Anaesthetic Room Research Articles

(Bio)Aesthetic Geographies and the Governance of Biopedagogical Spect(ato)rs

Believing that “place matters” to biopower and to the governance of the new public health, we examine how a children’s hospital setting might be interpreted as a biopedagogical site. We take as the starting point of our analysis a treatment room in Toronto’s Hospital for Sick Children (SickKids)—Canada’s largest pediatric hospital. This particular room, dubbed Cujo’s Crease Satellite Anesthesia Room, was funded by donations from Curtis “Cujo” Joseph, a former Toronto Maple Leafs goaltender in the National Hockey League (NHL). Using trompe l’œil techniques, an artist transformed the room to look like a Toronto Maple Leafs locker room. We examine the range of possible meanings that might be taken up in Cujo’s Crease, paying particular attention to the biopolitical and cultural intersections among medicine, hockey, and biocitizenship. We argue that specific visual signs are employed to mobilize the discourses required by the space: masculinity, hockey as a national civilizing project, normative bodies, health care in a neoliberal age, and the NHL as benevolent care-giving corporation. We concluded that the discursive regimes of Cujo’s Crease are not innocent but are implicated in (bio)economical and biopedagogical imaginaries that render the sick child’s body as an assemblage of neoliberalism’s biocitizenship projects.

Vestibulitis: a medic's struggle with vulval pain from the other side of the curtain.

Going to the doctor about ‘women’s things’ is never pleasant but it’s even worse when, despite everyone’s best efforts, your symptoms remain unexplained. I’ve decided to share my personal experience of vestibulitis, under the guidance of GP Anjana Singh and consultant gynaecologist Gabrielle Downey, in order to raise awareness and facilitate prompt diagnosis for future patients. On 10 September 2013 I lay on the trolley in an anaesthetic room, petrified at the thought of having surgery but also excited about what the operation would hopefully achieve. Earlier that year I had been in the very same room as a 3rd year medical student, observing the anaesthetic induction of a patient who was about to undergo a procedure called a Fenton’s vestibulectomy. The gynaecologist explained that the procedure was for a specific type of dyspareunia called vestibulitis. She diagnosed this by the relief of pain after the application of local anaesthetic cream around the introitus. At this point my mind was racing; I had been experiencing superficial dyspareunia that was relieved by the use of local …

Nursesʼ experiences of advocacy in the perioperative department: a systematic review

Background Patient advocacy is central to nursing practice; acting as a patient advocate in the perioperative environment requires the care of patients that are highly vulnerable and unable to speak up for themselves, in a busy and often highly pressurized environment involving multiple professional groups providing care simultaneously. This can present particular challenges for nurses, particularly those unfamiliar with the expectations of being a patient advocate. Objectives The objective of this review was to identify the meaningfulness of perioperative nurses' experiences of advocacy. The specific objectives were to explore the following questions: What are perioperative nurses' experiences as patient advocates? How do perioperative nurses define advocacy? What are the barriers to and strategies for promoting advocacy in the perioperative environment? Inclusion criteria Types of participants Registered nurses, enrolled nurses, licensed practical nurses, licensed vocational nurses, and midwives working in the perioperative department, including anesthetic, scrub/scout and post-anesthetic care room nurses, were eligible for inclusion. Phenomena of interest Perioperative nurses' experiences of acting as patient advocates were the phenomena of interest in this review. This includes experiences of the barriers to nursing advocacy, strategies used, and explorations of how nursing advocacy benefits perioperative patients. Context The perioperative department, including preoperative, intraoperative and postoperative recovery areas, was of interest in this review. Types of studies This review aimed to consider all qualitative studies that sought to examine perioperative nurses' experiences of advocacy including but not limited to phenomenology, ethnography, hermeneutics, action research, grounded theory, feminist research and naturalistic inquiry. Search strategy Searches were conducted across 13 databases, including four for unpublished studies, with no language restriction, and with the date range of 1985 to April 2014. Studies were assessed for relevance to the review using a Verification of Relevance form developed by the reviewers and based on the recommendations of the Cochrane Collaboration. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). A third reviewer was used to assess three papers where disagreements between the first two reviewers could not be resolved through discussion. Data extraction Data were extracted from papers included in the review using the standardized data extraction tool from JBI-QARI. Data synthesis Findings were pooled using JBI-QARI. Findings were assembled and rated according to their quality, and categorized on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings. The ConQual approach for grading the synthesized findings was used. Results Nine studies were included in the review. From these, 31 findings were aggregated into five categories, which were then meta-synthesized into two synthesized findings which provide evidence for nursing practice. The two synthesized findings are:safeguarding from harm - being the patient's voice; and challenges of patient advocacy can be alleviated by experience and training. Conclusions Perioperative nurses identify being a voice, communicating with, and safeguarding the patient as key advocacy activities that they undertake within their roles. Establishing trust between the nurse and patient is an important aspect of patient advocacy in this environment. Acting as a patient advocate can expose perioperative nurses to workplace conflict and cause them distress. While professional experience prepares nurses to be patient advocates, less experience in the perioperative environment and time pressures were reported as barriers to the role.

