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PubMed1998

Caudal anaesthesia with 0.375% ropivacaine or 0.375% bupivacaine in paediatric patients.

We have determined the effectiveness and degree of motor block produced by the new local anaesthetic, ropivacaine, when used for caudal anaesthesia in children. We studied 60 children, aged 3-6 yr, ASA I, allocated randomly in a double-blind manner, to receive one of two local anaesthetics: 0.375% ropivacaine 1.0 ml kg-1 or 0.375% bupivacaine 1.0 ml kg-1. Patients were anaesthetized with continuous infusion of propofol 200 micrograms kg-1 min-1. The lungs were ventilated with 50% nitrous oxide in oxygen. Heart rate and arterial pressure were measured every 5 min after administration of local anaesthetic until discharge from the recovery room. The extent of motor block in the recovery room was scored as 1-3. Adverse events and time to first analgesic requirements were recorded. Patients in the two groups did not differ in age, weight or height. There were no differences in heart rate or arterial pressure between the two groups. No adverse events were observed. The degree of motor block was significantly different between the two groups. The ropivacaine group showed a shorter duration of motor block than the bupivacaine group (P < 0.05). Postoperative analgesia was required at a mean time of 5 (SD 3.2) h in the ropivacaine group compared with 5 (2.8) h in the bupivacaine group. These findings suggest that caudal anaesthesia with ropivacaine in paediatric patients is effective and produces less motor block in the postoperative period.

Amides↗
PubMed1999

[Transfusion needs during intraoperative and immediate postoperative periods in arthroplasty of the hip and knee].

OBJECTIVES: To determine the factors associated with immediate perioperative transfusion requirements of hip or knee arthroplasty patients who have not been enrolled in a blood salvage program. PATIENTS AND METHODS: This prospective study collected demographic (age, sex, weight, height, etc.), physiological (hemoglobin levels, coagulation times, preoperative platelet counts, etc.), clinical history and anesthetic and surgical data (type of anesthesia, surgical diagnosis, duration of procedure) in 112 patients undergoing orthopedic surgery: 19 cases of primary knee arthroplasty, 77 cases of hip arthroplasty and 16 replacements of hip arthroplasty. Logistic regression analysis of the aforementioned variables was performed to search for factors related to transfusional needs during and after hip arthroplasty or after knee arthroplasty, which was performed with a tourniquet applied to render intraoperative transfusion unnecessary. RESULTS: The variables that increased the risk of transfusion during surgery were duration of procedure exceeding 120 min (OR 15.24; p = 0.01) and loss of over 500 ml of blood during surgery (OR 11.4; p = 0.02). The variables associated with perioperative transfusion were loss of over 500 ml in the postanesthetic recovery room (OR 12.6; p < 0.0001), hypotensive episodes during recovery (OR 11.7; p = 0.0001), prosthetic replacement (OR 6.33; p = 0.005), height < 160 cm (OR 5.03; p = 0.02), preoperative hemoglobin level < 13.5 g/dl (OR 4.97; p = 0.02), and surgery for reasons other than osteoarthritis (arthritis, pathological fractures, etc.) (OR 4.60; p = 0.04). Variables associated with transfusion of over two units of packed red cells were a history of neoplastic disease unrelated to arthroplasty (OR 378.67; p = 0.005), prosthetic replacement (OR 49.71; p = 0.009), diabetes (OR 36.49; p = 0.02) and a hypotensive event while in the postanesthetic recovery room (OR 29.12; p = 0.02). CONCLUSION: These results suggest that certain modifiable factors increase the risk of blood transfusion in knee and hip arthroplasty. Specifically, they are duration of surgery, intra- and postoperative bleeding, preoperative hemoglobin level and instances of perioperative hypotension. Other factors outside our control are height or patient clinical history.

Aged↗
PubMed1995

Selective use of the intensive care unit following carotid endarterectomy.

