[Is training on basic skills and management of critical events responsible of ethical considerations in anaesthesia and intensive care?].
OBJECTIVE
To provide information on morbidity and ethical questions associated with learning of invasive techniques (tracheal intubation, positioning of central venous or epidural catheters) and management of anaphylactic shock.


METHODS
Retrospective survey.


METHODS
Written questionnaire to 54 anaesthesiologists and 55 residents.


RESULTS
Training was primarily performed by residents having a 6 months-experience for general anaesthesia and by more experienced residents for epidural analgesia. Residents observed first two or three procedures performed by seniors, but did not have theoretical lectures in 30 to 50% of cases. Dead bodies or manikins were rarely used. Despite the presence of experienced anaesthesiologists during the first attempts, there was a high morbidity rate which was considered by 22 to 37% of the interviewed anaesthesiologists a loss of benefit for the patients. Despite a high level of coaching, a high morbidity rate was associated with the first attempts. However, only few residents explicitly stated to be concerned by ethical questions. Among anaesthesiologists, who had yet to manage anaphylactic shock, 21 and 35% of them reported that diagnostic and treatment could have been performed faster. Virtual learning was misunderstood but 46% of anaesthesiologist described numerous advantages in using simulator of anaesthesia.


CONCLUSIONS
Despite an apparent morbidity with a loss of benefit, informed consent of the patients were rarely obtained.
Lejus
C
C
Service d'anesthésie-réanimation chirurgicale, hôpital Mère-Enfant-Hôtel-Dieu, CHU de Nantes, 44093 France. corinne.lejus@chu-nantes.fr
Maugars
Y
Y
Barrier
J-H
JH
Blanloeil
Y
Y
Pinaud
M
M
D000707:Anaphylaxis / Q000628:therapy; D000758:Anesthesia / Q000009:adverse effects; D000767:Anesthesia, Epidural; D000776:Anesthesiology / Q000193:education* / Q000941:ethics*; D001296:Audiovisual Aids; D002102:Cadaver; D002405:Catheterization, Central Venous; D002983:Clinical Competence; D003422:Critical Care; D003479:Curriculum; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal; D008348:Manikins; D012189:Retrospective Studies; D011795:Surveys and Questionnaires