Anaesthesia
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Observational Study
The impact of emergency department patient-controlled analgesia (PCA) on the incidence of chronic pain following trauma and non-traumatic abdominal pain.
The effect of patient-controlled analgesia during the emergency phase of care on the prevalence of persistent pain is unkown. We studied individuals with traumatic injuries or abdominal pain 6 months after hospital admission via the emergency department using an opportunistic observational study design. This was conducted using postal questionnaires that were sent to participants recruited to the multi-centre pain solutions in the emergency setting study. ⋯ Persistent pain is common 6 months after hospital admission, particularly following trauma. The study findings suggest that it may be possible to reduce persistent pain (at least in patients with abdominal pain) by delivering better acute pain management. Further research is needed to confirm this hypothesis.
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Peri-operative hyperglycaemia, whether the cause is known diabetes, undiagnosed diabetes or stress hyperglycaemia, is a risk factor for harm, increased length of stay and death. There is increasing evidence that peri-operative hyperglycaemia is a modifiable risk factor, and many of the interventions required to improve the outcome of surgery must be instituted before the actual surgical admission. These interventions depend on communication and collaboration within the multidisciplinary team along each stage of the patient journey to ensure that integration of care occurs across the whole of the patient-centred care pathway.
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Several studies have investigated the effects of general anaesthesia on neurodevelopment in children, with conflicting results. The potential for early general anaesthesia exposure to impact neurodevelopment in children may cause significant concern for parents. Administering a questionnaire in 200 parents, we aimed to explore their knowledge, concerns and perceptions, and determine factors which influence parents' willingness for their children to participate in relevant research studies. ⋯ Parents with children aged 2 years or younger, those whose children had previous general anaesthesia exposure, and those who had encountered information about potential neurodevelopmental effects were most likely to be concerned. The majority of parents (68%) would agree to participate in research studies, especially if they were able to receive the test results. Anaesthetists should pre-emptively initiate discussions to address any potential misconceptions regarding the effects of general anaesthesia on neurodevelopment in children.
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There are approximately 8.5 million Jehovah's Witnesses and around 150,000 live in Great Britain and Ireland. Based on their beliefs and core values, Jehovah's Witnesses refuse blood component transfusion (including red cells, plasma and platelets). They regard non-consensual transfusion as a physical violation. ⋯ After discussion, a plan should then be made that is acceptable to the patient and appropriate consent obtained. When agreement cannot be reached between the doctor and the patient, referral for a second opinion should be considered. When the patient is a child, the same strategy should be used but on occasion the clinical team may have to obtain legal help.