Abstract：
:Healthcare litigation in the UK continues to grow at an alarming rate, with claims against anaesthetists and critical care physicians increasing each year. This has led to a huge financial burden for the taxpayer and a sharp increase in professional indemnity fees for individual doctors. Although such litigation should provide valuable information to educate practitioners and reduce future similar claims, there appear to be significant barriers preventing important lessons from being learned. Detailed learning opportunities are available only to the healthcare providers being sued or the expert witnesses employed to analyse the claims. Most practitioners have to rely on indemnifiers' case reports, closed-claim analyses, and ad hoc publications for information. In this review, we suggest ways in which important lessons from litigation could be brought to the attention of all clinicians. Currently, most clinicians are unable to determine whether key components of their practice such as consent, clinical decision-making, and documentation are of an acceptable standard for legal scrutiny. By reporting outcomes of Coroners' inquests, clinical and criminal negligence cases, and referrals to the General Medical Council, it would be hoped that more explicit standards of performance could be derived. Ultimately, this may not only improve patient safety, but protect practitioners from unjustifiable claims. Finally, given the critical importance of experts in the above process, we believe that a system for professional registration and regulation should be explored to ensure that they offer accurate, representative, and unbiased opinions and have the appropriate expertise in the subject matter to be analysed.
journal_name
Br J Anaesthjournal_title
British journal of anaesthesiaauthors
Adams JP,Bell MD,Bodenham ARdoi
10.1093/bja/aes188subject
Has Abstractpub_date
2012-07-01 00:00:00pages
110-22issue
1eissn
0007-0912issn
1471-6771pii
S0007-0912(17)32938-0journal_volume
109pub_type
杂志文章abstract：:The respiratory effects of a new strong analgesic, meptazinol, were compared with a placebo and with equianalgesic doses of morphine and pentazocine in a double-blind crossover trial in seven healthy volunteers. No significant change in the ventilatory response to rebreathing carbon dioxide was observed after meptazin...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1093/bja/51.6.497
更新日期：1979-06-01 00:00:00
abstract：BACKGROUND:Experimental studies and investigations in patients with cardiac diseases suggest that opioids at clinical concentrations have no important direct effect on myocardial relaxation and contractility. In vivo data on the effect of remifentanil on myocardial function in humans are scarce. This study aimed to inv...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/aeq414
更新日期：2011-04-01 00:00:00
abstract：:The results of the ventilatory management of babies, obtained in the first 3 years of a neonatal surgical intensive care unit, are assessed. Overall mortality figures and detailed examination of the cause of death in individual diagnostic groups support a selective approach to intermittent positive pressure ventilatio...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/52.3.273
更新日期：1980-03-01 00:00:00
abstract：:We have compared insertion of a tracheal tube and laryngeal mask airway (LMA) both with and without the presence of a tube in the oesophagus in 20 ASA I and II patients undergoing elective laparoscopy. After induction of anaesthesia and neuromuscular block, we measured the times for an experienced anaesthetist to corr...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/73.5.688
更新日期：1994-11-01 00:00:00
abstract：BACKGROUND:High-frequency oscillation (HFO) is a widely used lung-protective ventilatory strategy in paediatric and neonatal acute lung injury. Its safe and effective use has been hindered by inadequate recruitment of the lung during oscillation and, until recently, the lack of an adequately powered oscillator for use ...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/88.5.708
更新日期：2002-05-01 00:00:00
abstract：BACKGROUND:Microvascular dysfunction is considered to play an important pathophysiological role in sepsis. We addressed the hypothesis that macrovascular and microvascular flow are uncoupled in early sepsis, using a rodent model with well-characterized haemodynamic and biochemical markers of severity and subsequent mor...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/aes093
更新日期：2012-06-01 00:00:00
abstract：:Six patients with airway stenosis were submitted to bronchoscopy under general anaesthesia. Each was ventilated with a gas mixture of 50% oxygen and nitrogen using successively manual jet insufflation (JV) using the Sanders technique at 20 b.p.m., and high frequency jet ventilation (HFJV) at rates of 150, 300 and 500 ...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/55.10.969
更新日期：1983-10-01 00:00:00
abstract：BACKGROUND:In regional anaesthesia, there is a risk of direct nerve injury. The purpose of this study was to determine whether the diameter of the applied needle is associated with the magnitude of nerve injury after needle nerve perforation. METHODS:In five anaesthetized pigs, the brachial plexus were exposed bilater...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/aep366
更新日期：2010-02-01 00:00:00