The purpose of this study was to develop criteria by which selected patients can be observed solely on the ward following carotid endarterectomy (CEA). One hundred consecutive CEA patients were retrospectively reviewed. Preoperative medical conditions were identified, and the postanesthesia recovery room course was reviewed in an attempt to predict the need for intensive care unit (ICU) level care. Forty-four of our 100 patients developed perioperative complications or conditions that required some intervention. Conditions included hypertension in 23, hypotension in nine, arrhythmias in six, and myocardial ischemia in two. Complications included nonfatal cerebrovascular accident (CVA) in one, fatal CVA in one, and postoperative bleeding in two. Sixteen patients required ICU level intervention (hypertension in five, hypotension in five, arrhythmias in two, nonfatal CVA in one, fatal CVA in one, and postoperative bleeding in two. Fifteen of the 16 were identified in the recovery room. Fifty-three patients had a medical history of significant hypertension (42), cardiac disease (27), and/or recent CVA (seven). Thirty-six (68%) of these patients required perioperative intervention in some form; 12 (23%) required ICU level therapy. Eight of 47 (17%) patients without a significant medical history required intervention; only four (9%) required ICU level care. All eight patients were identified in recovery. Only 16 of 100 CEA patients required ICU level care. Fifteen of 16 were identified in recovery. Certain patients identified in the recovery room can be followed safely in a less intense and costly setting.

Adult↗
PubMed1995

Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis.

BACKGROUND: Controversy exists as to the risk for postoperative apnea in former preterm infants. The conclusions of published studies are limited by the small number of patients. METHODS: The original data from eight prospective studies were subject to a combined analysis. Only patients having inguinal herniorrhaphy under general anesthesia were included; patients receiving caffeine, regional anesthesia, or undergoing other surgical procedures were excluded. A uniform definition for apnea was used for all patients. Eleven risk factors were examined: gestational age, postconceptual age, birth weight, history of respiratory distress syndrome, bronchopulmonary dysplasia, neonatal apnea, necrotizing enterocolitis, ongoing apnea, anemia, and use of opioids or nondepolarizing muscle relaxants. RESULTS: Two hundred fifty-five of 384 patients from eight studies at four institutions fulfilled study criteria. There was significant variation in apnea rates and the location of apnea (recovery room and postrecovery room) between institutions (P < 0.001). There was considerable variation in the duration and type of monitoring, definitions of apnea, and availability of historical information. The incidence of detected apnea was greater when continuous recording devices were used compared to standard impedance pneumography with alarms or nursing observations. Despite these limitations, it was determined that: (1) apnea was strongly and inversely related to both gestational age (P = 0.0005) and postconceptual age (P < 0.0001); (2) an associated risk factor was continuing apnea at home; (3) small-for-gestational-age infants seemed to be somewhat protected from apnea compared to appropriate- and large-for-gestational-age infants; (4) anemia was a significant risk factor, particularly for patients > 43 weeks' postconceptual age; (5) a relationship to apnea with history of necrotizing enterocolitis, neonatal apnea, respiratory distress syndrome, bronchopulmonary dysplasia, or operative use of opioids and/or muscle relaxants could not be demonstrated. CONCLUSIONS: The analysis suggests that, if it is assumed that the statistical models used are equally valid over the full range of ages considered and that the average rate of apnea reported across the studies analyzed is accurate and representative of actual rates in all institutions, the probability of apnea in nonanemic infants free of recovery-room apnea is not less than 5%, with 95% statistical confidence until postconceptual age was 48 weeks with gestational age 35 weeks. This risk is not less than 1%, with 95% statistical confidence, for that same subset of infants, until postconceptual age was 56 weeks with gestational age 32 weeks or postconceptual age was 54 weeks and gestational age 35 weeks. Older infants with apnea in the recovery room or anemia also should be admitted and monitored. The data do not allow prediction with confidence up to what age this precaution should continue to be taken for infants with anemia. The data were insufficient to allow recommendations regarding how long infants should be observed in recovery. There is additional uncertainty in the results due to the dramatically different rates of detected apnea in different institutions, which appear to be related to the use of different monitoring devices. Given the limitations of this combined analysis, each physician and institution must decide what is an acceptable risk for postoperative apnea.

