<strong>Anaesthesia</strong> <strong>News</strong> February 2003The Naked GasmanIrecently returned from holiday to find a brand new computersitting on my desk, which was some feat in itself asfor years I have not been able to see what my desk-top ismade from because of piles of papers, journals and reportswhich are strewn all over it. I have a very simple filing system– everything goes into a pile and, when I need to refer toanything, I thumb down through the pile. At the moment twoinches equals one month, so it is quite easy to find things! Ilearnt this technique many years ago as a senior registrarwhen I was having problems claiming excess rent allowancefollowing an interhospital move. Every time I telephoned theregional finance officer he would say “oh yes, I’ve got yourfile in front of me” which made me think he was alreadyworking on it and that the payment would soon come tricklingdown to me. In the end I decided to see him in personand, whilst I was there, another senior registrar telephonedhim with a problem. “Oh yes, I’ve got your file in front ofme” was his response, and he waved the hand not holdingthe ’phone at a three foot high pile of files on the corner ofhis desk.These computers have been provided by our Trust, whichis supposed to be strapped for cash owing to another Trustwithin our Workforce Confederation being grossly overspent.However, the money comes from a separate IT budget whichI understand all Trusts (including the one aforementioned)have access to, and has been made available so that we mayachieve another of The Leader’s promises, that we should bea paper-free NHS in time to win the next election. This proliferationof computers within our department has broughtmany changes. For a start, the windows now all have locksand blinds; our CD has sent his first e-mail ever, althoughwhen he first plugged in his computer, the nearest plugmeant that the monitor was facing the wall and he was verytempted to leave it that way. He has also realised that whathe had always thought were handy drinks coasters were, infact, floppy disks.Anyway, in the midst of clearing a space on my desk, Icame across a reprint of what I presume was a spoof articlein the form of a short booklet (reminiscent of an Associationglossy), dated 1989, allegedly a publication from anantipodean anaesthetic institution entitled ‘CrayoningDuring <strong>Anaesthesia</strong>.’ It is unattributed and if anyone knowswho the author was I would be delighted to give them thepublicity they deserve. The article is concerned with thepolychromatic representation of certain physiological variablesduring anaesthesia, and is not shy of stating that “clinicalcrayoning by a vigilant, designated specialist graphicanaesthetist armed with a full range of brightly coloured pensis the basis of patient care during anaesthesia.”This medical practitioner’s sole responsibility is the provisionof a completed A4 size canvas for each patient, frominduction of anaesthesia until safe transfer to the RecoveryRoom or Intensive Scribbling Unit. Certain recommendationsare made. For example, blood pressure and pulseshould be shown to undulate gently in a visually pleasingsine wave pattern about a mean. Staccato patterns of abruptvariation are to be deprecated and trainees should bedespatched to the coffee room during periods of unstableanaesthesia until they master the skills of physiological averagingand selective representation.The booklet has some sound advice on oxygenation, recommendingthat the patient must be kept well oxygenated inorder to avoid charting an excessive number of lines of negativegradient, as these have been correlated with a poor outcome.When recording Pulse Oximetry, the suggestion is touse a red pen down to 90% and a blue pen below this.Anaesthetists with a well-developed sense of pitch may alsolike to record falls in saturation as a line of crotchets in adescending scale from high C.I know several colleagues who draw the initial ECG ontheir charts, however this booklet warns against attemptingto reproduce every ECG complex and quotes a case of ananaesthetist who topped himself after failing to represent asustained period of SVT in his patient. There remains plentyof scope for individuality in recording other measurements;for example little thermometers with a scale beside themdrawn across the chart can look quite cute.Of course I cannot endorse any of these suggestions as theanaesthetic chart is a medicolegal document, not to be takenlightly. I have known colleagues who filled the whole chartin before leaving the anaesthetic room, another who on anold chart headed ‘Type of Anaesthetic’ would just write“bloody good!”, and others who wrote so much detail on thechart that, unless you had been there, you would havethought it an entry for the Booker prize. My own advice totrainees has always been to make sure the final values for allparameters on your chart fall within the normal range foryour patient, whatever that may be.The concluding advice from the ‘Crayoning During<strong>Anaesthesia</strong>’ booklet is “Be creative, this is art not science.No-one will ever know whether you gave a good anaestheticor not - unless you are silly enough to record the fact on apiece of paper!”REMEMBER, THE AAGBI NOW HAS ANEW ADDRESS:21 Portland Place, London W1B 1PY14
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