Anaesthesia 2015, 70, 502–510
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tists’ Association, Regional Anaesthesia UK and Association of Paediatric Anaesthetists of Great Britain and Ireland. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014; 69: 1279–86. Maddock A, Ball DR, Jefferson P. Aseptic precautions for caudal anaesthesia. Anaesthesia 2015; 70: 233–4. West SJ, Pawa A. Continuing to use 2% chlorhexidine applicators. Anaesthesia 2015; 70: 234–5. Plaat F, Campbell J. A reply. Anaesthesia 2015; 70: 235–6. Bogod D. The truth, the whole truth? Anaesthesia News 2010; 271: 7–8. Killeen T, Kamat A, Walsh D, Parker A, Aliashkevich . Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia 2012; 67: 1386–94. Adams D, Quayum M, Worthington T, Lambert P, Elliott T. Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. Journal of Hospital Infection 2005; 61: 287–90. Crowley L, Preston R, Wong A, et al. What is the best skin disinfectant solution for labour epidural analgesia? A randomized, prospective trial comparing Chloroprep, Duraprep and chlorhexidine 0.5% in 70% alcohol. Anesthesia and Analgesia 2008; 106: AA221. The 3rd National Audit Project of the RCoA. Major complications of central neuraxial block in the United Kingdom. London: Royal College of Anaesthetists, 2009. doi:10.1111/anae.13046
Cricoid cartilage compression devices We were interested to read the recent article by Taylor et al. describing their cricoid compression device [1] because it validated the results of our description of a visually interactive guidance device for applying cricoid presure, published in 2013 [2]. Whereas Taylor et al. used the mechanical deformation of their device as a gauge of applied force, ours was a simple electronic 504
Correspondence
device with a thin-film force sensor that allows the anaesthetist to feel and apply force more directly to the patient’s cricoid cartilage than is possible with Taylor et al.’s device, which necessarily separates the anaesthetist’s fingers from the patient’s neck by some distance. Further, our device indicates the correct amount of applied force by illuminating a green light, while too much or too little pressure results in different warning colours. Were cricoid pressure to be applied by a trainee or nurse in clinical practice, Taylor et al.’s device provides little external feedback to the anaesthetist that the procedure is being correctly performed. The independent development of these devices implies a clinical need and suggests that a commercial cricoid pressure guidance device could be a viable medical product. We empathise with the lack of commercial manufacturing interest in Taylor et al.’s design; we were similarly unsuccessful in that regard. However, we have since turned our experimental efforts towards using disposable thin-film force sensors as a means of monitoring for the onset of tissue ischaemia and decubitus ulcers in prolonged surgery, intensive care units and long-term care. R. Saffary E. Feliz C. W. Connor Boston Medical Center, Boston, MA, USA Email: [email protected] Patent applied for by Anaesthesia Associates of Massachusetts. No
external funding or authors’ competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthe siacorrespondence.com.
References 1. Taylor RJ, Smurthwaite G, Mehmood I, Kitchen GB, Baker RD. A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure. Anaesthesia 2015; 70: 18–25. 2. Connor CW, Saffary R, Feliz E. Performance of the Sellick maneuver significantly improves when residents and trained nurses use a visually interactive guidance device in simulation. Physiological Measurement 2013; 34: 1645–56. doi:10.1111/anae.13056
Regional service evaluation of echocardiography trainers Sharma et al. are to be congratulated for their comprehensive overview of the current state of training in echocardiography in anaesthesia and intensive care [1]. With the potential for ‘focused intensive care echocardiography’ (FICE) accreditation to become incorporated as a compulsory module into the Faculty of Intensive Care Medicine syllabus, our group (South Yorkshire Hospitals Audit and Research Collaborative – SHARC) had concerns that this would be unachievable in South Yorkshire owing to a lack of suitable mentors. We therefore conducted a service evaluation of echocardiography training and practice in consultants working on intensive care units across all five trusts in the South Yorkshire region. Data were collected using ‘bring your own device technology’
© 2015 The Association of Anaesthetists of Great Britain and Ireland
2.
3.
4. 5. 6.
7.
8.