Aging↗
PubMed1993

Preoperative intensive care unit consultations: accurate and effective.

OBJECTIVES: To determine if a structured preoperative ICU consultation would correctly assign patients to preoperative invasive monitoring, postoperative ICU care, or recovery room care, and to compare morbidity, mortality, and resource utilization among all groups. DESIGN: Prospective, observational study. SETTING: A university hospital. PATIENTS: A total of 475 patients who were referred preoperatively by surgeons for ICU consultation and were evaluated by ICU physicians. INTERVENTIONS: Patients assessed to have clinical evidence of cardiovascular compromise were admitted preoperatively to the ICU for invasive hemodynamic monitoring and optimization. Patients without such evidence, but who were to undergo major operations or had anticipated major fluid replacement were independently selected for invasive monitoring by anesthesiologists. Patients who developed physiologic instability or became unstable due to hemorrhage also underwent invasive monitoring. Nonmonitored patients who remained stable were given postoperative ICU care or went to the recovery room based on an assessment by the surgeon and anesthesiologist at the end of the operation. MEASUREMENTS AND MAIN RESULTS: Of 8,916 elective surgical cases, ICU physicians were consulted in 475 (5.3%) patients preoperatively. Sixty-seven patients were admitted preoperatively to the ICU for invasive hemodynamic monitoring and optimization; 60 patients had surgery (0.7% of elective cases, 12.6% of ICU consultations). Patients selected for ICU preoperative monitoring were older than non-monitored patients and had higher numbers of cardiovascular and total risk factors than any other group. They had higher Acute Physiology and Chronic Health Evaluation (APACHE II) scores, higher Therapeutic Intervention Scoring System (TISS) points, a higher number of complications, and longer ICU stays than non-monitored postoperative ICU patients. In addition, they had a higher number of complications than nonmonitored recovery room patients. APACHE II scores, TISS points, number of complications, and ICU days in the preoperative ICU admission group were not increased when compared with all other monitored patients. Neither hospital days nor total hospital charges were increased when compared with the other elective ICU patients. Patients selected for ICU preoperative monitoring who underwent surgery had an 11.7% mortality rate and accounted for four of five cardiovascular-related deaths. CONCLUSIONS: A small number of high-risk patients can be selected for preoperative monitoring on the basis of clinical assessment without increasing ICU stay or hospital bills. A structured preoperative consultation correctly identifies those patients who need monitoring and ICU care, but does not overutilize scarce and expensive ICU beds.

Aged↗
PubMed1988

The implications of a national study of risk of anaesthesia.

In order to set up measures to improve safety in anesthesia, the French Ministry of Health charged the Institut National de la Santé et de la Recherche Médicale (I.N.S.E.R.M.) with conducting an epidemiological survey of complications associated with anaesthesia. A prospective survey was carried out from 1978 to 1982 in a representative sample of 198,103 anaesthesias performed in 460 public and private institutions randomly selected throughout the country. There were 268 major complications associated with anaesthesia occurring during or within 24 hours after anaesthesia (incidence 1.35 per 1000), among these 67 were followed by death and 16 by coma. The incidence of deaths and comas totally attributable to anaesthesia was one per 7924. Half of the deaths and comas totally attributable to anaesthesia were from post-anaesthetic respiratory depression which could be directly linked to a dramatic lack of recovery rooms. The extension of the study to all institutions revealed that 25% of teaching hospitals, 43% of non-teaching hospitals and 20% of private clinics did not have a recovery room available. A total number of 12,000 recovery beds was estimated to be necessary in France; 40% being currently available leaving 60% to be created.

Anesthesia↗
PubMed1995

[Air pollution by sevoflurane in operating room and serum and urine inorganic fluoride of anesthetists].

