Anaesthetic Doctors Research Articles

Knowledge, Application and Practice of "Stop and Mock Before You Block" among Anaesthetic Doctors in Hospital Kuala Lumpur

Introduction : Safe practice during regional anaesthesia is important to ensure avoidance of morbidity and mortality. The Stop and Mock Before You Block is a safety initiative that is developed to prevent wrong sided and site regional blocks. The study aims to identify the incidences of wrong side or site blocks and also identify the knowledge, application and practice of anaesthetic doctors in Hospital Kuala Lumpur. Method : This is a observational descriptive study, where a questionnaire in the format of Google Form is distributed among Anaesthetic doctors via Whatsapp. The data was then collected and analysed using SPSS to generate frequencies and mean of responses. It was also used to analyse the relationship between the variables and demographics. Results : A total of 143 anaesthetic doctors responded. The study found an incidence of 8 wrongly performed blocks. The study also found significant correlation between years of practice and doctor’s grade to the knowledge, application and practice components. Conclusion : The study has identified 8 occurrences of wrong side or site block that has occurred among the anaesthetic doctors in Hospital Kuala Lumpur. Based on the results of the study, majority of the anaesthetic doctors had moderate to poor knowledge, application and practice of the Stop and Mock Before You Block safety initiative.

Recruitment to higher specialty training in anaesthesia in the UK during the COVID‐19 pandemic: a national survey

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful. We surveyed applicants to investigate their experience of the recruitment process (response rate 536/1056; 51%). Approximately 61% of respondents were not offered ST3 posts (n = 326). We enquired about their career plans for the next 12-24 months. Most respondents (79%) intended to take up a post equivalent to a third year of core training or a clinical fellow post from August 2021. Other options considered included: pursuing work abroad (17%); embarking on career breaks (16%); taking up higher training posts in intensive care medicine (15%); and permanently leaving medicine (9%). Nine per cent of respondents also expressed plans to pursue training in another medical specialty. Some expressed an intention to pursue further education or research (10%). A large proportion (42%) expressed a lack of confidence in being able to achieve the training requirements to later apply for a higher training post. The majority reported not feeling confident in achieving specialist registration in anaesthesia in the future without a training number (75%), and noted disruption to their wider life plans from the impending time out of training (78%). Sentiment analysis of free-text responses indicated generally negative sentiment about the recruitment process. Themes elicited included: feeling the recruitment process was unfair; burnout and negative impact on well-being; difficulties in making life plans; and feeling undervalued and abandoned. These results suggest that junior anaesthetic doctors in the UK negatively perceived postgraduate training structures and changes to the postgraduate curriculum and experienced difficulties in securing higher training.

Psychological distress during the acceleration phase of the COVID-19 pandemic: a survey of doctors practising in emergency medicine, anaesthesia and intensive care medicine in the UK and Ireland

ObjectiveTo quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in the UK and Ireland.MethodsInitial cross-sectional electronic survey distributed during acceleration phase...

Study of Bacterial Contamination of Mobile Phones of Anaesthetists and other Doctors in Surgical Departments During Theatre Sessions

Background: Personal items such as mobile phones are commonly used by doctors working in the operationtheatre. The hands and personal use items of anaesthetic doctors working in the operation theatre may serveas vectors for transmission of nosocomial pathogens among surgical patients. Our aim was to determine themobile phones contamination among anaesthetists working in the operation theatres of anaesthetic doctors.Method : Forty anaesthetic doctors and other surgical department doctors working in the operation theatresat Sri Lakshmi Narayana Institute of Medical sciences, puducherry and Bharath Medical college andHospital, Chennai were enrolled in the study. Swabs from fingertips and keypads of mobile phones weretaken using moist sterile swabs and plated on Mac Conkey and Blood agar plates. The bacteria isolated wereidentified by biochemical tests.Results: Hand washing was performed by 50% (n=20/40) doctors entering the theatre. 95% (n=38/40)brought their mobile phone to the theatre and 80% used it at least once during the theatre session. Bacterialgrowth was detected from mobile phone swabs. Staphylococci were predominantly cultured from allthe specimens tested. Staphylococci 15%, Methicillin- resistant Staphylococcus aureus (MRSA) 10%,pseudomonas 5%, coagulase negative staphylococci 15%,pseudomonas 5% and total 50% anaesthetist andother doctors mobile phones growth were detected.Conclusion: Personal use items of doctors such as mobile phones show a high percentage of bacterialcontamination. Hand washing compliance was moderate among the study population. Thus personal useitems and hands may act as an important source of nosocomial pathogens in the operation theatre settings.Therefore it is important to encourage higher compliance to hand washing practices and routine surfacedisinfection of personal use items brought to the operation theatre.Mobile phone disinfection should be partof infection prevention protocols in Operation Theatre.