9.
tists’ Association, Regional Anaesthesia UK and Association of Paediatric Anaesthetists of Great Britain and Ireland. Safety guideline: skin antisepsis for central neuraxial blockade. Anaesthesia 2014; 69: 1279–86. Maddock A, Ball DR, Jefferson P. Aseptic precautions for caudal anaesthesia. Anaesthesia 2015; 70: 233–4. West SJ, Pawa A. Continuing to use 2% chlorhexidine applicators. Anaesthesia 2015; 70: 234–5. Plaat F, Campbell J. A reply. Anaesthesia 2015; 70: 235–6. Bogod D. The truth, the whole truth? Anaesthesia News 2010; 271: 7–8. Killeen T, Kamat A, Walsh D, Parker A, Aliashkevich . Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia: a case report and review. Anaesthesia 2012; 67: 1386–94. Adams D, Quayum M, Worthington T, Lambert P, Elliott T. Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. Journal of Hospital Infection 2005; 61: 287–90. Crowley L, Preston R, Wong A, et al. What is the best skin disinfectant solution for labour epidural analgesia? A randomized, prospective trial comparing Chloroprep, Duraprep and chlorhexidine 0.5% in 70% alcohol. Anesthesia and Analgesia 2008; 106: AA221. The 3rd National Audit Project of the RCoA. Major complications of central neuraxial block in the United Kingdom. London: Royal College of Anaesthetists, 2009. doi:10.1111/anae.13046
Cricoid cartilage compression devices We were interested to read the recent article by Taylor et al. describing their cricoid compression device [1] because it validated the results of our description of a visually interactive guidance device for applying cricoid presure, published in 2013 [2]. Whereas Taylor et al. used the mechanical deformation of their device as a gauge of applied force, ours was a simple electronic 504
Correspondence
device with a thin-film force sensor that allows the anaesthetist to feel and apply force more directly to the patient’s cricoid cartilage than is possible with Taylor et al.’s device, which necessarily separates the anaesthetist’s fingers from the patient’s neck by some distance. Further, our device indicates the correct amount of applied force by illuminating a green light, while too much or too little pressure results in different warning colours. Were cricoid pressure to be applied by a trainee or nurse in clinical practice, Taylor et al.’s device provides little external feedback to the anaesthetist that the procedure is being correctly performed. The independent development of these devices implies a clinical need and suggests that a commercial cricoid pressure guidance device could be a viable medical product. We empathise with the lack of commercial manufacturing interest in Taylor et al.’s design; we were similarly unsuccessful in that regard. However, we have since turned our experimental efforts towards using disposable thin-film force sensors as a means of monitoring for the onset of tissue ischaemia and decubitus ulcers in prolonged surgery, intensive care units and long-term care. R. Saffary E. Feliz C. W. Connor Boston Medical Center, Boston, MA, USA Email: [email protected] Patent applied for by Anaesthesia Associates of Massachusetts. No
external funding or authors’ competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthe siacorrespondence.com.
References 1. Taylor RJ, Smurthwaite G, Mehmood I, Kitchen GB, Baker RD. A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure. Anaesthesia 2015; 70: 18–25. 2. Connor CW, Saffary R, Feliz E. Performance of the Sellick maneuver significantly improves when residents and trained nurses use a visually interactive guidance device in simulation. Physiological Measurement 2013; 34: 1645–56. doi:10.1111/anae.13056
Regional service evaluation of echocardiography trainers Sharma et al. are to be congratulated for their comprehensive overview of the current state of training in echocardiography in anaesthesia and intensive care [1]. With the potential for ‘focused intensive care echocardiography’ (FICE) accreditation to become incorporated as a compulsory module into the Faculty of Intensive Care Medicine syllabus, our group (South Yorkshire Hospitals Audit and Research Collaborative – SHARC) had concerns that this would be unachievable in South Yorkshire owing to a lack of suitable mentors. We therefore conducted a service evaluation of echocardiography training and practice in consultants working on intensive care units across all five trusts in the South Yorkshire region. Data were collected using ‘bring your own device technology’
© 2015 The Association of Anaesthetists of Great Britain and Ireland