Since lower blood-gas partition coefficient of sevoflurane provides rapid induction and emergence from anesthesia, sevoflurane has been used widely for inhalational anesthesia. However, because higher minimum alveolar concentration of sevoflurane requires a large dosage of anesthetic than other volatile anesthetics, air pollution with sevoflurane in the operating room might be of great concern. Anesthetists may keep inhaling the low concentration of anesthetics every day, even though scavenging system is equipped in the operating room. The purpose of this study is to evaluate the effects on anesthetists of the low concentration of anesthetics by measuring the inorganic fluoride concentration in the urine and serum of anesthetists and operating room nurses. Healthy 29 anesthesiologists and two operating room nurses were studied. Informed consent was obtained. Inorganic fluoride ions in the serum and urine were measured. Simultaneously sevoflurane concentration in operating room was measured in three operating rooms, at two places in the corridor and in the recovery room. Sevoflurane concentrations in three operating rooms were 1.22 ppm, 2.13 ppm and 6.05 ppm respectively. Concentration in the recovery room was 0.544 ppm. Serum and urine concentrations of inorganic fluoride were 1.1 +/- 0.1 mumol.l-1 and 36.2 +/- 17.1 mumol.l-1, respectively (mean +/- SD). Serum concentration of inorganic fluoride was within normal ranges. Although it is possible that fluoride concentration in urine is influenced by urine volume and a half of fluoride deposits in bone, no abnormal values in urine were found in this study. These results suggest that long term exposure to low concentration of sevoflurane and isoflurane causes no significant increase in their metabolites in operating room staffs.

Adult↗
PubMed1991

[The combination of general anesthesia and interscalene block in shoulder surgery].

Surgery on the shoulder often causes severe pain and, therefore, requires high doses of opiates. As postoperative pain is frequently treated inadequately, it is desirable to seek alternatives for providing effective analgesia. In a prospective study we examined the efficacy of balanced anesthesia consisting of general anesthesia combined with interscalene brachial plexus blockade for intra- and postoperative analgesia for operations on the shoulder. METHODS. Using the technique described by Winnie, interscalene block (ISB) was performed in 100 awake patients. After location of the brachial plexus by means of a peripheral nerve stimulator, we injected 40 ml bupivacaine 0.375%, after which general anesthesia (GA) was induced. At three predetermined points in time (recovery room, 8 h, and 24 h after the end of surgery), pain was evaluated by a visual analogue scale ranging from 0 to 10 and the extent of sensory blockade was tested by the pinprick method. The results of the pain scores and individual demands for analgesics were compared with a group of 22 patients who received only GA. Both groups were comparable in age, sex, and type of surgical procedure. RESULTS. We noted technical failure of the ISB in 8% of our patients. Side effects such as Horner's syndrome (18%), phrenic nerve paralysis (10%), and recurrent laryngeal nerve block (1%) were only temporarily observed during the action of the local anesthetics. During the surgical procedure, the group with ISB received a mean dose of 0.13 +/- 0.07 mg fentanyl versus 0.29 +/- 0.08 mg in the GA group (P less than 0.01) with equipotent doses of volatile anesthetics (1.0 to 1.5 MAC enflurane). Postoperative pain occurred for the first time in 39% of the patients given ISB later than 12 h after the end of surgery (average 8.7 +/- 5.9 h). In contrast, 95% of the patients with GA complained of pain in the recovery room. Pain measurement by the analogue scale clearly demonstrated the advantages of balanced anesthesia directly and 8 h after the operation (P less than 0.01). Even 24 h after the end of the surgical procedure the patients had better pain relief (P less than 0.05) in spite of the decreasing effect of the ISB. These significant differences led to the following results for postoperative treatment: 35% of the patients with ISB did not require additional analgesics during the first 24-h period after surgery, whereas 95% of those with GA requested analgesia. Only 32% of the ISB patients required opioids versus 86% with GA. The average duration of stay in the recovery room was reduced by 25% in the group with ISB (86 vs 134 min). In a final assessment, 84% of the patients were satisfied with the balanced anesthesia and only 5% were disappointed with the method. CONCLUSION. The combination of ISB and GA allows a reduction in intraoperative doses of opiates and facilitates postoperative pain management. Because of the low incidence of side effects, the lack of complications, and the high degree of patient acceptance, we recommend this type of balanced anesthesia for patients undergoing shoulder surgery.

