in the UK: practice and complications over 80 years. Anaesthesia 2021; 76:414-416. [PMID: 33523471 DOI: 10.1111/anae.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- K Collins
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
| | - S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
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3
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Yentis SM, Shinde S, Bogod D, Flatt N, Hartley H, Keats P, Leifer S, Pappachan J, Parfitt E, Pooni J, Rowland A. Audio/visual recording of doctors in hospitals: Guideline from the Association of Anaesthetists. Anaesthesia 2020; 75:1082-1085. [PMID: 32124425 DOI: 10.1111/anae.15010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 11/29/2022]
Abstract
Guidelines are presented that summarise the legal position regarding the audio/visual recording of doctors and others in hospitals. In general, there are few, if any, legal grounds for refusing a request by patients to record procedures and/or discussions with clinicians, although some staff may feel uncomfortable being recorded. Trusts and others are advised to draw up local policies and ensure staff and patients are adequately informed.
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Affiliation(s)
- S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, co-Chair, Association of Anaesthetists Working Party, London, UK
| | - S Shinde
- Department of Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Vice-President, Association of Anaesthetists Board of Directors and co-Chair, Association of Anaesthetists Working Party, Bristol, UK
| | - D Bogod
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Council member, Royal College of Anaesthetists, Nottingham, UK
| | - N Flatt
- Department of Anaesthesia, Royal Albert Edward Infirmary, Consultants Committee Anaesthetic Specialty Lead, British Medical Association, Wigan, UK
| | - H Hartley
- Medical Protection Society, London, UK
| | - P Keats
- Association of Anaesthetists Board of Directors, London, UK
| | - S Leifer
- Department of Anaesthesia, Lancashire Teaching Hospitals NHS Foundation Trust, Member, Association of Anaesthetists Trainee Committee, Preston, UK
| | - J Pappachan
- Department of Paediatric Intensive Care Medicine, University Hospital Southampton NHS Foundation Trust, Associate Professor, University of Southampton, Council member, Paediatric Intensive Care Society, Southampton, UK
| | - E Parfitt
- Medical and Dental Defence, Union of Scotland, London, UK
| | - J Pooni
- Department of Anaesthesia and Intensive Care, The Royal Wolverhampton NHS Trust, Council member, Intensive Care Society, Wolverhampton, UK
| | - A Rowland
- Business Transformation and Safeguarding for Fitness to Practise, General Medical Council, London, UK
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4
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Yentis SM, Lucas DN, Brigante L, Collis R, Cowley P, Denning S, Fawcett WJ, Gibson A. Safety guideline: neurological monitoring associated with obstetric neuraxial block 2020. Anaesthesia 2020; 75:913-919. [DOI: 10.1111/anae.14993] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- S. M. Yentis
- Department of Anaesthesia Chelsea and Westminster Hospital London UK
- Imperial College Working Party co‐Chair and Association of Anaesthetists London UK
| | - D. N. Lucas
- Department of Anaesthesia Northwick Park Hospital Working Party co‐Chair and Obstetric Anaesthetists’ Association London UK
| | - L. Brigante
- Quality and Standards Advisor Royal College of Midwives London UK
| | - R. Collis
- Department of Anaesthesia University Hospital of Wales Obstetric Anaesthetists’ Association Cardiff UK
| | - P. Cowley
- Department of Radiology National Hospital for Neurology and Neurosurgery London UK
| | - S. Denning
- East Midlands School of Anaesthesia Association of Anaesthetists Training Committee UK
| | - W. J. Fawcett
- Royal Surrey County Hospital Association of Anaesthetists Guildford Surrey UK
| | - A. Gibson
- Department of Surgery Royal National Orthopaedic Hospital British Association of Spinal Surgeons Stanmore Middlesex UK
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5
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Abstract
Which journals cite work published in anaesthetic journals is of potential interest to authors, editors and publishers. We analysed citations made in 2017-2018 for articles, reviews, editorials and letters published by 12 anaesthetic journals in 2016, using the Web of Science™ citation index platform. We analysed 12,544 citations made for 3518 items. Citations were most often made by specialist anaesthesia journals and critical care journals, and occurred most commonly in articles, followed by reviews, editorials and letters. The median (IQR [range]) number of citations made per item was 3.3 (2.6-4.1 [1.6-5.1]). The median (IQR [range]) number of journals that cited the 12 source journals was 302 (236-449 [139-671]). The median (IQR [range]) proportion of citations made by the same journal that published the items (i.e. 'self-citations') was 15% (11-17% [5-32%]). There were 1305/1932 (68%) citations made by North American journals for items published in North American journals and 1712/2063 (83%) citations made by European journals for items published in European journals, p < 0.0001. Our analysis may inform authors, editors and publishers where to submit work, what editorial policy to pursue and what journal strategy to follow, respectively.
