Anaesthesia
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Randomized Controlled Trial Clinical Trial
Comparison of caudal block using bupivacaine and ketamine with ilioinguinal nerve block for orchidopexy in children.
Forty boys weighing less than 25 kg undergoing unilateral orchidopexy were randomly allocated to receive one of two analgesic regimens. Group C received a caudal epidural block with 0.25% bupivacaine 1 ml.kg-1 and preservative-free ketamine 0.5 mg.kg-1; Group L received an ilioinguinal nerve block with 0.25% bupivacaine 0.5 ml.kg-1 and infiltration of the wound with 0.25% bupivacaine 0.5 ml.kg-1. All subjects received diclofenac sodium 1-2 mg.kg-1 as a rectal suppository. ⋯ The median duration of analgesia was 10 h (range 2.6 to > 24 h) in Group C and 2.9 h (range 0.7 to > 24 h) in Group L (p < 0.05). There were no differences between groups in the incidence of motor block, urinary retention, postoperative vomiting or postoperative sedation. Subjects in Group L required significantly more doses of postoperative analgesia than those in Group C (p < 0.05).
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We audited and analysed the adverse effects and safety of postoperative pain management on 2509 consecutive patients under care of the Acute Pain Service at a tertiary referral teaching hospital over a 32-month period. Our standard respiratory monitoring consisted of continuous pulse oximetry, hourly respiratory rate counting, sedation scoring and intermittent arterial blood gas sampling. This protocol was reliable and detected six episodes of bradypnoea, 13 of hypercapnia and 23 of oxygen desaturation occurring in 39 patients (1.8% of all spontaneously breathing patients). ⋯ Postoperative nausea and vomiting decreased analgesic efficacy by discouraging the use of patient-controlled analgesia and was regarded as equally distressing as pain. Other side-effects included: pruritus in 182 patients; dizziness in 333 and lower limb weakness in 73 (21.2% of patients receiving epidural local anaesthetics). It is concluded that a standard monitoring and management protocol, an experienced nursing team and reliable Acute Pain Service coverage is mandatory for the safe use of modern analgesic techniques.
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Working on an intensive care unit is perceived as stressful. This study investigated occupational stress in staff working on an intensive care unit using the occupational stress indicator. Questionnaires were given to all intensive care staff; the replies were then analysed and compared with normative data. ⋯ Their coping strategies differ but the only significantly different measure of adverse outcome was related to personal relationships at work. The job itself was not found to be a significant source of stress. Nursing staff have different sources of stress from medical staff and individuals with partners or children are relatively protected from stress.
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We sought to determine whether the forced air convection warmers (nine Bair Huggers, Augustine Medical, and one Warm Touch, Mallinkrodt Medical) used in our operating theatres could be a source of microbial pathogens. Agar plates were placed directly in the air stream of the warmers. Four of these grew potentially pathogenic organisms. ⋯ We conclude that these warming devices are a potential source of nosocomial infection. They should only be used in conjunction with perforated blankets, should have their microbial filters changed regularly and their hoses sterilised. The inclusion of a microbial filter into the nozzle of the hose could be incorporated into the design of the warmer.
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We studied the effects of hypothermia and cardiopulmonary bypass (CPB) on four depth of anaesthesia monitors; spectral edge frequency (SEF), median frequency (MF), bispectral index (BIS) and auditory evoked potential index (AEPIndex) in 12 patients during uneventful cardiac anaesthesia. Each variable was recorded simultaneously at 10 periods during anaesthesia. All four variables were not affected by the transition to CPB. ⋯ The variability decreased during rewarming. The values of AEPIndex throughout the anaesthesia never overlapped with those before induction of anaesthesia. The AEPIndex was the most stable and reliable as a depth of anaesthesia monitor among the four variables in cardiac bypass surgery.