Acromion↗
PubMed1994

Designing an anaesthesia data management system for a medium size country hospital. A report of four years experiences.

By the end of 1990 the anaesthesia department of the Offenburg hospital, a 500 bed hospital, started to install a data management system in the main operating theatres. In a first phase, 23 PCs were installed in 7 induction rooms and 7 theatres as well as in the 9-bed recovery-room. All PCs are connected via ethernet to a VAX-server. The main functions of the system may be summarized as follows: 1) On-line data acquisition from the patient monitor and from the anaesthesia machine (the ventilator); 2) Off-line data entry of other variables including drugs, fluids and postop. orders as well as demographic and administrative data; 3) Data transfer from induction room to theatre and from theatre to the recovery room; 4) Printout of an automatic anaesthesia record at the end of each case--a hand-written protocol no longer required; 5) Storage of data-files on the VAX-server with possibility of reviewing individual cases and also of performing all types of statistical analysis. The set-up of the whole system including 12 ICU beds and other workstations (total of 42 PC-stations) is described as well as hard- and software used. Problems encountered during installation of hardware and experiences during implementation of software are briefly discussed. A short overview is given concerning future development.

Anesthesiology↗
PubMedDate not supplied

Pharmacoeconomic analysis of sevoflurane versus isoflurane anesthesia in elective ambulatory surgery.

This study investigated the economic aspects of sevoflurane and isoflurane anesthesia in 47 healthy women undergoing elective ambulatory surgery, as part of a randomized, prospective clinical trial. Patient records were analyzed for anesthetic; duration of surgery, anesthesia, and recovery room stay; and associated charges. Sevoflurane is shorter acting than isoflurane, but it was not associated with a shorter duration of anesthesia or surgical unit stay, or earlier hospital discharge. Total charges associated with sevoflurane anesthesia were greater than those for isoflurane ($2641 and $2230, respectively) and primarily related to prolonged anesthesia and surgical unit stay. A minor decrease in recovery room charges ($15) associated with earlier discharge was observed with sevoflurane (p>0.05), but the agent was not associated with lower hospital charges. Larger trials and assessment of other patient populations may show sevoflurane to be more pharmacoeconomically advantageous than isoflurane.

Adult↗
PubMed1977

The nurse's role in immediate postoperative care.

From the time that a patient leaves the care of the anaesthetist after an operation until he wakes in the ward his physiological state should be continuously and expertly supervised. Postoperative nurses are provided only when the operating theatre has a recovery room. A survey among consultants and nurses in one region showed that many surgical units did not have recovery rooms and that inexperienced ward nurses were often sent to collect patients. The survey showed that most nurses were competent to care for unconscious patients so long as an emergency did not arise. In many hospitals the facilities for the safe nursing of postoperative patients were totally inadequate. The very least that is needed is good communications with the anaesthetist, adequate lighting, and a source of oxygen and suction. Because of the shortage of nurses likely to have to care for postanaesthetic patients early on and to train them accordingly. Nevertheless, recovery nurses, whose sole responsibility is to care for a patient until be has recovered from anaesthesia, should be appointed for all busy surgical units.

Anesthesia↗
PubMed1995

Recovery of intraoperatively shed blood in aortoiliac surgery: comparison of cell washing with simple filtration.