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Affiliation(s)
- U M McHugh
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
| | - S M Yentis
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.,Imperial College, London, UK
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6
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Shinde S, Yentis SM, Asanati K, Coetzee RH, Cole‐King A, Gerada C, Harding K, Hawton K, Hennessy A, Keats P, Kumar N, McGlennan A, Pappenheim K, Plunkett E, Prior K, Rowland A. Guidelines on suicide amongst anaesthetists 2019. Anaesthesia 2019; 75:96-108. [DOI: 10.1111/anae.14890] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 02/01/2023]
Affiliation(s)
- S. Shinde
- Department of Anaesthesia Southmead Hospital North Bristol NHS Trust Vice‐President, Association of Anaesthetists and Co‐Chair, Association of Anaesthetists Working Party Bristol UK
| | - S. M. Yentis
- Department of Anaesthesia Chelsea and Westminster Hospital NHS Foundation Trust Co‐Chair, Association of Anaesthetists Working Party London UK
| | - K. Asanati
- Occupational Health Services Epsom and St. Helier University Hospitals NHS Trust Honorary Clinical Senior Lecturer, Imperial College London London UK
| | | | - A. Cole‐King
- Department of Liaison Psychiatry Glan Clwyd Hospital Betsi Cadwaladr University Health Board Wales UK
| | | | - K. Harding
- Palliative Care Doctor and part‐time GP Hereford UK
| | - K. Hawton
- Centre for Suicide Research University Department of Psychiatry Warneford Hospital Oxford UK
| | - A. Hennessy
- Department of Anaesthesia Beaumont Hospital Honorary Secretary, College of Anaesthesiologists of Ireland Dublin Ireland
| | - P. Keats
- Association of Anaesthetists London UK
| | - N. Kumar
- Health Education England – North East Newcastle upon Tyne UK
| | - A. McGlennan
- Chase Farm Hospital Royal Free London NHS Foundation Trust London UK
| | | | - E. Plunkett
- Department of Anaesthesia University Hospitals Birmingham UK
| | - K. Prior
- Department of Anaesthesia King's College Hospital Surgeon Commander, Royal Navy; Royal College of Anaesthetists representative, London, UK, London UK
| | - A. Rowland
- Business Transformation and Safeguarding for Fitness to Practise General Medical Council London UK
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7
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Ivermee C, Yentis SM. Attitudes of postnatal women and maternity staff towards audio recording of consent discussions. Anaesthesia 2019; 74:1095-1100. [PMID: 30973191 DOI: 10.1111/anae.14660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
Audio recording consent discussions, and giving a copy of the recording to the patient to keep, might improve the consent process and reduce the risk of misunderstandings, complaints or medicolegal claims. However, there may be concerns over confidentiality and how being recorded could affect the consent discussion. We ascertained the views of 50 postnatal women and 100 maternity staff (25 anaesthetists, 25 obstetricians and 50 midwives) on making audio recordings of consent discussions. There was a wide range of opinions, with women and staff similarly supportive of audio recording overall, but the women were more supportive of recording than the staff when asked if they were against it, or whether they would support recording the discussion if the patient requested it; and less concerned than the staff regarding the potential disadvantages of audio recording. There were no significant differences in the views between anaesthetists, obstetricians and midwives.
