RESUMEN
BACKGROUND AND OBJECTIVES: Intrathecal anesthesia is the method of choice for transurethral prostate resection in the United Kingdom, despite its associated hypotension. Intrathecal ketamine with epinephrine has been used for lower limb surgery with minimal cardiovascular disturbance. Because cardiovascular stability might be advantageous in this group of elderly patients, we undertook this study to determine if intrathecal ketamine was a suitable intrathecal anesthetic agent for transurethral prostate surgery. Because of the high incidence of side effects and inadequate analgesia, the study was terminated after only ten patients had been recruited. METHODS: Ten ASA I to III males were studied. Spinal anesthesia was performed with a 25-gauge Whitacre needle at the L2-L3 or L3-L4 space. The dose of ketamine was determined by a sequential allocation technique after initial empirical doses of 0.5 and 0.75 mg/kg. Sensory and motor block were monitored using pinprick and modified Bromage score, respectively. If spinal anesthesia was inadequate at any time, a general anesthetic was administered. RESULTS: At doses higher than 0.7 mg/kg, intrathecal ketamine produced both motor and sensory block. The onset of motor block was within 2-3 minutes, peaked in 5-10 minutes, and lasted 30-60 minutes. Sensory block took 5-20 minutes to reach its maximal height. Maximum sensory block height varied from L1 to T7. Despite adequate block to pinprick, half the patients sensed the diathermy and were given a general anesthetic. The incidence of severe psychotomimetic side effects was 30%. CONCLUSIONS: Intrathecal ketamine at doses of 0.7-0.95 mg/kg produces sensory and motor block. The frequency of psychomimetic disturbance, inadequate analgesia, and short duration of action preclude its use as a sole anesthetic agent.
Asunto(s)
Anestésicos Disociativos/farmacología , Ketamina/farmacología , Anciano , Humanos , Inyecciones Espinales , Ketamina/administración & dosificación , Ketamina/efectos adversos , MasculinoRESUMEN
Music is frequently played in operating theatres, but may prove distracting to anaesthetists. We undertook a laboratory-based study of the effects of music on the psychomotor performance of 12 anaesthetic trainees. Using part of the computer-based PsychE psychomotor evaluation programme, we were unable to demonstrate any effect of self-chosen music, silence, white noise or classical music on their performance in these tests.
Asunto(s)
Anestesiología , Competencia Clínica , Música , Desempeño Psicomotor , Adulto , Anestesiología/educación , Atención , Educación de Postgrado en Medicina , Femenino , Humanos , Masculino , Quirófanos , Tiempo de ReacciónRESUMEN
Music played to staff in the operating theatre is thought to improve surgeons' concentration but its effects on other theatre staff are unknown. We surveyed 200 anaesthetists to determine the prevalence of music playing in the operating theatre and anaesthetists' attitudes to it. The response rate was 72% and of these 72% (104) worked in a theatre where music was played regularly. Around 26% of the sample felt that music reduced their vigilance and impaired their communication with other staff while 11.5% felt that music might distract their attention from alarms. Fifty-one per cent felt that music was distracting when a problem was encountered during the anaesthetic.
Asunto(s)
Anestesiología , Actitud del Personal de Salud , Música/psicología , Quirófanos , Adulto , Atención , Competencia Clínica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
The outcome of patients transported by coastguard helicopter to the Lewis Hospital, Stornoway was studied for the first 30 months of the service. Although undoubtedly life-saving in some cases, some patients were transferred for trivial reasons. Feedback between the hospital and ships' captains and owners may reduce possible abuse of this service. Most patients were uplifted entirely appropriately.
Asunto(s)
Aeronaves/normas , Servicios Médicos de Urgencia/normas , Transporte de Pacientes/normas , Adulto , Estudios de Evaluación como Asunto , Femenino , Investigación sobre Servicios de Salud , Hébridas , Humanos , Masculino , Evaluación de Resultado en la Atención de SaludRESUMEN
Elbow injuries are commonly seen in accident departments. Patients with possible bony injuries to the elbow were assessed to see if inability to fully extend the elbow was a good indicator of bony injury and hence the need for X-ray. The sensitivity of this test was 90.7% (95% confidence limits 80.7-100.7) and the specificity 69.5% (95% confidence limits 60.3-78.7). Use of this simple test would reduce both radiography costs and unnecessary exposure to radiation.