To regain blood shed intraoperatively, two different systems are clinically established: washing and centrifuging red blood cells to produce autologous erythrocyte concentrates and devices for immediate reinfusion of whole blood after mere filtration. In a prospective-randomised study to compare both methods regarding their efficiency, adverse effects, and economy, 20 patients of our department undergoing elective aortoiliac surgery received intraoperative autotransfusion by means of either cell-washing (CS) or salvage of whole blood (WB). Patients were preoperatively randomized into one of the two groups and were evaluated with respect to standard metabolic and haematological laboratory parameters preoperatively, during surgery, after transfer into the recovery room, 24 h after surgery, after transfer into the recovery room, 24 h after surgery, and at discharge. Both patient groups were well comparable in demographics, preoperative laboratory data, and indication for operation. Handling was easier, the set-up time was shorter with the whole blood filtration device (10.2 +/- 2.3 versus 21 +/- 1.9 min, p = 0.0023), and no additional personnel was needed to run the system. The whole blood device also allowed a greater percentage of aspirated blood to be returned intraoperatively compared to cell washing (73.5% +/- 7.2 versus 51.1% +/- 6.5, p = 0.03). Thrombocytopenia occurred in 7 (CS) and 3 (WB) patients intraoperatively with a significant difference in platelet count between the two groups (118 +/- 17 [CS] versus 170 +/- 12 [WB]*10(9)/L, p = 0.025). Expected changes in the perioperative course of the clotting parameters such as highly increased PTT levels and moderately prolonged prothrombin times occurred in all cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[The implementation of nursing diagnosis in a postanesthesia recovery unit--a pilot study].

Implementation of the nursing process at the Post-anesthesia Recovery Room--a preliminary study. This paper presents the preliminary results about a research on Nursing Diagnoses at the Post-Anesthesia Recovery Room based on the Taxonomy I. In a population of 19 patients, the nursing diagnoses with high frequency plus then 50% were injury (potential), hypothermia, and alteration in comfort.

Anesthesia Recovery Period↗
PubMed2007

Premedication with controlled-release oxycodone does not improve management of postoperative pain after day-case gynaecological laparoscopic surgery.

BACKGROUND: Controlled-release (CR) oxycodone provides an option for the prevention of postoperative pain. We designed this randomized double-blinded placebo controlled study to evaluate the control of pain after premedication with CR oxycodone 15 mg in addition to ibuprofen 800 mg orally in day-case gynaecological laparoscopic surgery. METHODS: Sixty consenting patients were anaesthetized in a standardized fashion. Postoperative analgesia was provided by ibuprofen 800 mg twice a day in combination with fentanyl i.v. in the recovery room and normal-release (NR) oxycodone orally after the recovery room. The visual analogue scale (VAS) scores for pain and side-effects, and the amounts of postoperative analgesics were recorded for 24 h after discharge from the hospital. After a statistical analysis of the original study, we extended the study to investigate another 10 patients, who received CR oxycodone 15 mg orally in an open-labelled fashion 60 min before surgery. The plasma concentrations of oxycodone were measured from samples drawn before and 2, 4, 6 and 8 h after premedication. RESULTS: The amounts of fentanyl [100 microg (0-330) in the CR oxycodone group; 125 microg (0-330) in the placebo group], NR oxycodone, or the VAS scores for pain during the first 24 h after the discharge from the hospital did not differ after the premedication with CR oxycodone or placebo. In the extension study group, the peak plasma concentration (C(max)) of oxycodone was 10.0 (4.6-14.7) ng ml(-1), indicating possibly a sub-therapeutic level. CONCLUSION: Oral premedication with CR oxycodone did not improve management of postoperative pain after day-case gynaecological laparoscopic surgery.

Adult↗
PubMed1997

The effect of local infiltration with morphine before carpal tunnel release.

We compared the effect of infiltration with a mixture of 1 per cent lidocaine and two milligrams of morphine in twenty-five patients who were to be managed with a carpal tunnel release with the effect of infiltration with 1 per cent lidocaine only in a second group of twenty-five patients who were to have such a release. In both groups, the injection was administered after inflation of the tourniquet. During the procedure, the patients' movement and vocalization of discomfort did not differ substantially between the groups. However, in the immediate postoperative period, the patients who had received morphine indicated a significantly higher score (on a visual-analog scale) for peak intraoperative pain than did the patients who had received lidocaine only (2.44 +/- 1.73 points compared with 1.32 +/- 1.22 points; p = 0.01). The numbers of patients who had pain in the recovery room, the numbers of patients who received analgesics in the recovery room, and the scores for pain at the time of discharge were similar for the two groups. The score for pain on the first postoperative day was more than 4 points for seven patients who had received morphine, whereas no patient who had received lidocaine only had a score of more than 4 points (p = 0.01); however, the amount of analgesics taken at home was similar for the two groups. Postoperative complications, which included hypotension, fainting, weakness, and chest pain, occurred in eight patients (32 per cent) who had received morphine and in none who had received lidocaine only (p < 0.01).

