Department of Anaesthesia, Western Infirmary & Gartnavel Hospitals, Glasgow, UK.
Anaesthesia. 2011 Mar;66(3):175-9. doi: 10.1111/j.1365-2044.2011.06623.x.
In aviation, the sterile cockpit rule prohibits non-essential activities during critical phases of flight, takeoff and landing, phases analogous to induction of, and emergence from, anaesthesia. We studied distraction during 30 anaesthetic inductions, maintenances and emergences. Mean (SD) noise during emergence (58.3 (6.2) dB) was higher than during induction (46.4 (4.3) dB) and maintenance (52 (4.5) dB; p<0.001). Sudden loud noises, greater than 70 dB, occurred more frequently at emergence (occurring 34 times) than at induction (occurring nine times) or maintenance (occurring 13 times). The median (IQR [range]) of staff entrances or exits were 0 (0-2 [0-7]), 6 (3-10 [1-18]) and 10 (5-12 [1-20]) for induction, maintenance and emergence, respectively (p<0.001). Conversations unrelated to the procedure occurred in 28/30 (93%) emergences. These data demonstrate increased distraction during emergence compared with other phases of anaesthesia. Recognising and minimising distraction should improve patient safety. Applying aviation's sterile cockpit rule may be a useful addition to our clinical practice.
在航空领域，无菌驾驶舱规则禁止在飞行的关键阶段（起飞和降落）进行非必要的活动，这些阶段类似于麻醉诱导和苏醒。我们研究了 30 次麻醉诱导、维持和苏醒期间的分心情况。苏醒期间的平均（标准差）噪声（58.3（6.2）dB）高于诱导期间（46.4（4.3）dB）和维持期间（52（4.5）dB；p<0.001）。突然的大声噪音，大于 70dB，在苏醒期间（发生 34 次）比在诱导期间（发生 9 次）或维持期间（发生 13 次）更频繁发生。工作人员进出的中位数（IQR [范围]）分别为诱导期 0（0-2 [0-7]）、维持期 6（3-10 [1-18]）和苏醒期 10（5-12 [1-20]）（p<0.001）。在 30 次苏醒中有 28/30（93%）次发生了与程序无关的对话。这些数据表明，与麻醉的其他阶段相比，苏醒期间的分心程度更高。识别和最小化分心应该会提高患者的安全性。将航空业的无菌驾驶舱规则应用于我们的临床实践可能是一个有用的补充。
