Dimitri A. Cozanitis

A comparison of ranitidine, droperidol or placebo in the prevention of nausea and vomiting after hysterectomy

PurposeThe effect of ranitidine on postoperative nausea and vomiting (PONV) was assessed when compared with droperidol and with placebo.MethodsThree groups of sixty patients were studied in a double-blind randomized manner. The first group received ranitidine tablets 300 mg on the night before and on the following morning, one hour before induction of anaesthesia. Thirty minutes before surgery ended they were given isotonic saline 0.3 ml iv. The second group had placebo in place of ranitidine while before the operation ended, droperidol 0.75 mg (0.3 ml) was injected. The third group received placebos rather than the study drugs. The immediate two-hour postoperative recovery room period and that on the ward were evaluated until the next morning. PONV information was gathered from complaints by the patients and from direct questioning by the nursing staff. Droperidol 0.75 mg iv served as the “rescue drug”.ResultsLess PONV occurred in patients who received antiemetics vthan those given placebo: recovery room, P = 0.0109; ward, P = 0.007. Droperidol better suppressed PONV in the recovery room (P = 0.005) with no statistical significance seen between ranitidine and placebo. On the ward, both antiemetics were more effective than placebo (ranitidine, P = 0.01; droperidol, P = 0.003). “Rescue drug” requirements throughout the study periods were not statistically significant.ConclusionAlthough both anti-emetics were associated with a smaller incidence of PONV than was placebo, droperidol was superior to ranitidine in preventing sickness during the immediate postoperative period. The need for the “rescue drug” was similar in all groups.RésuméObjectifComparer l’effet de la ranitidine sur les nausées et vomissements postopératoires à celui du dropéridol et d’un placebo.MéthodesCette étude randomisée et en double aveugle portait sur trois groupes de 60 patients. Le premier groupe a reçu de la ranitidine en tablette 300 mg la veille et le matin de l’intervention, une heure avant l’induction de l’anesthésie. Trente minutes avant la fin de l’intervention, ses membres ont reçu 0,3 ml iv de sol. physiologique isotonique. Le deuxième groupe a reçu un placebo au lieu de la ranitidine et avant la fin de l’intervention, du dropéridol 0,75 mg (0,3 ml) iv. Le troisième groupe n ’a reçu que du placebo. L’évaluation a été effectuée à la salle de réveil pendant les deux heures qui ont suivi l’intervention et, dans le service, jusqu ’au lendemain matin. Les renseignement sur les nausées et vomissements provenaient des plaintes spontanées et des questions du personnel infirmier. Le médicament de sauvetage était dropéridol 0,75 mg iv.RésultatsLes nausées et vomissements ont été moins fréquents chez les patients qui avaient reçu des antiémétiques plutôt qu’un placebo: à la salle de réveil, P = 0,0109; dans le service, P = 0,007. Le dropéridol protège mieux des nausées et des vomissements en salle de réveil (P = 0,005) et il n’y pas eu de différence entre la ranitidine et le placebo. Dans le service, les deux antiémétiques ont été plus efficaces que le placebo (ranitidine, P = 0,01; dropéridol, P = 0.003). Les besoins en médicament de sauvetage n ’ont pas différé.ConclusionBien que les deux antiémétiques aient été associés à une incidence plus faible de nausées et vomissements, le dropéridol a été supérieur à la ranitidine pendant la période postopératoire immédiate. Les besoins en médicaments de sauvetage ont été les mêmes dans tous les groupes.

Heinrich Irenaeus Quincke (1842–1922): The Nobel Prize but for the problem of age

Born in 1842 in Frankfurt an der Oder, Heinrich Irenaenus Quincke (figure 1) was the youngest of four sons of a titled physician, Hermann Quincke. His mother’s predecessors were of the Huguenot faith and had fled to Germany following the Revocation of the Edict of Nantes in 1685. They were textile merchants. At his baptism, Heinrich received his name Irenaeus as witnessed by 13 honourary god-fathers [1]. The family moved to Frankfurt am Main where the young Heinrich was raised in comfortable surroundings but in strict Prussian fashion. Adept at mathematics [2], he attended private school and was a serious, ambitious and extraordinarily correct student. It was here that Heinrich met Bernhard Naunyn who became his lifelong ‘‘true friend’’ [2] and colleague. In keeping with the tradition of the Hohenzollern dynasty which ruled Germany until 1918, that a young man learn a useful, practical skill, Quincke chose wood-working as his handicraft and built a desk that he used throughout his life. His technical aptitude was applied to the designing of many inventions e.g., his spinal needle (figure 2), the Closetdouche [3], and for improving a monoaural stethoscope in 1870 [4]. The German Patent Office certified, however, that he never applied for any patent. Quincke began his medical training at the age of 16 in Berlin and then moved both to Würzburg and Heidelberg before returning to Berlin where he completed his studies at the age of 21. After qualifying, in keeping with custom, he visited hospitals abroad in Switzerland, Paris and London. It was these trips which led to Quincke’s belief that the light and airy conditions of these ‘‘ideal’’ hospitals and their salutary gardens offered the patients a much needed sense of well being. This became a lifelong predilection for him. Heinrich married Bertha Wrede, 12 years his junior and the daughter of a prosperous family in Frankfurt. His father was their physician. The couple led a harmonious life except they had no children. Quincke’s marriage made him independently wealthy. Bertha was an elegant hostess who enjoyed a good life. In addition to her making fashion jaunts to Paris with the wife of one of her husband’s colleagues, the couple often visited Switzerland and travelled to Rome, Athens, and Constantinople. Later in life, Heinrich suffered from two episodes of depression. Rest in Algers and Nervi along with the support by colleagues close to him proved effective. Quincke had his peculiarities. The window of his bedroom faced the east to catch the morning sun. He slept with his window

The extent of inaccurate aneroid sphygmomanometers in a hospital setting

ZusammenfassungAlle tragbaren, aneroiden Sphygmomanometer eines Krankenhauses wurden auf ihre Messgenauigkeit (Toleranz ± 3 mmHg) hin überprüft. Bei diesem Vergleich mit einem zertifizierten Quecksilbermanometer lieferten 59 % der insgesamt 832 Sphygmomanometer ungenaue Messergebnisse, and zwar in der Mehrzahl der Fälle zu niedrige Werte. Diese unbefriedigende Erkenntnis ist im Einklang mit früheren Studien, in denen sich aber die Versuchsanordnungen und die Meinungen bezüglich noch akzeptabler Messabweichungen deutlich unterschieden. Während ihres täglichen Gebrauchs sind die Sphygmomanometer Erschütterungen und anderen Einflüssen ausgesetzt, die zu Materialverschleiß und Beschädigungen und so zu Messfehlern führen können. Die gemeinhin anerkannte Empfehlung, aneroide Sphygmomanometer alle sechs Monate einer Routinekontrolle zu unterziehen, erscheint im Lichte der vorliegenden Studie als unzureichend.SummaryAll 832 hospital hand-held aneroid sphygmomanometers without exception were examined for their accuracy within a ± 3 mmHg margin by comparing them to a certified mercury device. Of these, 59.9% were inaccurate, with the majority giving lower readings than noted on the mercury scale. The findings are unsatisfactory and correspond to earlier reports whose study designs and interpretations of permissible limits varied widely. The instruments daily wear and tear is compounded by damage incurred by dropping and/or jolting, which could render the device inaccurate. Although it is generally recommended that aneroid manometers be inspected every six months, this seems not to be adequate.