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BACKGROUND: The way that pain is assessed in the PACU could impact on postoperative pain and analgesic consumption. However, there is currently no evidence to support this speculation. The authors hypothesised that using a comfort scale reduces postoperative opioid consumption when compared with a standard numerical rating scale (NRS) to evaluate pain in the PACU. METHODS: In this cluster-randomised trial, patients were assessed using either a comfort scale (comfort group) or a pain NRS (NRS group). The primary outcome was the opioid consumption in the PACU. The main secondary outcomes were postoperative pain, nausea and vomiting, length of stay in the PACU, and satisfaction. RESULTS: Of 885 randomised patients, 860 were included in the analysis. Opioid consumption in the PACU was comparable in the comfort and NRS groups (median [interquartile range [IQR] 0 (0-5) vs 0 (0-6); P=0.2436), irrespective of the type of surgical procedure. The majority of patients did not need any postoperative opioid (59% in the comfort group and 56% in the NRS group, P=0.2260). There was no difference in postoperative pain, nausea and vomiting, time to reach an Aldrete score ≥9 after extubation, and global satisfaction. CONCLUSIONS: Using a comfort scale to assess pain in the PACU did not spare any opioid compared with use of a standard NRS. Further studies focusing on patients at risk of increased postoperative opioid consumption are necessary. CLINICAL TRIAL REGISTRATION: NCT05234216.

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OBJECTIVE: To estimate the incidence of influenza infection with a rapid diagnostic test in patients hospitalized in an intensive care unit (ICU) during the epidemic periods of two consecutive winters (2005-2006). METHODS: This study tested nasal aspirate of all patients admitted to the ICU for acute respiratory failure during the influenza epidemic period with the QuickVue influenza rapid diagnostic test. RESULTS: The study included 39 patients: 22 men and 17 women. Their mean age was 69.7+/-13 years, their mean SAPS II score 54+/-21, their mean length of stay 14.7+/-20 days, and 43.5% had been vaccinated against influenza. The mortality rate was 33.3% (n=13). Four patients (10.2%) had a positive QuickVue test and were considered to have influenza associated with their primary diagnosis: pneumococcal pneumonia, haemophilus pneumonia, acute bronchitis, and acute bronchitis with acute cardiogenic edema. These patients were older than those with a negative test (80+/-7 versus 68+/-13 years, p=0.02). Their SAPS II, length of stay and mortality rate did not differ statistically from those with negative results. Chronic heart failure (but not COPD or non-vaccination) was more frequent in these patients (p=0.01). DISCUSSION: Several published studies report a satisfactory specificity and sensitivity for QuickVue. With this test, we estimated the incidence of influenza in patients hospitalized in our ICU for acute respiratory failure during flu epidemics at around 10%, close to that reported in previous studies.

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Nicardipine is used in the treatment of premature labor. There are no previous reports in the anesthesia literature of serious side effects associated with this drug. We report a case of pulmonary edema induced by nicardipine therapy for tocolysis in a pregnant 27-yr-old patient admitted to our hospital for preterm labor with intact membranes at 27 wk of gestation.

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OBJECTIVE: To compare measurements of cardiac output using a new pulmonary artery catheter with those obtained using two "gold standard" methods: the periaortic transit time ultrasonic flow probe and the conventional pulmonary artery thermodilution. DESIGN: Prospective clinical trial. SETTING: Cardiac surgery operating room and surgical ICU in a university hospital. MATERIAL AND METHODS: In the operating room, a new pulmonary artery catheter (truCCOMS system) was inserted in eight patients. A periaortic flow probe was inserted in four of them. Measurements of cardiac output obtained with the truCCOMS catheter and with the flow probe were compared at different phases of the surgical procedure. In the intensive care unit, the cardiac output displayed by the truCCOMS monitor was compared with the value obtained after bolus injection performed subsequently. RESULTS: In the operating room (70 measurements), the coefficient of correlation between cardiac output measured by the flow probe and the truCCOMS system was r2 = 0.79, the bias was +0.11 l/min with a precision of 0.47 l/min, and limits of agreement -0.83 to +1.05 l/min. In the intensive care unit (108 measurements), the coefficient of correlation between cardiac output measured by thermodilution and the truCCOMS system was r2 = 0.56, the bias was -0.07 l/min, the precision was 0.66 l/min, and the limits of agreement were -1.39 to +1.25 l/min. CONCLUSION: The truCCOMS system is a reliable method of continuous cardiac output measurement in cardiac surgery patients.

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Noninvasive positive-pressure ventilation (NIPPV) is widely used to treat acute respiratory failure, the goal being to avoid exposing patients to the morbidity associated with tracheal intubation. NIPPV may reduce the rates of intubation, morbidity, and mortality in selected patient subgroups. Although time-consuming for physicians and nurses, NIPPV is fairly easy to use, and few severe complications have been reported. Esophageal perforation is a well-recognized complication of tracheal intubation but has not been described in association with NIPPV. We report a case of fatal esophageal perforation associated with NIPPV after a surgical procedure.

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OBJECTIVE: To evaluate the impact of an alfentanil dose on bispectral index (BIS) variations during tracheal suction in ICU sedated patients. DESIGN AND SETTING: A prospective open-label pilot study in a 12-bed surgical ICU in a university-affiliated, tertiary referral hospital. PATIENTS: Eleven sedated (midazolam plus fentanyl) mechanically ventilated patients. INTERVENTIONS: Continuous monitoring of BIS with arterial pressure and heart rate before, during, and after tracheal suction without (control period) and with an intravenous bolus of alfentanil (15 microg/kg, alfentanil period) before suction. RESULTS: Steady-state BIS value was 61+/-8 for the control period and 59+/-7 for the alfentanil period. Blood pressure and heart rate were similar between baseline periods. One minute after tracheal suction, a significant increase in BIS level was observed in the control period, which remained significantly different from the alfentanil period until 10 min later. Significant higher systolic and diastolic blood pressure and heart rate were observed during the control period than the alfentanil period. However, no difference in Ramsay scores was observed between the two periods. CONCLUSIONS: An alfentanil bolus of 15 microg/kg markedly reduced the increase in BIS values, blood pressure, and heart rate observed immediately after tracheal suction. Therefore BIS monitoring in ICU may help to improve analgesia during invasive events.

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