Case-mix adjusted postanaesthesia care unit length of stay and business intelligence dashboards for feedback to anaesthetists

BackgroundDespite advances in business intelligence software and evidence that feedback to doctors can improve outcomes, objective feedback regarding patient outcomes for individual anaesthetists is hampered by lack of useful benchmarks. We aimed to address this issue by producing case-mix and risk-adjusted postanaesthesia care unit (PACU) length of stay (LOS) benchmarks for integration into modern reporting tools. MethodsWe extended existing hospital information systems to calculate predicted PACU LOS using a neural network trained on patient age, surgery duration, sex, operating specialty, urgency, weekday, and insurance status (n=100 511). We then calculated the difference between observed mean and predicted PACU LOS for individual doctors, and compared the results with and without case-mix adjustment. We report practical implications of using visual analytics dashboards displaying the difference between observed and predicted PACU LOS to provide feedback to anaesthetic doctors. ResultsThe neural network accounted for over half of observed variation in individual doctors' mean PACU LOS (mean predicted and mean actual LOS Spearman's r2=0.57). Account for case-mix reduced apparent spread, with 80% of individual doctors falling in a band of 4.3 min after case-mix adjusting, compared with a range of 24 min without adjustment. Case-mix adjusting also identified different individual doctors as outliers (Weighted Cohen's kappa [κ]=0.27). Finally, we demonstrated that we were able to integrate the adjusted metrics into routine reporting tools. ConclusionWith caution, case-mix adjustment of anaesthetic outcome measures such as PACU LOS potentially provides a useful continuous quality improvement tool. Unadjusted outcome measures are imprecise at best and misleading at worst.

Knowledge and Attitudes of Anaesthetic Resident Doctors, Anaesthetic Nurses and Psychiatric Nurses towards Electroconvulsive Therapy

Knowledge and Attitudes of Anaesthetic Resident Doctors, Anaesthetic Nurses and Psychiatric Nurses towards Electroconvulsive Therapy

Coffee consumption and work satisfaction among Scandinavian anaesthesiologists: A survey.

It is a common prejudice that anaesthetic doctors are believed to have high coffee consumption. In this study, we aimed to assess the association between coffee drinking and work satisfaction among Scandinavian anaesthesiologists. Wehypothesised that coffee consumption was positively correlated with work satisfaction. We invited anaesthesiologists attending the 34th congress of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine in Malmö, Sweden, September 2017 to participate in a paper-based survey. We collected data on characteristics of the respondents, coffee drinking and work satisfaction, and compared coffee vs non-coffee drinkers with regard to work satisfaction scored on a modified Wong-Baker Faces Pain Rating Scale (Visual Analogue Scale from 0 to 10). A total of 271 anaesthesiologists participated in the survey, of which 265 (97.7%) of the questionnaires contained valid data. Some 143 (54.0%) of the respondents were women, the median (interquartile range, IQR) age was 41.0 (35.0-49.5) years, and 242 (91.3%) were coffee drinkers. Coffee drinkers consumed median 4.0 (IQR: 2.5-5.0) cups of coffee daily. Overall work satisfaction was median 8 (IQR: 8-9), with no difference between respondents drinking coffee and those who did not (median 8 (IQR: 8-9) vs 8 (IQR: 8-9), Wilcoxon rank sum test, P=0.62). Also, we found no association between work satisfaction and the number of cups of coffee consumed daily (r2 =0.005, P=0.24). In this survey, we found high work satisfaction among Scandinavian anaesthesiologists, with no difference between coffee and non-coffee drinkers.

