British journal of anaesthesia
-
Patient satisfaction after anaesthesia is an important outcome of hospital care. We analysed our anaesthetic database to identify potentially modifiable factors associated with dissatisfaction. At the time of analysis, our database contained information on 10,811 in-patients interviewed on the first day after operation. ⋯ The overall level of satisfaction was high (96.8%); 246 (2.3%) patients were 'somewhat dissatisfied' and 97 (0.9%) were 'dissatisfied' with their anaesthetic care. After adjustment for patient and surgical factors, there was a strong relation between patient dissatisfaction and: (i) intraoperative awareness (odds ratio (OR) 54.9, 95% confidence intervals (CI) 15.7-191); (ii) moderate or severe postoperative pain (OR 3.94, 95% CI 3.16-4.91); (iii) severe nausea and vomiting (OR 4.09, 95% CI 3.18-5.25); and (iv) any other postoperative complications (OR 2.04, 95% CI 1.61-2.56). Several factors associated with dissatisfaction may be preventable or better treated.
-
Meta Analysis
Single-dose ketorolac and pethidine in acute postoperative pain: systematic review with meta-analysis.
For a systematic review of postoperative analgesic efficacy and adverse effects of single doses, injected or oral, of pethidine and ketorolac compared with placebo, we sought published randomized studies in moderate to severe postoperative pain. Information on summed pain intensity or pain relief outcomes over 4-6 h was extracted and converted to dichotomous information to produce the number of patients with at least 50% pain relief. This was used to calculate the relative benefit and number-needed-to-treat (NNT) for one patient to achieve at least 50% pain relief. ⋯ Most oral information was available for the 10 mg dose, which had an NNT of 2.6 (2.3-3.1). Oral ketorolac 10 mg was consistently at least as effective as ketorolac 30 mg i.m. Only with oral ketorolac 10 mg were there significantly more adverse effects than with placebo, with an NNH for any adverse effect of 7.3 (4.7-17).
-
Randomized Controlled Trial Clinical Trial
Wound infiltration with bupivacaine after surgery to the cervical spine using a posterior approach.
We have compared pain scores, morphine consumption and duration of stay for 50 adults who underwent elective cervical spine surgery via a posterior incision in a prospective, double-blind, placebo-controlled, randomized study. During wound closure, the paravertebral muscles and subcutaneous tissues were infiltrated with 40 ml of saline (control) or 0.25% bupivacaine. There were no significant differences in pain scores, morphine consumption or duration of stay between groups. In view of the potential risks of wound infiltration in the cervical region, we consider that this practice should be abandoned.
-
A patient experienced a severe vasovagal attack during regional anaesthesia for elective Caesarean section. The combination of vagal over-activity and sympathetic block produced profound hypotension that threatened the life of the mother and infant. The vasovagal syndrome is described, and its prevention and management discussed.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of different doses of remifentanil on the cardiovascular response to laryngoscopy and tracheal intubation.
We have compared three bolus and infusion regimens of remifentanil on the cardiovascular response to laryngoscopy and orotracheal intubation in three groups of 20 ASA I-II female patients, in a randomized, double-blind study. Patients in group 1 received glycopyrolate 200 micrograms i.v. followed by a bolus dose of remifentanil 1 microgram kg-1 over 30 s and an infusion of remifentanil at a rate of 0.5 microgram kg-1 min-1. The other patients received remifentanil 0.5 microgram kg-1 over 30 s and an infusion of 0.25 microgram kg-1 min-1 with (group 2) or without (group 3) pretreatment with glycopyrrolate 200 micrograms. ⋯ Baseline heart rate was similar in all groups, but decreased in group 3 (no glycopyrrolate) after induction and remained significantly lower after intubation compared with the other groups (P < 0.05). Heart rate and arterial pressure increased slightly after intubation in each group but there were no significant differences in mean arterial pressure between groups at any time. The incidence of bradycardia (one patient in group 2) and hypotension (two patients in groups 1 and 2 and three patients in group 3) was low.