“We must have better routines for anaesthetics in emergency situations; it’s about patient safety and saving lives. At the same time we need to consider the great need to help the patient to feel less afraid,” says Kati Knudsen, researcher at the University of Gävle.
Kati Knudsen is a nurse anaesthetist originally and has many years experience of putting people to sleep before an operation. Even then, at the beginning of her career, she discovered when she started to anaesthetise patients, that one assessed patient’s respiratory organs very differently.
“It was done differently from person to person and we often put ourselves in critical situations and risked patient safety.”
Kati developed a checklist for the assessment of the respiratory organs and then got the nurse anaesthetists to use that checklist when they were going to evaluate and anaesthetise patients before narcosis.
It dealt with documenting the risk factors such as the patient’s ability to open their jaw and the anatomical conditions in the mouth cavity, people that were overweight and those with thick necks, things that have an impact on whether it is difficult or easy to intubate.
When she later investigated this at anaesthetic clinics in Sweden she found that less than half of the clinics had routines for making assessments of the patients before narcosis.
It was equally bad regarding the policy for which patients should receive awake intubation, the safest way to get a free airway if there is a risk of a difficult intubation.
Of the twenty anaesthetists (doctors) interviewed, only three had made surgical airways, when one makes an incision in the throat so the patient can breathe, the last chance. They displayed great strength as it is a dreaded situation and nothing anyone would choose to do.
“If you get called to the A & E for example, then you have to work as a team although no one else understands my field.”
One must give further education and in simulation training practice different scenarios. If the anaesthetist doctor or nurse who has to do this is stressed then it is not certain that they can communicate in a rational way and say what they want to do.
“Then someone else can take over and guide the anaesthetist doctor or nurse.”
“We must help the patients more; we cannot just use hibiscrub sponges on them. It is well known that patients that are going to be operated on are scared. They want to receive tailor-made information about what is facing them.”
There have not been any studies about how patients have experienced being given awake intubation.
Kati has therefore interviewed patients who have been given this treatment and they describe that it feels as if one is being suffocated and they feel fear and stress.
“One can hold their hand so that they feel that someone is there for them, because once they insert the tube then they cannot communicate verbally.”
“They want eye contact and it is very important, but we are often positioned behind the head of the patient. Perhaps we could use a mirror to show we are there and to have eye contact with them. They do in fact entrust us with their lives. I am passionate about the patients and their rights; we must take more care of them. I have done this for my nursing corps, I want to help them,” concludes Kati.
Kati Knudsen defended her thesis on the 20th of May at Gävle hospital “Airway management in anaesthesia care - professional and patient perspectives.”
For further information, please contact:
Kati Knudsen, researcher in Health and Nursing Sciences at the University of Gävle
Tel: 026-64 82 23, 070-264 40 54