Nurses' experiences of advocacy in the perioperative department: a systematic review.

Patient advocacy is central to nursing practice; acting as a patient advocate in the perioperative environment requires the care of patients that are highly vulnerable and unable to speak up for themselves, in a busy and often highly pressurized environment involving multiple professional groups providing care simultaneously. This can present particular challenges for nurses, particularly those unfamiliar with the expectations of being a patient advocate. The objective of this review was to identify the meaningfulness of perioperative nurses' experiences of advocacy. The specific objectives were to explore the following questions: • What are perioperative nurses' experiences as patient advocates? • How do perioperative nurses define advocacy? • What are the barriers to and strategies for promoting advocacy in the perioperative environment? Registered nurses, enrolled nurses, licensed practical nurses, licensed vocational nurses, and midwives working in the perioperative department, including anesthetic, scrub/scout and post-anesthetic care room nurses, were eligible for inclusion. Perioperative nurses' experiences of acting as patient advocates were the phenomena of interest in this review. This includes experiences of the barriers to nursing advocacy, strategies used, and explorations of how nursing advocacy benefits perioperative patients. The perioperative department, including preoperative, intraoperative and postoperative recovery areas, was of interest in this review. TYPES OF STUDIES: This review aimed to consider all qualitative studies that sought to examine perioperative nurses' experiences of advocacy including but not limited to phenomenology, ethnography, hermeneutics, action research, grounded theory, feminist research and naturalistic inquiry. Searches were conducted across 13 databases, including four for unpublished studies, with no language restriction, and with the date range of 1985 to April 2014. Studies were assessed for relevance to the review using a Verification of Relevance form developed by the reviewers and based on the recommendations of the Cochrane Collaboration. Papers selected for retrieval were assessed by two independent reviewers for methodological validity using standardized critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. A third reviewer was used to assess three papers where disagreements between the first two reviewers could not be resolved through discussion. Data were extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute Qualitative Assessment and Review Instrument. Findings were pooled using Joanna Briggs Institute Qualitative Assessment and Review Instrument. Findings were assembled and rated according to their quality, and categorized on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings. The ConQual approach for grading the synthesized findings was used. Nine studies were included in the review. From these, 31 findings were aggregated into five categories, which were then meta-synthesized into two synthesized findings which provide evidence for nursing practice. The two synthesized findings are: safeguarding from harm - being the patient's voice; and challenges of patient advocacy can be alleviated by experience and training. Perioperative nurses identify being a voice, communicating with, and safeguarding the patient as key advocacy activities that they undertake within their roles. Establishing trust between the nurse and patient is an important aspect of patient advocacy in this environment. Acting as a patient advocate can expose perioperative nurses to workplace conflict and cause them distress. While professional experience prepares nurses to be patient advocates, less experience in the perioperative environment and time pressures were reported as barriers to the role.

Local anaesthetic systemic toxicity

Access the CPD MCQs for this issue online here ### Key points Well-placed local anaesthetics (LAs) can yield great clinical benefits. But systemic toxicity related to their use can be devastating. The highly publicized case in 2004 of Mayra Cabrera, a theatre nurse who died shortly after delivery of her baby boy when her epidural infusion of bupivacaine was mistakenly connected to her i.v. line, reminds us to be vigilant and to learn from such rare events. While prevention is clearly the most important element in avoiding morbidity and mortality associated with local anaesthetic systemic toxicity (LAST), such cases still occur despite best practice. Knowing how to manage these uncommon events is vital. In this review, we cover LA toxicity, its incidence, clinical features, risk factors, prevention, and management and examine i.v. lipid emulsion (ILE) therapy in more detail. LAST has been recognized for more than a hundred years, but the precise incidence is currently unknown. In 1928, the American Medical Association reported 40 deaths attributable to LAs.1 Cocaine was responsible for half of these deaths, but procaine was also implicated. These findings prompted the search for less toxic agents. Lidocaine, first synthesized in 1944, was the first amide LA to be used clinically. However, in 1979, the potentially fatal toxicity of amide LAs was highlighted by Albright.2 More recently, studies from 1993 …