Factors associated with failed spinal anaesthesia for Caesarean sections in Mthatha general hospital, Eastern Cape, South Africa

Background: The use of spinal anaesthesia has increased in the last three decades, given that it is the recommended anaesthetic of choice for better foetal and maternal outcomes in Caesarean section. Failed spinal anaesthesia (FSA) exposes patients to unfavourable experience of pain and the potential complications of general anaesthesia that are being avoided in the first instance. This study determines the incidence and the predictors of failed spinal anaesthesia in pregnant women presenting for Caesarean section at Mthatha General Hospital, Eastern Cape.
 
 Methods: This descriptive cross-sectional study included 197 pregnant women scheduled for Caesarean section under spinal anaesthesia at Mthatha General Hospital from May 1 to August 30, 2013. A standard proforma was utilised for data collection on items of demographic, surgical and anaesthetic records of each parturient. The main outcome measure was the incidence of failed spinal anaesthesia (defined as partial or incomplete spinal block requiring conversion to general anaesthesia). 
 
 Results: The incidence of failed spinal anaesthesia was 11.7%, which was slightly higher in emergency Caesarean sections. In univariate analysis, previous anaesthesia, obesity, dry tap of cerebrospinal fluid (CSF), bloody CSF and duration of work experience less than one year were significantly associated with FSA in the cohort.
 
 Conclusion: The study found a high incidence of failed spinal anaesthesia during Caesarean section in this setting. Upskilling of doctors in spinal anaesthesia is urgently needed in the study setting. 
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1292696

An Audit of the Knowledge and Practice of the Active Management of the Third Stage of Labor in a Resource Constrained Setting

Background: The high incidence of post-partum haemorrage (PPH) in South Africa draws into question the knowledge and practice of HCPs with regard to AMTSL. Hence we carried out this assessment of HCPs knowledge and practice of AMTSL in the Pietermaritzburg Metropolitan Area (PMB). Aim: To evaluate HCP’s knowledge and practice of AMTSL in the Pietermaritzburg Metropolitan Area and to determine if AMTSL is being correctly implemented. Method: A cross sectional questionnaire based survey of 280 HCPs involved in maternity services, at a tertiary, regional and district hospital and 3 clinics. Results: 94% of questionnaires were completed by HCPs, 52.2% being midwives and 47.8% doctors. 71.2% of midwives and 71.1% of the doctors defined AMTSL according to the FIGO/WHO definition, with 93% of midwives and 91.9% of doctors practising AMTSL. Manual removal of the placenta was incorrectly listed as a part of AMTSL by 60.3% of midwives and 50.5% of the doctors. 64% of midwives and 42.3% of doctors incorrectly thought that the routine administration of a uterotonic agent was part of expectant management of the third stage of labour (EMTSL). Early cord clamping was practised by 69% of midwives and 73.8% of doctors, while 92% of midwives and 82.8% of doctors delivered the placenta by controlled cord traction. At caesarean delivery 65% of obstetric doctors and 87% of anaesthetic doctors use oxytocin (as a combination dose of intravenous bolus and infusion). Conclusion: This study highlights that while there is a deficiency in the knowledge and practice of the HCPs with regard to AMTSL in our setting, the majority do practise AMTSL, with most of the recommended components being implemented.

Effects of "Doctor-nurse Integrating" mode on the operation room nursing quality improvement

Objective To explore the effects of Doctor-nurse Integrating mode on the operation room nursing quality improvement. Methods From July 2014 to Dec. 2014,11 423 operations in our hospital were chosen as control group,while 10 897 operations from Jan. 2015 to June 2015 as intervention group.An administrating group of Doctor-nurse Integrating mode was formed, with both doctors and nurses acting as quality controllers. A144 Regular Meetings System was also formed. The author retrospected and analyzed 11 423 negative accidents which occurred during operation. Management details and responsibilities were specified, and training was enhanced. All these were monitored, controlled, implemented and improved by operation doctors, anaesthesia doctors and operation room nurses. Results The rate of negative accidents dropped from 1.226% (140/11 423) to 0.340% (37/10 897) since the implementation of Doctor-nurse Integrating mode of operation quality control. Conclusions Doctor-nurse Integrating mode of operation quality control has positive effects on the improvement of operation nursing quality. Key words: Operation room; Doctor-nurse Integrating mode; Quality control

Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants

To evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. Eighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack-Lehane classification of the laryngeal view were recorded. The anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p=0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p=0.03). There were no significant differences in the Cormack-Lehane view between both groups. The anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