abstract：:Intra-oral masses in neonates can seriously compromise the airway, potentially causing hypoxia and death if not recognized and managed appropriately. We report a case in which an intra-oral mass was diagnosed on antenatal ultrasound scan. Preparation for delivery involved a multidisciplinary team approach, with a stra...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/83.6.951
更新日期：1999-12-01 00:00:00
abstract：:Blood concentrations of nitrous oxide were measured in anaesthetists, surgeons and theatre nurses. Comparison of anaesthetists and surgeons working in the same theatre showed that in ENT surgeons concentrations were greater (P < 0.01), while in general surgeons they were smaller (P < 0.003). Blood concentrations of ni...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/52.11.1143
更新日期：1980-11-01 00:00:00
abstract：Background:There is growing evidence that beta-blockade may reduce mortality in selected patients with sepsis. However, it is unclear if a pre-existing, chronic oral beta-blocker therapy should be continued or discontinued during the acute phase of severe sepsis and septic shock. Methods:The present secondary analysis...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/aex231
更新日期：2017-10-01 00:00:00
abstract：:The effect of the combination of opiates and hypnotics on bispectral index (BIS) is unclear. This double-blind placebo-controlled trial investigated the effect on BIS and sedation of different infusion doses of remifentanil combined with a steady infusion of propofol. Forty patients initially received a target-control...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1093/oxfordjournals.bja.a013474
更新日期：2000-04-01 00:00:00
abstract：BACKGROUND:A recent study showed that the noble gas helium induces early myocardial preconditioning. Cyclooxygenase-2 (COX-2) has been shown to be an important mediator in the signal transduction of late preconditioning. In the present study, we investigated whether helium induces late preconditioning in a concentratio...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/aep042
更新日期：2009-05-01 00:00:00
abstract：BACKGROUND:Fluid administration to increase stroke volume index (SVi) is a cornerstone of haemodynamic resuscitation. We assessed the accuracy of SVi variation during a calibrated abdominal compression manoeuvre (ΔSVi-CAC) to predict fluid responsiveness in children. METHODS:Patients younger than 8 yr with acute circu...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1016/j.bja.2018.06.030
更新日期：2018-12-01 00:00:00
abstract：:We studied the size 4 laryngeal mask airway (LMA) to test the hypothesis that oropharyngeal leak pressure and fibreoptic position improves with increasing cuff volume. After LMA insertion, 50 anaesthetized adult patients had the cuff inflated in 5-ml increments to 40 ml. Oropharyngeal leak pressure was optimal at 15 m...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/81.2.186
更新日期：1998-08-01 00:00:00
abstract：:Percutaneous tracheostomy is being used increasingly in the intensive care unit and endoscopic control of this procedure affords an improved level of safety. Training in such new minimal access techniques can be a significant risk factor in patient outcome. Surgical simulation provides training which minimizes this ri...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/81.3.401
更新日期：1998-09-01 00:00:00
abstract：:Twenty consecutive patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were allocated at random to group 1 (n = 10, high inspired oxygen fraction (FIO2) after CPB), or group 2 (n = 10, moderate FIO2 after CPB). The effects of each FIO2 on arterial and mixed venous concentrations of endothelin-1 (ET-1...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1093/bja/84.5.565
更新日期：2000-05-01 00:00:00
abstract：:The anaesthetic and surgical problems associated with Caesarean section in eight grossly obese patients (weight 150-204 kg) are described. In addition to an increase in the frequency and severity of the complications of obesity, those weighing more than 150 kg present a panniculus which may weigh 70 kg. Extradural ana...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/52.9.919
更新日期：1980-09-01 00:00:00
abstract：:We have studied post-tetanic count (PTC) and single twitch height at the onset of reflex movement to carinal stimulation after administration of vecuronium with five different types of anaesthesia. Seventy-five adult patients were allocated randomly to five groups of 15 patients each, to receive one of the following a...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验,收录出版
doi：10.1093/bja/72.6.688
更新日期：1994-06-01 00:00:00
abstract：:We have compared the ability of naïve intubators to intubate the trachea using a laryngoscope and an intubating laryngeal mask airway (ILMA) after receiving basic training, in a randomized, prospective, crossover study in 60 patients. Ventilation of the lungs via the ILMA was also compared with ventilation with a face...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1093/bja/83.4.615
更新日期：1999-10-01 00:00:00
abstract：BACKGROUND:Improvement of postoperative pain and other perioperative outcomes remain a significant challenge and a matter of debate among perioperative clinicians. This systematic review aims to evaluate the effects of perioperative i.v. lidocaine infusion on postoperative pain and recovery in patients undergoing vario...