Parents' lived experience in the anaesthetic room

Background: It is a common practice today in the UK that the majority of children are accompanied to the operating theatre by one or two parents. The Association of Anaesthetists of Great Britain and Ireland (AAGBI) recommends that this is offered to the parents as a recommended standard of care ( AAGBI, 2010 ). Aim: To describe the lived experiences of parents whose children had been scheduled for induction of general anaesthesia. Methods: This study (n=13) adopted a single-method approach involving purposeful sampling to select the participants aged 18–75 years, recruited from the pre-assessment clinics. The use of in-depth interviews was used to generate data about the participant's personal experiences. It is based on a descriptive approach within a phenomenological framework. Results: The analysis of the interviews and narrations of the participants led to the extraction of five major themes consisting of emotional impact, views of the impact of their presence, professional issues, information need and coping strategies. Conclusion: The experience of parents witnessing their children in the anaesthetic room being placed under anaesthesia can be considered to be stressful for the parents. Intervention strategies are needed to reduce the stress for the parents during this period. Health professionals need to have a better understanding of the individual coping strategies to support each parent and the impacts on parents' wellbeing.

Hand hygiene is as simple as the ABCs—always, be, careful, caring and compliant

Background: Health-care professionals (HCPs) who work in the operating room (OR) or post anaesthesia care unit (PACU) have a greater opportunity to cross-contaminate patients due to high workloads and frequent patient contact events. The prevalence of health-care-associated infections is a major health concern and patient contact in the OR and PACU can be a contributing factor, due to microbial contamination. The research published on maintaining the sterility of the OR is abundant, but less attention has been focused on patient contact by ’non-scrubbed’ HCPs in OR and PACU. Methods: An observational study was conducted on the hand hygiene compliance of ‘non-scrubbed’ HCPs working in the OR and PACU of the King Fahad Hospital, King Abdulaziz Medical City, a quaternary health-care facility in Saudi Arabia. The participants in the study were surgeons, anaesthetists, circulating and PACU nurses, with surreptitious observations being performed by two trained OR and PACU nurses. ’Sterile’ scrubbed HCPs were excluded. The observation timeframe was from January to December 2013 and the hand hygiene compliance components that were observed were the World Health Organisation ‘5 moments’ of hand hygiene ( Figure 1 ). Results: The study included 2300 opportunities (observations) for hand hygiene compliance and HCP observed 2000 nurses, 100 surgeons and 100 anaesthetists. Hand hygiene compliance in the King Abdulaziz Medical City OR and PACU was highest among nurses (> 90%) and lowest among physicians: surgeons (< 70%), followed by anaesthetists (< 50%). Conclusion: Adherence to hand hygiene guidelines by King Abdulaziz Medical City OR and PACU nurses was acceptably higher than anaesthetists and surgeons, noting that the organisational hand hygiene compliance target is 100%. However, the low compliance to hand hygiene guidelines by doctors potentially exposes patients to microbial transmission and harm and therefore validates a theory-practice-ethics gap.

The Tradition of Anaesthetic Rooms: Best Practice or Patient Risk?

In the United Kingdom (UK), anaesthetic rooms (ARs) are the standard site for induction of anaesthesia. Although advocates of ARs argue that they provide a quiet and comfortable place for patients to be anaesthetised, the competing argument is that ARs create a risk to those patients by transferring them whist they are unconscious and unmonitored. This study focuses on the current use of ARs and the rationale for their inclusion in new theatre design. It investigates decision-making and prioritisation of competing factors in clinical choice. Mixed methods were used to explore perspectives of anaesthetic clinicians and perioperative managers. Two hundred and two consultant anaesthetists from National Health Service Trusts across the East Midlands region of the UK completed an online survey, and 17 perioperative managers were interviewed regarding the incorporation of ARs in theatre design and changing practice. The majority of anaesthetists preferred to induce all types of patients in the AR, except high risk and obese patients. The most important reasons for choosing to induce in the AR were the ‘quiet environment’ and “patient experience’, whereas the least important reasons included ‘patient safety’ and ‘efficiency’. For the respondents who preferred to induce in the theatre the primary reason was ‘patient safety’. Manager interviews revealed their belief that the benefit of ARs is based on perception –not evidence. The research findings question the motives for using the AR for standard anaesthesia provision, as both the daily use of, and design considerations for ARs, seem driven by perception and experience, rather than clear and compelling evidence. Anaesthetic practice in the UK may be operating under the pretences of safety and performance, while carrying on with a traditional way of working which may one-day prove to be an unacceptable risk and investment.

