Anesthesiology
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It is a common practice for anesthesia to substitute for one another, especially for short breaks during long surgical procedures. The assets and liabilities of this practice of relief have not been examined previously. In the course of gathering 1,089 reports of preventable errors and failures associated with anesthesia management, we identified 96 which involved a relief anesthetist. ⋯ Although 70 of the 1,089 incidents were associated with substantive negative outcomes, e.g., death, cardiac arrest, or extended ICU stay, none of those incidents was caused by a relieving anesthetist. There is a strong implication that relief is beneficial more often than not even aside from the presumed beneficial effect on the vigilance of the primary anesthetist (the latter effect was outside the scope of this study). From the descriptions of the causes and discoveries of errors in these relief-related incidents, guidance can be drawn for the safe and effective conduct of the intraoperative exchange of anesthesia personnel.
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Different doses of epidural morphine were studied in order to determine their effectiveness in providing postoperative pain relief after surgery of the lower extremities and their relationship to the incidence of untoward reactions. The study was carried out in a double-blind fashion using five dosages of epidural morphine (0.5, 1.0, 2.0, 4.0, and 8.0 mg) and included 60 patients. The higher doses of morphine (2.0, 4.0, and 8.0 mg) were equally effective and more effective than the lower doses (0.5 and 1.0 mg) in providing postoperative analgesia. ⋯ No statistically significant difference was found between the doses studied with regard to itching, urinary retention, and respiratory depression; the latter was evaluated in a subgroup of 20 patients. These data suggest that effective postoperative pain relief after surgery of the lower extremities can be achieved with relatively low doses of morphine sulfate and with minimal side effects. For the type of surgery studied, 2 mg morphine sulfate appeared to be the optimum dose.