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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The effect of intrathecally administered magnesium sulphate on serum levels of magnesium, sodium, potassium, calcium and blood gas variables was studied in a rat model. Magnesium sulphate given intrathecally has previously been shown to produce segmental spinal blockade with no permanent neurological damage. The previous studies, however, had not investigated the possible systemic effects of the magnesium sulphate. ⋯ In all cases, the serum magnesium had returned to normal by 24 h. There were no significant changes in calcium, sodium or potassium levels, nor in arterial blood gas variables. These results show that intrathecally administered magnesium sulphate has little effect on electrolyte homeostasis.
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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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Letter Case Reports
Inadvertent dural tap related to problems with a loss of resistance device.