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Affiliation(s)
- C Ivermee
- Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
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8
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Yentis SM, Shinde S, Plunkett E, Mortimore A. Suicide amongst anaesthetists – an Association of Anaesthetists survey. Anaesthesia 2019; 74:1365-1373. [DOI: 10.1111/anae.14727] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
- S. M. Yentis
- Department of Anaesthesia Chelsea and Westminster Hospital LondonUK
- Imperial College LondonUK
| | - S. Shinde
- Department of Anaesthesia Southmead Hospital North Bristol NHS Trust BristolUK
| | - E. Plunkett
- Department of Anaesthesia University Hospitals Birmingham NHS Foundation Trust BirminghamUK
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9
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Abstract
We have studied whether the antiemetic effect of PC.6 (Neiguan) acupuncture at the wrist in preventing post-operative nausea and vomiting is affected by the timing of its administration in fifty patients undergoing major gynaecological surgery. Patients were randomly assigned to receive PC.6 acupuncture either five minutes before induction of anaesthesia (Group 1), five minutes after induction of anaesthesia (Group 2) or when awake in the recovery room post-operatively (Group 3). There were no significant differences in emetic sequelae amongst the three groups, with respective incidences of vomiting of 29%, 24% and 25% within the first 6 hours post-operatively. In order to have an 80% power of detecting a difference between groups of the magnitude found, over 3600 patients would need to be studied. We conclude that general anaesthesia does not affect the antiemetic action of PC.6 acupuncture.
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10
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Weale J, Soysa R, Yentis SM. Use of acronyms in anaesthetic and associated investigations: appropriate or unnecessary? - the UOAIAAAIAOU Study. Anaesthesia 2018; 73:1531-1534. [DOI: 10.1111/anae.14450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- J. Weale
- Magill Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - R. Soysa
- Magill Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - S. M. Yentis
- Magill Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
- Imperial College London; UK
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11
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Leifer S, Choi SW, Asanati K, Yentis SM. Upper limb disorders in anaesthetists - a survey of Association of Anaesthetists members. Anaesthesia 2018; 74:285-291. [PMID: 30311637 DOI: 10.1111/anae.14446] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - S. W. Choi
- Oral and Maxillofacial Surgery; The University of Hong Kong; Hong Kong
| | - K. Asanati
- Epsom and St Helier University Hospitals NHS Trust; London UK
- Imperial College London; London UK
| | - S. M. Yentis
- Chelsea and Westminster Hospital; London UK
- Imperial College; London UK
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12
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McHugh UM, Yentis SM. An analysis of retractions of papers authored by Scott Reuben, Joachim Boldt and Yoshitaka Fujii. Anaesthesia 2018; 74:17-21. [DOI: 10.1111/anae.14414] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - S. M. Yentis
- Chelsea and Westminster Hospital and Imperial College London; London UK
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13
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Carter AH, Yentis SM. Ethical considerations in the uptake of influenza vaccination by healthcare workers. Public Health 2018; 158:61-63. [PMID: 29574237 DOI: 10.1016/j.puhe.2018.01.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/19/2017] [Accepted: 01/23/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The World Health Organization (WHO) recommends annual seasonal influenza vaccination of healthcare workers (HCWs). Under the current voluntary scheme in England, uptake of vaccine in this group remains well below the 75% target. A mandatory scheme may improve rates, but raises the ethical issue of imposed vaccination. However, the existing voluntary scheme could also potentially infringe autonomy if those not wanting to join feel pressured or coerced into vaccination. The aim of this study was to explore HCW views and experiences with the current influenza vaccination programme. STUDY DESIGN Questionnaire survey. METHODS Between March 2015 and April 2016, a total of 140 questionnaires were completed across seven HCW groups, with the demographic, vaccination and opinion data statistically analysed using the chi-squared test, Kruskal-Wallis test and Mann-Whitney U-test as appropriate. RESULTS No staff group met the national influenza vaccination target of 75% and vaccination rates varied between HCW groups. All groups reported some degree of external pressure to be vaccinated and there were mixed views on the concept of mandatory vaccination, with a lack of certainty over the vaccine's efficacy and/or a lack of information the most common reasons for not supporting it. CONCLUSION The current voluntary influenza vaccination scheme has a number of flaws. Improvements in the quality and availability of information provided to employees may help Trusts increase vaccination rates, or achieve acceptance of any proposed mandatory programme.
