Anaesthesia
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The Department of Anaesthesia and Intensive Care at the Chinese University of Hong Kong provides a 4 week course in our specialty for final year medical students. Our curriculum covers basic concepts in anaesthesia and intensive care, management of common medical emergencies and the safe performance of basic practical skills. ⋯ We believe that our adaptation of the Objective Structural Clinical Examination is better than traditional methods of examination and it has allowed us to identify deficiencies in our teaching methods. The Objective Structured Clinical Examination has been well received by our students and is perceived by them to be a fair reflection of their level of knowledge and skill attainment during the course.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia with transdermal fentanyl following lower abdominal surgery.
In a randomised, placebo-controlled, double-blind study involving 81 patients undergoing total abdominal hysterectomy, the postoperative analgesia provided by transdermal fentanyl given at 25, 50, or 75 micrograms.h-1 for 72 h was compared with a placebo group. The efficacy of the Transdermal Therapeutic System was related to the rate of fentanyl delivery, higher rates being associated with significantly lower visual analogue pain scores (24, 20, 17 and 13, for placebo, 25, 50 and 75 micrograms.h-1 respectively) and reduced patient controlled analgesia morphine requirements (44, 38, 33 and 31 mg respectively). Patients' overall sedation scores were not increased by transdermal fentanyl, but respiratory rates decreased with higher transdermal fentanyl dosage.
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Randomized Controlled Trial Clinical Trial
Analgesia after caesarean section. The use of rectal diclofenac as an adjunct to spinal morphine.
A double-blind placebo-controlled study was performed to assess the analgesic effect of rectal sodium diclofenac 100 mg after Caesarean section using subarachnoid hyperbaric bupivacaine 0.5% and morphine 0.2 mg. During the 48 h follow-up period, both placebo and diclofenac groups had comparable analgesia as measured by visual analogue scores (VAS) at rest and on movement. However, diclofenac prolonged the mean time to first analgesia by more than 5 h from 13 h 45 min in the placebo group to 18 h 58 min (p < 0.03). The incidence of side effects (nausea, vomiting, itching, excessive lochia loss and the need for additional analgesia) were comparable in each group.
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Randomized Controlled Trial Comparative Study Clinical Trial
Maternal position during induction of spinal anaesthesia for caesarean section. A comparison of right lateral and sitting positions.
Forty women presenting for elective Caesarean section under spinal anaesthesia were randomly assigned to have anaesthesia induced in either the sitting or right lateral positions; 2.5 ml 0.5% hyperbaric bupivacaine was injected over 10 s before the mother was placed in a supine position with a 20 degree lateral tilt. The onset time and height of the subsequent analgesic and anaesthetic block was measured. ⋯ There was no difference in maximum block height or degree of motor block. Mothers in the lateral group required more ephedrine in the first 10 m after siting the spinal (13.5 vs 10.5 mg, p < 0.05).
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We have designed an automatic detector system for noninvasive monitoring of irrigating fluid absorption during transurethral resection of the prostate. Ethanol, which is used as a tracer for the fluid, is measured in the expired breath of the patient. The breath ethanol monitor can be used both in the awake patient and during general anaesthesia. ⋯ The monitor has been used in routine operations for one year. The interpretation of absorption routes was checked by control methods or by evaluation of the postoperative breath-ethanol curve. We found the indicated absorption to be correct in all resections with absorption large enough for the monitor to present an interpretation.