We have an anaesthetic machine, which seems to be solely used for giving
high N20/O2 ratios (it has the linkage safety mech).
The rest of anaesthesia done in the department is done using TIVA techniques
(total intravenous anaesthesia).
We also have an old but entirely functional ICU ventilator plus the usual
Doubt that we would miss the Boyles machine if it went. An argument for
keeping it has been that you can "gas down" a patient with a critical
airway. In practice I have never seen this done as such patients are either
a) well enough to be taken to theatre, or b) too sick to have anything but
an emergent RSI with surgical airway as a get out method.
SpR in Emergency Medicine
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Evidence based emergency medicine
----- Original Message -----
From: "Paul Bailey" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 29, 2001 6:24 AM
Subject: Re: anaesthetic machines in A&E
> Hi everyone,
> > Of course you need anaesthetic machines.
> Well, to take a contrary opinion.... no, they are not required.... I
> guess that it depends on what we mean by 'anaesthetic machines'. I take
> it we are talking about a Boyles machine with Nitrous / Inhaled
> anaesthetic / O2 / Ventilator.....
> >As you know, I have equipped each bay in the new Emergency Unit with its
> own to ensure best quality care throughout. There are many occasions where
> patients need emergency intubation and ventilation, and must be
> anaesthetised to facilitate this.
> > They then need to be kept anaesthetised, and this can only safely be
> done with an interlinked modern anaesthetic provision.
> This is where the majority of EM Docs in Australia would disagree. It is
> perfectly safe to 'anaesthetise' patients without access to a Boyles
> machine. All that is required is a Morph + Midaz infusion to keep them
> asleep, and an Oxylog, and an appropriate monitoring environment. The
> sole purpose, as far as I can see, of a Boyles machine is to make the
> Anaesthetists feel at home if / when they enter the department to take
> care of someone's airway. This, and the fact that they take a lot of
> maintenance to keep fully operational.
> Interested to hear alternative viewpoints.
> Dr Paul Bailey MB BS FACEM
> Western Australia
> > Best wishes,
> > Rowley Cottingham
> > [log in to unmask]
> > http://www.emergencyunit.com