Sunday, 25 August 2013

From Mindless to Mindful Practice – Cognitive Bias and Clinical Decision Making

Our brains tend to process and manage information either "intuitively" or "analytically". Intuitive thinking is fast, is based on experience and common sense, and is usually right, while analytical thinking is slow, thorough and ensures that we use all our available deductive powers and resources and don't miss things. Analytical thinking (eg thorough use of algorithms, checklists etc) usually results in fewer mistakes or oversights, but is time consuming and simply not practical when dealing with the many decisions required in our daily activities. The problem in medicine is that intuitive thinking (something many experienced clinicians are often proud of) accounts for most of the major clinical mistakes. How then do we balance our use of both thought processes to deal efficiently with the many clinical problems we face every day without exposing patients to unnecessary risks by mentally "cutting corners"? This editorial looks at this question and has enough in it to give us all reason to think about it.

PM

A Rude Awakening – The Perioperative Sleep Apnea Epidemic

The perioperative sleep apnoea epidemic has probably not been the "rude awakening" suggested in the title of this article for any anaesthetist working in Western Sydney any time this century. Just knowing about the problem, however, doesn't automatically mean we can fix it. This opinion piece highlights the increasingly common dilemma facing anaesthetists and surgeons and while it doesn't provide all the answers it does put out an important call for protocols that heighten awareness of the problem and make best use of the resources available to fix it. Westmead is looking at such protocols as well as contributing to the much needed research in this area. Worth a read.

MP

Risk of venous thromboembolism associated with peripherally inserted central catheters

PICC lines are commonly used and often have advantages over central lines, but their thrombotic complications have perhaps been under appreciated until now. This metanalysis shows that they have a slightly higher incidence of DVT than central lines, and a subsection of observational work quantifies this risk and identifies the patient groups at highest risk. It comes with a useful editorial for those that don't want to read all the fine print, but it's worth thinking about the next time you're weighing up the pros and cons of a PICCline over a central line.

MP

A Trial of Intraoperative Low Tidal Volume Ventilation in Abdominal Surgery

What effect does the ventilator settings have on the postoperative course of our patients? How often do you change the settings from the standard of 500 by 10? This original article makes a compelling argument for lung protective ventilation in any patient with intermediate to high risk of pulmonary complication having major abdominal surgery. Benefits include an almost 70% reduction in ventilatory support in the postoperative period, reduced hospital stay and less risk of pneumonia.

MP

RĂ©animation

Currently Westmead has 11 anaesthetists reviewing journal articles that may be of interest. We will endeavour to link to a selection of these articles each month, with a short blurb highlighting each article's relevance to anaesthesia.

PM, MP