Perioperative management for patients with hereditary angioedema.

Hereditary angioedema (HAE) is a rare autosomal dominant disease that results from mutations in the C1-esterase inhibitor (C1-INH) gene. HAE is characterized by recurrent episodes of angioedema of the skin (face, extremities, genitalia, trunk), the gastrointestinal tract, and respiratory tract. Symptoms experienced can be debilitating, may impact quality of life, and can be life threatening. Preventing attacks particularly for patients undergoing procedures is critical. Patients with HAE may now treat acute attacks or prevent attacks with medications that have recently become available in the United States; however, these same medications can be used for perioperative management for patients undergoing medical, surgical, and dental procedures. Periprocedural planning is important for patients to reduce the incidence of acute attacks. Education is critical and increasing awareness of short-term prophylaxis options will allow providers to develop an appropriate action plan for their patients. The goal of this review is to increase awareness for HAE treating physicians, surgeons, anesthesia, and emergency room physicians by examining the available treatment options, researching the literature, and summarizing available data for periprocedural management. The availability of treatment options has increased over the past few years, expanding options for physicians and patients living with HAE and improve safety during the perioperative period and at the time of other procedures.

'Tea trolley' difficult airway training.

The 4th National Audit Project (NAP4) recommended that the airway skills of trainee and consultant anaesthetists are maintained with regular education and training 1. We have developed a difficult airway ‘tea trolley’ for practising asleep/awake fibreoptic intubation and needle cricothyroidotomy that provides a cheap alternative to formal training courses (Fig. 1). Each ‘tea trolley’ teaching session is run by two anaesthetists, one of whom takes over the intra-operative care of a stable patient, releasing the listed anaesthetist for a 15-min teaching session in the anaesthetic room with the other, after which tea and cake are provided.

5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors

We present the main findings of the 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia (AAGA). Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19,600 anaesthetics (95% confidence interval 1:16,700-23,450). However, there was considerable variation across subtypes of techniques or subspecialities. The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000). The cases of AAGA reported to NAP5 were overwhelmingly cases of unintended awareness during NMB. The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300). Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental, rapid sequence induction, obesity, difficult airway management, NMB, and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex, age (younger adults, but not children), obesity, anaesthetist seniority (junior trainees), previous awareness, out-of-hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic), and use of NMB. The following factors were not risk factors for accidental awareness: ASA physical status, race, and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from NAP5--the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home.

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors.

We present the main findings of the 5th National Audit Project on accidental awareness during general anaesthesia. Incidences were estimated using reports of accidental awareness as the numerator, and a parallel national anaesthetic activity survey to provide denominator data. The incidence of certain/probable and possible accidental awareness cases was ~1:19600 anaesthetics (95% CI 1:16700-23450). However, there was considerable variation across subtypes of techniques or subspecialties. The incidence with neuromuscular blockade was ~1:8200 (1:7030-9700), and without it was ~1:135900 (1:78600-299000). The cases of accidental awareness during general anaesthesia reported to 5th National Audit Project were overwhelmingly cases of unintended awareness during neuromuscular blockade. The incidence of accidental awareness during caesarean section was ~1:670 (1:380-1300). Two thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia. During induction of anaesthesia, contributory factors included: use of thiopental; rapid sequence induction; obesity; difficult airway management; neuromuscular blockade; and interruptions of anaesthetic delivery during movement from anaesthetic room to theatre. During emergence from anaesthesia, residual paralysis was perceived by patients as accidental awareness, and commonly related to a failure to ensure full return of motor capacity. One third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, most due to problems at induction or towards the end of anaesthesia. Factors increasing the risk of accidental awareness included: female sex; age (younger adults, but not children); obesity; anaesthetist seniority (junior trainees); previous awareness; out-of-hours operating; emergencies; type of surgery (obstetric, cardiac, thoracic); and use of neuromuscular blockade. The following factors were not risk factors for accidental awareness: ASA physical status; race; and use or omission of nitrous oxide. We recommend that an anaesthetic checklist, to be an integral part of the World Health Organization Safer Surgery checklist, is introduced as an aid to preventing accidental awareness. This paper is a shortened version describing the main findings from 5th National Audit Project - the full report can be found at http://www.nationalauditprojects.org.uk/NAP5_home#pt.

Evaluating the optimal timing of surgical antimicrobial prophylaxis: study protocol for a randomized controlled trial.

BackgroundSurgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis.Methods/DesignIn this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5% surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years.DiscussionThe results of this randomized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital. Moreover, the results of this randomized controlled trial are of significant interest for patient safety and healthcare economics.Trial registrationThis trial is registered on ClinicalTrials.gov under the identifier NCT01790529.