Analysis of cricoid pressure application: anaesthetic trainee doctors vs. nursing anaesthetic assistants

Background and objectiveTo evaluate the ability of anaesthetic trainee doctors compared to nursing anaesthetic assistants in identifying the cricoid cartilage, applying the appropriate cricoid pressure and producing an adequate laryngeal inlet view. MethodsEighty-five participants, 42 anaesthetic trainee doctors and 43 nursing anaesthetic assistants, were asked to complete a set of questionnaires which included the correct amount of force to be applied to the cricoid cartilage. They were then asked to identify the cricoid cartilage and apply the cricoid pressure on an upper airway manikin placed on a weighing scale, and the pressure was recorded. Subsequently they applied cricoid pressure on actual anaesthetized patients following rapid sequence induction. Details regarding the cricoid pressure application and the Cormack–Lehane classification of the laryngeal view were recorded. ResultsThe anaesthetic trainee doctors were significantly better than the nursing anaesthetic assistants in identifying the cricoid cartilage (95.2% vs. 55.8%, p=0.001). However, both groups were equally poor in the knowledge about the amount of cricoid pressure force required (11.9% vs. 9.3% respectively) and in the correct application of cricoid pressure (16.7% vs. 20.9% respectively). The three-finger technique was performed by 85.7% of the anaesthetic trainee doctors and 65.1% of the nursing anaesthetic assistants (p=0.03). There were no significant differences in the Cormack–Lehane view between both groups. ConclusionThe anaesthetic trainee doctors were better than the nursing anaesthetic assistants in cricoid cartilage identification but both groups were equally poor in their knowledge and application of cricoid pressure.

The perspectives of eThekwini public service anaesthetic doctors on the informed consent process for anaesthesia

AbstractObjectives: This study aimed to ascertain the perspectives of anaesthetists with regard to their current practice of obtaining informed consent. The outcome of this study will eventually assist in creating a standardised system for informed consent which will be pivotal to the safe, ethical, medical and legally sound practice of anaesthesia.Design: This was an observational descriptive study that assessed the perspectives of anaesthetists in public service using manually and electronically distributed questionnaires that consisted of open- and closed-ended questions.Setting and subjects: The study canvassed the views of full-time anaesthetic doctors employed by state hospitals in the eThekwini municipality.Outcome measures: The practice, general impression and overall skills in respect of informed consent obtained by anaesthetists were measured in four main areas: the preanaesthetic interview, optimisation of the process, influence of litigation on the process, and expertise in determining patient...

Obstetric anaesthesia at district and regional hospitals in KwaZulu-Natal: human resources, caseloads and the experience of doctors

Objectives: Suboptimal treatment as a result of lack of basic skills in anaesthesia and resuscitation contributes significantly to the continuing increase in anaesthetic-related maternal deaths in South Africa. This study aimed to determine the number of doctors providing obstetric anaesthesia at district and regional hospitals in KwaZulu-Natal, their level of experience and caseload, and to identify specific groups that could be targeted for support and training. Design: This was a prospective open cohort observational study of obstetric anaesthetic services in KwaZulu-Natal, which considered the human resources, caseloads and the experience of doctors. Setting and subjects: Two separate questionnaires, directed independently to medical managers and doctors providing operative obstetric services, were sent to 48 district and regional hospitals in KwaZulu-Natal. One third of the hospitals, selected by stratified randomisation, were visited to improve response rates. Outcome measures: Medical managers were asked for caseload and staffing data. Doctors were asked for details of their qualifications, experience and their current workload. Results: Thirty-eight (a 79% response rate) medical managers and 266 doctors (an estimated response rate of 65%) completed questionnaires. Community service medical officers (CSMOs) at rural district hospitals constituted 27% of fulltime staff. CSMOs at all responding district hospitals were expected to provide obstetric anaesthesia independently. Foreign medical graduates provided obstetric anaesthesia in 71% (27/38) of hospitals and constituted 27% of full-time staff at rural district hospitals. Twenty-four doctors (all foreign-trained) reported no anaesthesia training during their internship. District hospitals were more reliant on part-time (sessional) appointments. Fifty-eight per cent of all (22/38) hospitals reported that a number of sessional appointments provided obstetric anaesthesia. In October 2010, 58% (22/38 active during the month) of sessional appointments at district-level hospitals administered only one obstetric anaesthetic, whereas all 15 sessional appointments who were active at regional level administered two or more. Only 24% of responding doctors had more than five years’ experience in their current employment. Only 3% of responding doctors working in rural hospitals had a Diploma in Anaesthesia, compared to 26% in urban hospitals. Only one doctor with more than five years of employment history and a Diploma in Anaesthesia worked at district level. Conclusion: This study highlights the lack of training and experience of doctors in obstetric anaesthesia and documents workload patterns at district hospitals. It also identifies specific target groups for future support and training.