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Affiliation(s)
- A H Carter
- Magill Department of Anaesthesia, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
| | - S M Yentis
- Magill Department of Anaesthesia, Chelsea & Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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14
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Pillai A, Monteiro RS, Choi SW, Yentis SM, Bogod D. Strength of commonly used spinal needles: the ability to deform and resist deformation. Anaesthesia 2017; 72:1125-1133. [PMID: 28696015 DOI: 10.1111/anae.13959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/29/2022]
Abstract
We investigated the strength of commonly used spinal needles in relation to the amount of deformation, and registered forces during standardised testing. We investigated differences between manufacturers for the same length and gauge of Luer and non-Luer needles, and examined the effect of the internal stylet in terms of needle strength. A specialised rig was designed to perform the testing in both the horizontal and axial plane, reflecting common industrial tests and clinical use. Needles from four commonly used manufacturers were used (Vygon, Becton Dickinson, B Braun, and Pajunk). Needles of 25 G and 27 G were tested in 90-mm and 120-mm lengths. We found significant differences in terms of the size of final deformation and 'toughness'/resistance to deformation between needles of different brands. There were also significant differences between horizontal tests conducted as an industry standard and our own axial test. This may have bearing on clinical use in terms of the incidence of bending and breakage. The presence of the internal stylet resulted in significantly greater toughness in many needles, but had little effect on the degree of deformation. Comparison of Luer and non-Luer needles of the same brand and size showed few significant differences in strength. This result is reassuring, given the imminent change from Luer to non-Luer needles that is to occur in the UK.
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Affiliation(s)
- A Pillai
- Department of Anaesthesia, Nottingham University Hospitals, Nottingham, UK
| | - R S Monteiro
- Department of Anaesthesia, Brighton and Sussex University Hospitals, Brighton, UK
| | - S W Choi
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, China
| | - S M Yentis
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
| | - D Bogod
- Department of Anaesthesia, Nottingham University Hospitals, Nottingham, UK
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15
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Affiliation(s)
- S M Yentis
- Chelsea and Westminster Hospital, London, UK
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16
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Green A, Tatham KC, Yentis SM, Wilson J, Cox M. An analysis of the delivery of anaesthetic training sessions in the United Kingdom. Anaesthesia 2017; 72:1327-1333. [DOI: 10.1111/anae.13950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. Green
- Chelsea and Westminster Hospital NHS Foundation Trust; London UK
| | | | - S. M. Yentis
- Chelsea and Westminster Hospital NHS Foundation Trust; London UK
- Imperial College London; London UK
| | - J. Wilson
- Imperial College Healthcare NHS Trust; London UK
| | - M. Cox
- Chelsea and Westminster Hospital NHS Foundation Trust; London UK
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18
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Monteiro RS, Pillai A, Choi SW, Bogod D, Yentis SM. Flow characteristics of Luer and non-Luer spinal needles. Anaesthesia 2017; 72:749-754. [DOI: 10.1111/anae.13851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- R. S. Monteiro
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - A. Pillai
- Department of Anaesthesia; Nottingham University Hospitals; Nottingham UK
| | - S. W. Choi
- Laboratory and Clinical Research Institute for Pain; Department of Anaesthesiology; The University of Hong Kong; Hong Kong China
| | - D. Bogod
- Department of Anaesthesia; Nottingham University Hospitals; Nottingham UK
| | - S. M. Yentis
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
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19
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Roderick E, Hoyle J, Yentis SM. A national survey of neurological monitoring practice after obstetric regional anaesthesia in the UK. Anaesthesia 2017; 72:755-759. [DOI: 10.1111/anae.13800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - J. Hoyle
- Whipps Cross Hospital; London UK
| | - S. M. Yentis
- Chelsea and Westminster Hospital; London UK
- Imperial College; London UK
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20
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Yentis SM, Hartle AJ, Barker IR, Barker P, Bogod DG, Clutton‐Brock TH, Ruck Keene A, Leifer S, Naughton A, Plunkett E. AAGBI: Consent for anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia 2017; 72:93-105. [PMID: 27988961 PMCID: PMC6680217 DOI: 10.1111/anae.13762] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/24/2022]
Abstract
Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.
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Affiliation(s)
- S. M. Yentis
- Chelsea and Westminster Hospital/Imperial College LondonAAGBI Board of Directors (Working Party Chair from July 2015)LondonUK
| | - A. J. Hartle
- Imperial College Healthcare NHS TrustAAGBI (to Sept 2016; Working Party Chair to July 2015)LondonUK
| | - I. R. Barker
- Imperial RotationLondonUK
- Present address:
Imperial College Healthcare NHS TrustLondonUK
| | - P. Barker
- AAGBI Board of DirectorsNorfolk and Norwich University HospitalsNorwichUK
| | - D. G. Bogod
- Nottingham University Hospitals NHS TrustNottinghamUK
| | - T. H. Clutton‐Brock
- University of BirminghamRoyal College of Anaesthetists (to Feb. 2016)BirminghamUK
| | - A. Ruck Keene
- University of ManchesterKing's College London39 Essex ChambersLondonUK
| | - S. Leifer
- AAGBI Group of Anaesthetists in Training (GAT) CommitteeManchester RotationManchesterUK
| | | | - E. Plunkett
- AAGBI GAT CommitteeBirmingham School of AnaesthesiaBirminghamUK
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21
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Yentis SM. Training in the ethics of audit, quality improvement and research - a reply. Anaesthesia 2016; 71:1114. [PMID: 27523059 DOI: 10.1111/anae.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S M Yentis
- Chelsea and Westminster Hospital, London, UK.
