Annals of the Royal College of Surgeons of England
-
The work of surgical departments involves varying proportions of investigation, diagnosis and treatment and the object of audit is to measure and monitor the outcome of this activity. It also serves as a secondary but important role in education, research and resource planning. The different methods of audit described in this symposium gave varying contributions to the definition of workload and outcome and to the education of the surgical staff. ⋯ The determination fo longer term response to surgical treatment in terms of graft patency,tumour recurrence and patient survival is not possible by any of the methods currently described. It is an undertaking of great importance and proportions and clearly has a bearing on clinical practice. Short term clinical audit will therefore be only one part of the evaluation of surgical care.
-
Ann R Coll Surg Engl · Sep 1989
Randomized Controlled Trial Clinical TrialIntrathecal diamorphine: a dose-response study.
A randomised double-blind study compared the dose-response relationship of intrathecal diamorphine (0, 0.25, 0.75, 1.5, and 2.5 mg) for postoperative pain relief, in 35 subjects who underwent total knee replacement surgery. Assessments commenced 2 h after the opioid injection and continued for 20 h. Pain, analgesic effect, supplementary analgesic requirements and adverse effects were noted. ⋯ Intrathecal diamorphine was safe and was not associated with clinically apparent respiratory depression. Its effects were inconsistent and its use was associated with irritating side effects. Possible explanations for the erratic behaviour of the diamorphine are discussed.
-
A 3-month prospective study of the workload of a surgical unit in a district general hospital was performed to identify the relationship between outpatient work, admissions to hospital, and scheduled operating lists. We have shown that under 60% of all new cases seen in the outpatient clinic had admissions arranged after initial consultation. Over two-thirds of inpatient admissions were for emergencies or urgent cases, and thus not able to be controlled by the surgical team. ⋯ One third of the total number of cases on scheduled lists were emergency or urgent cases (taking up approximately 50% of the operating time). Of all admissions, 32% were as day cases. Of all routine operations, 35% were performed at a community hospital taking only 18% of all our admissions.
-
Ann R Coll Surg Engl · Jul 1989
Randomized Controlled Trial Clinical TrialCaudal anaesthesia for postoperative pain relief in children: a comparative trial of different regimens using plain bupivacaine.
A comparative trial between three different dosage regimens of bupivacaine administered by the caudal route, used for the prevention of postoperative pain in children undergoing elective inguinal herniotomy or ligation of patient processus vaginalis was undertaken. The regimens compared were bupivacaine 0.25% (1 ml/kg), bupivacaine 0.25% or 0.5%: (Age (years +2)/10 ml per dermatome to be blocked. ⋯ Time to onset of analgesia, as indicated by changes in intraoperative heart rate in response to surgical stimulation were also similar in all groups. No evidence of postoperative motor weakness or disturbance of bladder function was found and there were no symptoms or signs attributable to local anaesthetic toxicity.