A qualitative investigation of expectant and new mothers' understanding of the model of a stand-alone midwifery-led birth centre

ObjectiveTo determine understanding of the model of a stand-alone Midwifery led unit, in order to inform and develop education programs for potential users.DesignQualitative study using interviews.SettingDistrict General Hospital Maternity service.Participants10...

Stress and fatigue among anaesthesia and intensive care doctors in Lithuania

Evidence shows that anaesthesia and intensive care is a stressful occupation and it may have an impact on anaesthetists' and intensive care doctors' well-being. The goal of the study was to evaluate stress and fatigue and their correlation with working conditions among anaesthesiologists and intensive care specialists employed in Kaunas city (Lithuania) hospitals.

Bacterial Contamination of Anaesthetists Hands, Personal Mobile Phones and Wrist Watches used during Theatre Sessions

Background: Personal items such as mobile phones and wrist watches are commonly used by doctors working in the operation theatre. The hands and personal use items of anaesthetic doctors working in the operation theatre may serve as vectors for transmission of nosocomial pathogens among surgical patients. Our aim was to determine the hand contamination among anaesthetists working in the operation theatre and contamination of mobile phones and wrist watches of anaesthetic doctors. Method: Forty five anaesthetic doctors working in the operation theatres at Colombo South Teaching Hospital and Ratnapura General Hospital were enrolled in the study. Swabs from fingertips, keypads of mobile phones and wrist watches were taken using moist sterile swabs and plated on Mac Conkey and Blood agar plates. The bacteria isolated were identified by biochemical tests. Results: Hand washing was performed by 60% (n=27/45) doctors entering the theatre. 95% (n=43/45) brought their mobile phone to the theatre and 78.5% used it at least once during the theatre session. A wrist watch was worn by 71% (n=32/45) of the anaesthetic doctors working in the theatre. Bacterial growth was detected from 84% wrist watch swabs, 71% fingertip swabs and 70% mobile phone swabs. Staphylococci were predominantly cultured from all three specimens tested. MRSA was isolated from 22% of swabs taken from fingertips, 15% mobile phones and 25% wrist watches respectively. Methicillin sensitive Staphylococcus aureus (MSSA) was isolated from 33%, 46.5% and 37.5% swabs from fingertips, mobile phones and wrist watches respectively. Coagulase negative Staphylococci was isolated from wrist watches (15%) and fingertip specimens (2%). 29% fingertip swabs and 30% mobile phone swabs did not show bacterial growth. Conclusion: Personal use items of doctors such as mobile phones and wrist watches show a high percentage of bacterial contamination. Hand washing compliance was moderate among the study population. Thus personal use items and hands may act as an important source of nosocomial pathogens in the Sri Lankan operation theatre settings. Therefore it is important to encourage higher compliance to hand washing practices and routine surface disinfection of personal use items brought to the operation theatre. Key words: bacterial contamination, nosocomial infections doi: 10.4038/slja.v17i1.409 Sri Lankan Journal of Anaesthesiology 17(1) : 11-15 (2009)

The views of Foundation Year 1 doctors in anaesthesia: is this a valuable educational experience?

The views of Foundation Year 1 doctors in anaesthesia: is this a valuable educational experience?

Foundation doctors in Anaesthesia: should they be taught to administer an anaesthetic?

BackgroundAnaesthetic pre-registration house officer posts have been available since 1997. With the change to postgraduate medical training introduced in 2005, these posts have become vital building blocks for Foundation Programmes.DiscussionWe debate the skills that new Foundation Programme doctors in such posts should be taught, particularly whether administration of an anaesthetic holds an important place. The opinion of college tutors prior to the institution of the foundation programme is included. These were obtained from a postal questionnaire.SummaryWe maintain that teaching how to administer an anaesthetic remains an important learning objective and something that should be actively pursued.

