British journal of anaesthesia
-
Randomized Controlled Trial Clinical Trial
Optimal concentration of epidural fentanyl in bupivacaine 0.1% after thoracotomy.
The aim of this prospective, double-blind, randomized controlled trial was to investigate the analgesic and adverse effects of three commonly used concentrations of thoracic epidural fentanyl with bupivacaine in patients undergoing thoracotomy for lung resection. ⋯ We conclude that thoracic epidural fentanyl 5 microg ml(-1) with bupivacaine 0.1% provides the optimum balance between pain relief and side effects following thoracotomy.
-
Optimal treatment for acute pain is a function of an individual's willingness to make trade-offs between treatment side effects and pain control. The objective was to investigate the degree to which patients are willing to make these trade-offs. ⋯ We conclude that people have different relative preferences for different side effects and are willing to trade-off pain relief for less upsetting and/or less severe side effects but to different degrees. Thus, physicians should consider offering pain medications with fewer side effects than narcotics as a first choice. Our study indicates the need to balance analgesia and side effects in order for patients to achieve optimal pain control.
-
Multicenter Study
Rhetoric and reality on acute pain services in the UK: a national postal questionnaire survey.
The study aimed to explore the extent to which NHS acute pain services (APSs) have been established in accordance with national guidance, and to assess the degree to which clinicians in acute pain management believe that these services are fulfilling their role. ⋯ More than a decade since the 1990 report Pain after Surgery, national coverage of comprehensive acute pain services is still far from being achieved. Despite wide consensus about the problems, concrete solutions are proving hard to implement. There is strong support for a two-fold response: securing greater political commitment to pain services and using organizational approaches to address current deficits.
-
Children frequently suffer transient cerebral ischaemia during cardiac surgery. We measured cerebral ischaemia in children during cardiac surgery by combining two methods of monitoring. ⋯ Children less than 4 yr of age are more likely to have cerebral ischaemia caused by hypotension during cardiac surgery. Ineffective cerebral autoregulation and haemodilution during CPB may be responsible.
-
Ventilation in the prone position is used in patients with acute respiratory distress syndrome (ARDS), although data supporting this strategy are limited, and benefit for patients with other conditions is unclear. The patient in this report had severe hypoxaemia from diffuse alveolar haemorrhage caused by vasculitis with positive antineutrophil cytoplasmic antibodies (ANCA). Ventilation in the prone position improved oxygenation dramatically. ⋯ Prone ventilation was used on three consecutive days for 10, 14 and 15 h, respectively. Prone ventilation could improve oxygenation by better ventilation-perfusion (V/Q) matching and improved drainage of blood from the dorsal lung. The improved oxygenation in this patient should encourage the use of prone ventilation in other patients with pulmonary haemorrhage and severe hypoxia.