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22
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Abstract
Both the recent 'Warner' review of the UK research ethics committee (REC) system and the subsequent consultation document produced by the Central Office for Research Ethics Committees (COREC) emphasize the need to distinguish 'research' from what might be termed 'non-research'. This is to be determined through a process of filtering or 'triage', the intention being that RECs will avoid considering proposals with 'no material ethical issues'. In this paper we argue that trying to distinguish 'true' research from other projects is counterproductive, misleading and potentially unethical. Our case is built around three assertions: (1) the distinction between research and non-research is imprecise; (2) both medical research and non-research can generate similar ethical issues; and (3) projects should be judged according to what they involve, not how they are labelled.
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Affiliation(s)
- S M Yentis
- Magill Dept of Anaesthesia, Intensive Care & Pain Management, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK
| | - A J Dawson
- Centre for Professional Ethics, Keele Hall, Keele University, Staffs, ST5 5BG, UK
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23
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Affiliation(s)
- S. M. Yentis
- Chelsea and Westminster Hospital; London UK
- Hon. Reader, Imperial College London; London UK
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24
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Affiliation(s)
- S. M. Yentis
- Chelsea and Westminster Hospital Honorary Reader; Imperial College; London UK
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25
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Affiliation(s)
- S. M. Yentis
- Chelsea and Westminster Hospital Honorary Reader; Imperial College; London UK
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26
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Affiliation(s)
- D N Lucas
- Northwick Park Hospital, Harrow, Middlesex, UK.
| | - S M Yentis
- Chelsea and Westminster Hospital, London, UK
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27
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Affiliation(s)
| | - S. M. Yentis
- Magill Department of Anaesthesia, Intensive Care & Pain Management; London UK
- Imperial College; Chelsea & Westminster Hospital; London UK
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Carlisle JB, Dexter F, Pandit JJ, Shafer SL, Yentis SM. Calculating the probability of random sampling for continuous variables in submitted or published randomised controlled trials. Anaesthesia 2015; 70:848-58. [PMID: 26032950 DOI: 10.1111/anae.13126] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 12/23/2022]
Abstract
In a previous paper, one of the authors (JBC) used a chi-squared method to analyse the means (SD) of baseline variables, such as height or weight, from randomised controlled trials by Fujii et al., concluding that the probabilities that the reported distributions arose by chance were infinitesimally small. Subsequent testing of that chi-squared method, using simulation, suggested that the method was incorrect. This paper corrects the chi-squared method and tests its performance and the performance of Monte Carlo simulations and ANOVA to analyse the probability of random sampling. The corrected chi-squared method and ANOVA method became inaccurate when applied to means that were reported imprecisely. Monte Carlo simulations confirmed that baseline data from 158 randomised controlled trials by Fujii et al. were different to those from 329 trials published by other authors and that the distribution of Fujii et al.'s data were different to the expected distribution, both p < 10(-16) . The number of Fujii randomised controlled trials with unlikely distributions was less with Monte Carlo simulation than with the 2012 chi-squared method: 102 vs 117 trials with p < 0.05; 60 vs 86 for p < 0.01; 30 vs 56 for p < 0.001; and 12 vs 24 for p < 0.00001, respectively. The Monte Carlo analysis nevertheless confirmed the original conclusion that the distribution of the data presented by Fujii et al. was extremely unlikely to have arisen from observed data. The Monte Carlo analysis may be an appropriate screening tool to check for non-random (i.e. unreliable) data in randomised controlled trials submitted to journals.
