British journal of anaesthesia
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Randomized Controlled Trial
Rectal acetaminophen does not reduce morphine consumption after major surgery in young infants.
The safety and value of acetaminophen (paracetamol) in addition to continuous morphine infusion has never been studied in newborns and young infants. We investigated the addition of acetaminophen to evaluate whether it decreased morphine consumption in this age group after major thoracic (non-cardiac) or abdominal surgery. ⋯ Acetaminophen, as an adjuvant to continuous morphine infusion, does not have an additional analgesic effect and should not be considered as standard of care in young infants, 0-2 months of age, after major thoracic (non-cardiac) or abdominal surgery.
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Randomized Controlled Trial
The coiling length of thoracic epidural catheters: the influence of epidural approach angle.
Thoracic epidural catheters are used for anaesthesia and postoperative analgesia. Usually, epidural catheters are placed without confirmation of their position despite frequent reports of complications as a result of malposition. In this study, we evaluated the threading length of thoracic epidural catheters without coiling and assessed the influence of two different epidural approach angles on the threading length without coiling. ⋯ Approaching the thoracic epidural space with an obtuse approach angle provides longer coiling length. We recommend that an obtuse approach angle should be used to maximize the chance of the catheter reaching the intended level with minimum risk of coiling.
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Randomized Controlled Trial
Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block.
When the level achieved by a spinal anaesthetic is too low to perform surgery, patients are usually placed in the Trendelenburg position. However, cephalad spread of the hyperbaric spinal anaesthetics may be limited by the lumbar lordosis. The Trendelenburg position with the lumbar lordosis flattened by hip flexion was evaluated as a method to extend the analgesic level after the administration of hyperbaric local anaesthetic. ⋯ When the level of spinal anaesthesia is lower than required, flexion of the hips in the Trendelenburg position may be useful as a strategy attempt to increase the level of the block.
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Patient safety research has shown poor communication among intensive care unit (ICU) nurses and doctors to be a common causal factor underlying critical incidents in intensive care. This study examines whether ICU doctors and nurses have a shared perception of interdisciplinary communication in the UK ICU. ⋯ Members of ICU teams have divergent perceptions of their communication with one another. Communication openness among team members is also associated with the degree to which they understand patient care goals. It is necessary to create an atmosphere where team members feel they can communicate openly without fear of reprisal or embarrassment.
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Comparative Study
Comparative effect of thermal, mechanical, and electrical noxious stimuli on the electroencephalogram of the rat.
Thermal, mechanical, and electrical stimuli are often used in acute pain studies and cause qualitatively different pain sensations. Yet, the comparative electroencephalogram (EEG) changes caused by these stimuli have not been studied. We hypothesized that because these stimuli cause different pain sensations, EEG responses would also differ. ⋯ Different noxious stimuli caused differing EEG changes. As the somatosensory cortex contains relatively few exclusively nociceptive neurons, the EEG recorded from this region during the application of predominantly noxious stimuli (mechanical and thermal) may demonstrate minimal cortical activation compared with non-specific electrical noxious stimuli.