The Impact of Anaesthetic Assistants on Anaesthesia Service in Sudan

History of the establishment of the School of Anaesthetic Assistants (SAA ) in Sudan was mentioned in details where it was clear that in the late fifties and early sixties surgical services were expanding without similar expansion in anaesthetic services due to lack of interest from doctors in anaesthesia. This is taken as a prototype to what is happening in most African Countries (Akinyemi & Soyannwo 1980). The effort of the pioneers to overcome this problem was tremendous; they managed to solve the problem, though on a lower profile, by the establishment of the SAA, while their effort to gain more doctors to the specialty continued. The lack of job description for the anaesthetic assistants was clear. The curriculum of the school was updated. But the shortage of trainers was obvious. The study done in Soba University Hospital (SUH), Khartoum Teaching Hospital (KTH) & and some States hospitals showed clearly that the best anaesthetic outcome was obtained where both physician anaesthetist and anaesthetic assistant work together. The mortality rates were higher with the assistants working unsupervised, while morbidity was higher with the physician anaesthetists and this is due to their ability to recognize and manage complications more than the assistants. The study recommends that a clear job description for the assistants should be put forward. More effort should be spent to attract more doctors to the specialty. More care should be paid to the proper documentation for anaesthetic events in the patient record sheets. ABBREVIATIONS SAA (school of anaesthesia assistant) KTH (Khartoum Teaching Hospital) SUH (Sopa University Hospital) AA (anaesthesia assistant) INTRODUCTION History of the establishment of the School of Anaesthetic Assistants (SAA ) in Sudan was mentioned in details where it was clear that in the late fifties and early sixties surgical services were expanding without similar expansion in anaesthetic services due to lack of interest from doctors in anaesthesia. This may be due to the lack of doctors in the country as a whole. Amina (1995) stated that from 1898 till independence in 1955 the number of Sudanese doctors was only 150. At that time the intake of students to the medical school was every two years and the number did not exceed twelve student at most. The first registrars of anaesthesia were taken in April 1958. There was no proper training locally and they depended on self-learning till they left to United Kingdom to get their degrees. Those were Professor Eltahir Fadl Mahmoud and Dr. Abdel Ghani Farah (prof Eltahir F. 2001, pers. Comm., 3 April). METHODOLOGY A) Study site: This study was conducted at I) School of Anaesthetic assistants, Khartoum Teaching Hospital. II) Soba University Hospital (SUH) III) Khartoum Teaching Hospital (KTH) IV) Five hospitals from the States, namely Port Sudan, Kassala, Gadarif, El Rahad and Medani. B) The history of the SAA was taken by different means i) From records of the School. ii) Senior graduates of the School. iii) Pioneers who started the School. iv) the current Dean of the School. The Impact of Anaesthetic Assistants on Anaesthesia Service in Sudan 2 of 7 v) Individual Anaesthetists. C) The Selected hospitals were studied by the following means: i) Visits and appropriate data collection. ii) For KTH and SUH the study included a retrospective and prospective periods. SUH: Retrospective period: from Jan 98 to March 99 and from June 2000 to Dec 2000. Prospective period: from April 99 to Dec 99 and from January 2001 to June 2001. KTH: Retrospective period: From Jan 99 – April 2000. Prospective period: from May 2000 to Dec 2000 and from July 2001 to Oct 2001. Data collected included number of anaesthetics done, who conducted the anaesthesia, Hospitals in the States: data collected was mainly retrospective; from records when available or from assistants and surgeons working in these hospitals (Mohamed A 2000, Babiker A 2000, Abdalla A 2000, Mohamed E 2001, Eshag 2001, Yousif E 2001, Enour H 2001 pers. Cumm). Obtain recorded information from SUH, KTH and provinces as regards:Number of patients and type of anaesthesia 1. administered. Outcome and complication recorded. 2. Number and type of anaesthetic personnel in Sudan 3. general and in selected hospitals specially. Satisfaction and evaluation of surgeons and 4. obstetricians throw designed questioner from anaesthesia service. Designed questioner to the directors of hospitals 5. (5) hospitals were selected to know size of service provided by (AA) in these hospitals.