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Affiliation(s)
- J B Carlisle
- Department of Anaesthesia, Torbay Hospital, Torquay, Devon, UK
| | - F Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa, Iowa, USA
| | - J J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals, Oxford, UK
| | - S L Shafer
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - S M Yentis
- Department of Anaesthesia, Chelsea and Westminster Hospital and Honorary Reader, Imperial College, London, UK
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Lucas DN, Yentis SM. Unsettled weather and the end for thiopental? Obstetric general anaesthesia after the NAP5 and MBRRACE-UK reports. Anaesthesia 2015; 70:375-9. [DOI: 10.1111/anae.13034] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. N. Lucas
- Northwick Park Hospital; Harrow Middlesex UK
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Yentis SM. Editor-in-Chief's reply. Anaesthesia 2014; 69:1399. [PMID: 25394700 DOI: 10.1111/anae.12882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Hoyle J, Yentis SM. Assessing the height of block for caesarean section over the past three decades: trends from the literature. Anaesthesia 2014; 70:421-8. [DOI: 10.1111/anae.12927] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J. Hoyle
- Chelsea and Westminster Hospital; London UK
| | - S. M. Yentis
- Chelsea and Westminster Hospital; London UK
- Imperial College; London UK
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Butcher M, George RT, Ip J, Campbell JP, Yentis SM. Identification of the midline by obese and non-obese women during late pregnancy. Anaesthesia 2014; 69:1351-4. [DOI: 10.1111/anae.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Butcher
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - R. T. George
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - J. Ip
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - J. P. Campbell
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - S. M. Yentis
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
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Butcher M, Ip J, Bushby D, Yentis SM. Efficacy of cardiopulmonary resuscitation in the supine position with manual displacement of the uterus vs lateral tilt using a firm wedge: a manikin study. Anaesthesia 2014; 69:868-71. [PMID: 24810899 DOI: 10.1111/anae.12714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Abstract
Prevention of aortocaval compression is essential for effective cardiopulmonary resuscitation in late pregnancy. This can be achieved by either lateral maternal tilt or lateral uterine displacement. Results from a previous manikin study show that a firm foam-rubber wedge allowed successful chest compressions whilst providing stable and reliable lateral tilt. However, it did not investigate resuscitation in the supine position with manual uterine displacement. The aim of this study was to compare the effectiveness of chest compressions in a manikin in the supine position vs lateral tilt using a foam-rubber wedge, both on the floor and on a typical patient bed. Overall, we found that compressions were easier to perform in the supine position (p = 0.007 (bed) and 0.048 (floor)), and with greater stability in the supine position on the floor (p = 0.011). The effectiveness of chest compressions was similar in both the supine/uterine displacement and the lateral tilt positions, suggesting that either method may be suitable for CPR.
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Affiliation(s)
- M Butcher
- Chelsea and Westminster Hospital, London, UK
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George RT, Butcher M, Yentis SM. Pregnant women's views on informed consent for research in labour. Int J Obstet Anesth 2014; 23:233-7. [PMID: 24910351 DOI: 10.1016/j.ijoa.2014.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 02/05/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies of the optimal treatment of accidental dural puncture occurring during epidural insertion in labour are difficult for practical reasons and because of the ethical issues around seeking consent. In a recent study of accidental dural puncture, participants were assigned to one of two treatment groups and only informed about the study and consent sought, after treatment. We sought the views of parturients on the timing of consent for such a study. METHODS After ethical approval and written consent, 100 nulliparous women in the third trimester of pregnancy completed a structured, facilitated questionnaire, rating the acceptability of the consent process occurring: (i) in antenatal clinic; (ii) after the epidural was requested in labour; (iii) after the accidental dural puncture had occurred but before treatment; (iv) after the allocated treatment; or (v) without consent (waived consent). Results were analysed with the Friedman and Wilcoxon signed-rank tests. RESULTS Antenatal consent was considered the most acceptable option, whilst consent on request for epidural analgesia and after accidental dural puncture were least acceptable. Consent after treatment and waived consent were rated in-between these extremes. There was a statistically significant difference between these three groups (P<0.0001). There was a wide range of opinions on each option presented. CONCLUSIONS Antenatal consent was the preferred option but if this is not possible and the need for the research is strong, consent for the use of women's data after intervention, or waived consent, is acceptable to many women. It is important to seek the views of the participants themselves before planning research with difficult ethical aspects.
