European journal of anaesthesiology
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All the anaesthetic machines in one District General Hospital were tested for faults on three occasions for both audit and re-audit using an extended checklist based on that devised by the Association of Anaesthetists of Great Britain and Ireland. Ninety completed checklists were analysed for the audit and 24 tests revealed 236 individual faults (range 1.1-64%). ⋯ Following introduction of COVERS (a pre-use checklist) re-audit of 102 completed checklists showed 20 tests revealing faults on 59 occasions (range 1.0-11.6%), 16 (27%) day to day and 43 (73%) non-recurring. COVERS supported by scheduled regular comprehensive checking delegated to another time and performer is recommended as the mandatory pre-use checklist.
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Randomized Controlled Trial Comparative Study Clinical Trial
Regional anaesthesia for circumcision. Subcutaneous ring block of the penis and subpubic penile block compared.
In this prospective study techniques for the subcutaneous ring block of the penis and subpubic block of the penis for analgesia after circumcision were compared. Forty-five boys having circumcision as day-case patients were allocated randomly to have either a subcutaneous ring block or a subpubic penile block. The blocks were inserted after induction of anaesthesia but before surgery. ⋯ Four of the 24 boys who had subpubic penile blocks and nine of the 16 boys who had subcutaneous ring blocks were given morphine for post-operative pain (P = 0.015). The surgeons complained about oedematous tissues in three patients, all of whom had had subcutaneous ring blocks. The subpubic penile block provided significantly better analgesia than the subcutaneous ring block of the penis.
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Randomized Controlled Trial Clinical Trial
Dose-response and concentration-response relation of rocuronium infusion during propofol-nitrous oxide and isoflurane-nitrous oxide anaesthesia.
The dose-response and concentration-response relation of rocuronium infusion was studied in 20 adult surgical patients during propofol-nitrous oxide and isoflurane (1 MAC)-nitrous oxide anaesthesia. Neuromuscular block was kept constant, initially at 90% and then at 50% with a closed-loop feedback controller. At 90% block the steady-state infusion of rocuronium was 0.55 +/- 0.16 mg kg-1 h-1 and the corresponding concentration 1714 +/- 281 ng mL-1 in patients receiving propofol. ⋯ At 50% block isoflurane reduced the rate of infusion by 52% (P < 0.005) and the concentration by 59% (P < 0.001); at 90% block both the mean infusion rate and the concentration of rocuronium were reduced by 35% (P < 0.005). The mean rocuronium clearance at 50% block was unaffected by the type of anaesthesia; it was 4.1 +/- 1.6 and 4.9 +/- 2.7 mL kg-1 min-1 in the groups receiving propofol and isoflurane anaesthesia, respectively. We conclude that isoflurane reduces the infusion requirements of rocuronium by changing the pharmacodynamic behaviour.