journal_title：British journal of anaesthesia
pub_type： 杂志文章,meta分析,评审
doi：10.1093/bja/aew101
更新日期：2016-06-01 00:00:00
abstract：:Mean venous pressures were measured in 20 patients in whom a catheter, inserted via the external jugular vein, failed to pass centrally. The catheter used had a rounded end and two side holes. Pressures were measured with the patient's head in three different positions. The pressures were compared with the central ven...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/58.12.1384
更新日期：1986-12-01 00:00:00
abstract：:The safety of aspirin therapy in neuraxial anaesthesia has been historically questioned, and the current recommendations are still heterogeneous. A comprehensive review of clinical evidence and a comparative analysis of European and American guidelines were performed. Low-dose aspirin produces a selective, complete an...
journal_title：British journal of anaesthesia
pub_type： 杂志文章,评审
doi：10.1093/bja/aev348
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND:Anaesthesia and surgery are associated with impairment of the immune system expressed as an excessive proinflammatory immune response and suppression of cell-mediated immunity that may affect the course of the postoperative period. Addition of anaesthetic agents capable of attenuating the alterations in peri...
journal_title：British journal of anaesthesia
pub_type： 杂志文章,随机对照试验
doi：10.1093/bja/aem218
更新日期：2007-10-01 00:00:00
abstract：:The effects of bolus doses of phenoperidine 1-2 mg i.v. either alone, or combined with pancuronium 2-4 mg, were investigated in seven patients in traumatic coma. Phenoperidine alone significantly reduced mean arterial pressure (MAP) by a mean (+/- SEM) of 13.2 (+/- 2.8) mm Hg. Overall there was no significant change i...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/59.5.592
更新日期：1987-05-01 00:00:00
abstract：:The time course of the plasma lignocaine concentration, following caudal anaesthesia, was studied in 11 healthy children (3.5-9 yr). Plasma lignocaine concentrations were measured for up to 6 h after administration (5 mg kg-1). Peak plasma concentration was 2.05 +/- 0.08 micrograms ml-1 and occurred at 28.2 +/- 2.9 mi...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/56.12.1399
更新日期：1984-12-01 00:00:00
abstract：:A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. Postoperatively the patient received eno...
journal_title：British journal of anaesthesia
pub_type： 杂志文章
doi：10.1093/bja/aeh242
更新日期：2004-10-01 00:00:00
abstract：BACKGROUND:General anaesthesia is a balance between hypnosis and analgesia. We investigated whether an increase in remifentanil blood concentration would reduce the amount of propofol required to maintain a comparable level of anaesthesia in 60 patients undergoing ambulatory surgery. METHODS:Patients were allocated ra...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1093/bja/aeg115
更新日期：2003-05-01 00:00:00
abstract：:The concept of rapid delivery of multiple blood products to the bedside of a massively haemorrhaging patient seems to be a logical approach to the management of the massively bleeding patient. However, controversy exists in the use of fixed blood component ratios. Assessing the extent of the coagulopathy through point...
journal_title：British journal of anaesthesia
pub_type： 杂志文章,评审
doi：10.1093/bja/aeu379
更新日期：2014-12-01 00:00:00
abstract：:The analgesic effect of subanaesthetic concentrations of ether, trichloroethylene, methoxyflurane and halothane has been investigated previously using either clinical assessment or pain threshold measurements, but with conflicting results. The purpose of the present study was to evaluate the analgesic effect of isoflu...
journal_title：British journal of anaesthesia
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1093/bja/75.1.55
更新日期：1995-07-01 00:00:00