What you would not expect after a difficult intra-aortic balloon pump removal

Figure 1: Intra-aortic balloon pump catheter after removal, showing an intact balloon envelope but a broken internal wire (arrow). The balloon was inserted prophylactically with an uncomplicated sheetless technique at the time of operation in the anaesthetic room. The patient was extubated on postoperative day 1 and the balloon had to be removed the following morning (i.e. 48 h after its insertion).

Effect of interesting games on relief of preoperative anxiety in preschool children

PurposeTo evaluate the effect of interesting games on reducing preoperative anxiety and improving compliance with anaesthesia in children. MethodsNinety preschool-aged children undergoing elective surgery were randomly assigned to two groups. The children in the control group were admitted to a general preoperative room with one parent for 15–20 min, and were then taken into the anaesthesia room. During anaesthetic induction, the nurse attracted the children's attention using an interesting game with encouragement and attention diversion. The children's anxiety was assessed using the Modified Yale Preoperative Anxiety Scale (mYPAS) when they entered the operating room, while they were waiting to undergo s0urgery, and during anaesthetic induction. Moreover, the children's compliance with anaesthetic induction was assessed using the Induction Compliance Checklist (ICC). ResultsNo statistically significant differences in the mYPAS scores were observed between the two groups upon entering the operating room (p > 0.05). The mYPAS scores were significantly lower in the experimental group than in the control group while waiting for surgery and during anaesthetic induction (p < 0.05), while there were no significant differences in the mYPAS scores upon entering the operating room. The children's compliance with anaesthetic induction was significantly higher in the experimental group than in the control group (p < 0.05). ConclusionEngagement in an interesting game can reduce preschool-aged children's preoperative anxiety and improve their compliance with anaesthetic induction.

Postoperative outcome of patients undergoing off pump coronary bypass surgery in critical preoperative state

Introduction: Critical preoperative sate (ventricular tachycardia or ventricular fibrillation or aborted sudden death, preoperative cardiac massage, preoperative ventilation before anesthetic room, preoperative inotropes or IABP, preoperative acute renal failure) has been considered risk factor for worst outcome. This study was undertaken to see if critical preoperative state has any impact in postoperative outcome in patients undergoing off pump coronary bypass surgery (OPCAB).

The Analgesic and Adverse Effects of Intrathecal Opioids for Cesarean Section: 11 Years’ Experience in 10,061 Cases

Purposes: To evaluate analgesic effect and adverse effects of intrathecal morphine and fentanyl in parturients undergoing cesarean section. Methods: This is a retrospective, descriptive study from anesthetic and recovery room records from January 2001 to August 2011. Results: From this 11-year retrospective, descriptive analysis in 10,061 patients undergoing cesarean section who received intrathecal opioids, it had been found that their pain scores both at rest and with movement were mild and moderate, respectively. Nausea / vomiting and pruritus were common complications but no patient experienced respiratory depression. Conclusions: Intrathecal morphine is effective for controlling postcesarean pain with minor adverse effects.

Morphine spinal block anesthesia in patients who undergo an open hemorrhoidectomy: a prospective analysis of pain control and postoperative complications.

PurposeThis study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy.MethodsForty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded.ResultsThere were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention.ConclusionA hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure.

Presença de familiares durante a indução anestésica de crianças: Revisão da literatura

Children usually become anxious and agitated during anesthetic induction, increasing the risk of apnea and laryngospasm. The presence of a family member can decrease anxiety and improve cooperation, reducing risks. Objective: To identify, in the literature, positive and negative aspects that the experience to witnessing anesthetic induction in children can provide to family members, the children themselves, and the surgical center staff. Method: A literature review using the keywords “parents”, “child”, and “surgicenters” on scientific articles published between 1989 and 2012 indexed at National Library of Medicine (MEDLINE) and Latin American and Caribbean Health Sciences (LILACS) database. Results: The experiences of allowing the presence of parents in the anesthetic induction room show that there is a eduction of the anxiety level of children and parents, with lower necessity for physical restraint. Regarding the surgical center staff, despite the anxiety presented by professionals in relation to their performance and the difficulties related to the human resources needed to implement this practice, a better nurse-patient relationship was observed. Conclusions: In view of the benefits arising from the adoption of this practice, this work shows the importance of increasingly enabling parental presence during induction of anesthesia in children.

Comparing pain and analgesia requirements in different procedures for the treatment of hip fractures

Comparing pain and analgesia requirements in different procedures for the treatment of hip fractures