RESUMEN
BACKGROUND: Lidocaine and bupivacaine are commonly infiltrated into surgical cutaneous wounds to provide local anaesthesia after surgical procedures. However, very little is known about their effects on cutaneous wound healing. If an inhibitory effect is demonstrated, then the balance between the benefits of postoperative local anaesthesia and the negatives of impaired cutaneous wound healing may affect the decision to use local anaesthesia or not. Furthermore, if a difference in the rate of healing of lidocaine- and bupivacaine-treated cutaneous wounds is revealed, or if an inhibitory effect is found to be dose-dependent, then this may well influence the choice of agent and its concentration for clinical use. METHODS: Immediately before incisional wounding, we administered lidocaine and bupivacaine intradermally to adult female mice, some of which had been ovariectomized to act as a model of post-menopausal women (like post-menopausal women, ovariectomized mice heal wounds poorly, with increased proteolysis and inflammation). Day 3 wound tissue was analysed histologically and tested for expression of inflammatory and proteolytic factors. RESULTS: On day 3 post-wounding, wound areas and extent of re-epithelialization were comparable between the control and local anaesthetic-treated animals, in both intact and ovariectomized groups. Both tested drugs significantly increased wound activity of the degradative enzyme matrix metalloproteinase-2 relative to controls, while lidocaine also increased wound neutrophil numbers. CONCLUSIONS: Although lidocaine and bupivacaine influenced local inflammatory and proteolytic factors, they did not impair the rate of healing in either of two well-established models (mimicking normal human wound healing and impaired age-related healing).
Asunto(s)
Anestésicos Locales/farmacología , Bupivacaína/farmacología , Lidocaína/farmacología , Piel/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Envejecimiento/fisiología , Anestésicos Locales/administración & dosificación , Animales , Bupivacaína/administración & dosificación , Colágeno/metabolismo , Procedimientos Quirúrgicos Dermatologicos , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Lidocaína/administración & dosificación , Ratones , Ratones Endogámicos C57BL , Posmenopausia/fisiología , Piel/metabolismo , Cicatrización de Heridas/fisiologíaAsunto(s)
Anestesia Obstétrica/métodos , Anestesia Raquidea/métodos , Cesárea , Adulto , Asma/complicaciones , Femenino , Humanos , Embarazo , Complicaciones del EmbarazoRESUMEN
A postal survey of all trainee anaesthetists in the North West Region of England was conducted to investigate areas important in determining the trainee's quality of life. The questionnaire enquired about life on-call, hospital facilities available to doctors and trainees' morale. The results suggest that changes are urgently required to improve trainees' lifestyles and therefore help raise morale within the profession.
Asunto(s)
Anestesiología/educación , Moral , Calidad de Vida , Servicio de Alimentación en Hospital , Vivienda , Humanos , Satisfacción en el Trabajo , Estacionamientos , Privación de Sueño , Factores de TiempoRESUMEN
We have compared a rapid sequence induction of anaesthesia using propofol 2 mg.kg-1 and alfentanil 50 micrograms.kg-1, with a standard technique using thiopentone 5 mg.kg-1 and suxamethonium 1 mg.kg-1. The incidence of complications, and the quality of conditions for intubation, were similar in both groups. The patients receiving propofol and alfentanil showed a significant decrease in blood pressure and heart rate following induction (p < 0.01), whereas the group receiving thiopentone and suxamethonium showed a significant increase in blood pressure and heart rate following induction (p < 0.01). The use of propofol and alfentanil provided a satisfactory alternative to thiopentone and suxamethonium for a rapid sequence induction of anaesthesia.