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Affiliation(s)
- R T George
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
| | - M Butcher
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
| | - S M Yentis
- Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK
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Yentis SM. Editor-in-Chief's reply. Anaesthesia 2013; 68:986. [PMID: 24047370 DOI: 10.1111/anae.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Yentis SM. Editor-in-Chief's reply. Anaesthesia 2013; 68:980. [DOI: 10.1111/anae.12398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Halder S, Butcher M, Allam J, Cormack C, Cox M, Dob D, Durbridge J, Norman B, Pickering E, Yentis SM. Preservative-free bicarbonate for epidural top-up. Anaesthesia 2013; 68:878-9. [DOI: 10.1111/anae.12365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S. Halder
- Chelsea and Westminster Hospital; London; UK
| | - M. Butcher
- Chelsea and Westminster Hospital; London; UK
| | - J. Allam
- Chelsea and Westminster Hospital; London; UK
| | - C. Cormack
- Chelsea and Westminster Hospital; London; UK
| | - M. Cox
- Chelsea and Westminster Hospital; London; UK
| | - D. Dob
- Chelsea and Westminster Hospital; London; UK
| | | | - B. Norman
- Chelsea and Westminster Hospital; London; UK
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Ip JK, Campbell JP, Bushby D, Yentis SM. Cardiopulmonary resuscitation in the pregnant patient: a manikin-based evaluation of methods for producing lateral tilt. Anaesthesia 2013; 68:694-9. [DOI: 10.1111/anae.12181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J. K. Ip
- Chelsea and Westminster Hospital; London; UK
| | | | - D. Bushby
- Chelsea and Westminster Hospital; London; UK
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Mahajan RP, Yentis SM. Editorial note. Anaesthesia 2013; 68:333-4. [DOI: 10.1111/anae.12216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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41
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Sogbodjor A, Robson EJ, Yentis SM. Misleading neurological symptoms during insertion of an epidural catheter in labour. Int J Obstet Anesth 2013; 22:173-4. [PMID: 23453466 DOI: 10.1016/j.ijoa.2012.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 12/09/2012] [Accepted: 12/17/2012] [Indexed: 11/28/2022]
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Campbell JP, Mackenzie MJ, Yentis SM, Sooranna SR, Johnson MR. An evaluation of the ability of leucocyte depletion filters to remove components of amniotic fluid*. Anaesthesia 2012; 67:1152-7. [DOI: 10.1111/j.1365-2044.2012.07247.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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43
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Carlisle JB, Pandit JJ, Yentis SM. A reply. Anaesthesia 2012. [DOI: 10.1111/j.1365-2044.2012.07190.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Macafee B, Campbell JP, Ashpole K, Cox M, Matthey F, Acton L, Yentis SM. Reference ranges for thromboelastography (TEG(®) ) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia*. Anaesthesia 2012; 67:741-7. [PMID: 22486761 DOI: 10.1111/j.1365-2044.2012.07101.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There has been little published work defining 'normal' thromboelastography (TEG(®) ) values in healthy parturients, and few large studies defining reference ranges for traditional coagulation tests in this patient group. Our aim was to establish peri-operative reference ranges for TEG and for standard laboratory coagulation tests in our pregnant population. Fifty healthy term parturients presenting for elective caesarean section under spinal anaesthesia had blood samples taken pre-operatively, on arrival in the recovery room and, in a subset of 33 women, 4 h after routine thromboprophylaxis with enoxaparin 40 mg. All three samples had TEG analysis, the first and second having standard laboratory coagulation tests in addition. Reference ranges for our pregnant population were established, demonstrating a hypercoagulable state in term parturients and a significant effect of enoxaparin. The standard coagulation reference ranges were within 98% of the local non-pregnant ranges. These reference ranges provide a useful comparator for peri-operative TEG and routine coagulation analysis in term parturients.
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Affiliation(s)
- B Macafee
- Chelsea and Westminster Hospital, London, UK.
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46
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47
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Jackson GNB, Sensky T, Reide P, Yentis SM. The capacity to consent to epidural analgesia in labour. Int J Obstet Anesth 2011; 20:269-70. [PMID: 21641199 DOI: 10.1016/j.ijoa.2011.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 02/20/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
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50
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Malhotra S, Dharmadasa A, Yentis SM. One vs two applications of chlorhexidine/ethanol for disinfecting the skin: implications for regional anaesthesia*. Anaesthesia 2011; 66:574-8. [DOI: 10.1111/j.1365-2044.2011.06706.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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