Adult↗
PubMed1995

The order of ward rounds influences nosocomial infection. A 2-year study in gastroenterologic surgery patients.

We studied the effect of the order of ward rounds on nosocomial infection in gastroenterologic surgery patients. The subjects were patients with gastrointestinal diseases admitted between September 1992 and August 1994. During the 1st year, the round proceeded indiscriminately among recovery rooms and rooms with stable patients and isolated patients with methicillin-resistant Staphylococcus aureus (MRSA). In the subsequent year, the round started in the recovery rooms and moved into the general rooms with stable patients and finally into the isolation rooms. Against the time course, piecewise linear regression analyses were made with the number of culture-positive patients and the quantities of antibiotics and disinfectants used. Of a total of 1894 strains from 264 patients, isolates of MRSA (n = 200) decreased from 150 in the 1st year to 50 in the 2nd year. The number of MRSA-positive patients showed the point of inflexion in the analysis at the change of round order, with a later decrease. The trend was similar for Candida (n = 99) and Enterococcal (n = 225) species. The amount of antibiotics was unchanged while the amount of disinfectants used decreased in the 2nd year. Thus, the round re-ordering appeared to help prevent nosocomial infection. Ward rounds for patients who have had gastroenterologic surgery should proceed from compromised hosts to stable patients, and then isolated patients.

Anti-Infective Agents, Local↗
PubMed2005

Obstetric recovery practice: a survey of UK obstetric anaesthetists.

BACKGROUND: The 1998 guidelines for obstetric anaesthesia services state: "postoperative care of the obstetric patient should be in accordance with that of any postoperative patient". We sought to discover whether this standard of care was provided. METHOD: A questionnaire designed to investigate recovery room practice was sent to 251 UK obstetric units. The survey took place between January and June 2003. RESULTS: The response rate was 78%. A total of 123 units (63%) had a dedicated obstetric recovery area. Midwives were exclusively responsible for postoperative parturient care in 113 units (58%) between 0900 and 1700 h and in 124 units (64%) after 1700 h. Dedicated recovery nurses were available in 59 units (30%) during the day, in contrast to 36 units (19%) after 1700 h. The level of background training ranged from no training (39%) to locally organised courses (32%), rotation through surgical areas (21%) and nationally organised English National Board courses (8%). CONCLUSION: The survey demonstrates that current obstetric recovery room practice does not always adhere to the recommended Association of Anaesthetists of Great Britain and Ireland guidelines. The provision of dedicated recovery staff or a cohort of specifically trained midwives may help to improve existing standards.

Adult↗
PubMed1989

Telling the diagnosis of cancer.

Although a concensus has emerged in this country that patients should be told when cancer is discovered, no data is available to indicate how and where patients are currently told that they have cancer. Fifty-five patients undergoing anticancer therapy were therefore interviewed to learn how this process occurs. The majority of patients were told by surgeons (74%) and only a minority by primary care physicians (11%). Most were told in a traditional medical setting (42% in the doctor's office, 17% in a hospital room), but 23% were told over the telephone and 19% in the recovery room. Two indicators of patient satisfaction with the telling process suggested that different sites of telling were not equivalent. Patients told over the telephone or in the recovery room were more likely to describe the telling in negative terms and less likely to describe their doctors as being helpful in understanding their illness than those told in a doctor's office or in their hospital bed. This pilot study indicates considerable variation in this aspect of patient care and suggests directions for future research. To determine whether interviews that explore these issues with cancer patients are unpleasant or stressful, patients' reactions to being subjects in this study were sought. Patients asked directly at the completion of the interview or surveyed 2 to 4 months later said the interview had been helpful and/or a positive experience. None expressed negative feelings about participating. Concerns about the psychological harm resulting from such study of this patient group do not appear to be warranted and should not impede future research.

Female↗