Lalage Sanders

Propofol in short gynaecological procedures : comparison of recovery over 2 days after anaesthesia with propofol or thiopentone as sole anaesthetic agent

Recovery was assessed over 48 hours after anaesthesia with propofol or thiopentone as sole anaesthetic agent in 36 unpremedicated gynaecological patients. Immediate recovery, as measured by the Steward scale, was shown to be quicker for the patients given propofol. At one hour postoperatively the thiopentone group showed impaired visual‐motor coordination on the aiming test (p < 0.01) and dexterity task (p < 0.05), and a slowing of reaction time (p < 0.01). Patients given propofol showed only an increase in reaction time (p < 0.05). By 2 hours the thiopentone group showed impairment only in the aiming task (p < 0.05). No further significant impairment was detected at 4, 24 or 48 hours. However, patients reported symptoms throughout the 48 hours indicative of residual drug effects. There was a substantial practice effect with some tests which may have obscured impairment. It can be argued therefore that the better recovery profile after propofol is still evident at 24 hours.

Measuring academic behavioural confidence: the ABC scale revisited

The Academic Behavioural Confidence (ABC) scale has been shown to be valid and can be useful to teachers in understanding their students, enabling the design of more effective teaching sessions with large cohorts. However, some of the between‐group differences have been smaller than expected, leading to the hypothesis that the ABC scale many not be unidimensional and that inherent subscales may be behaving in different ways, reducing the size of anticipated ABC effects. This study aimed to analyse the factor structure of the ABC scale. Pre‐existing data sets were combined into a large composite data set (n = 865) of undergraduate student respondents to the ABC scale. Exploratory factor analyses using SPSS, and confirmatory factor analysis in AMOS, were carried out. A reduced, 17‐item ABC scale can be considered as having four factors, grades, verbalising, studying and attendance. From the data sets, the discriminative power of the factor structure has been confirmed, with the results providing further criterion validity of the ABC scale.

Stressful pre-operative preparation procedures. The routine removal of dentures during pre-operative preparation contributes to pre-operative distress.

One hundred and twenty‐four patients (76 women and 48 men) were interviewed within the first 36 hours after operation. Fifty per cent of those studied were denture wearers. They were asked to fill in a questionnaire which registered their levels of distress about the various pre‐operative preparation procedures. The most common factors contributing to pre‐operative distress were waiting for transfer to the operating theatre, the prohibition of fluids and the removal of dentures.

The subjective effects of low-dose propofol A double-blind study to evaluate dimensions of sedation and consciousness with low-dose propofol

In this study the subjective effects (sedation and mood) of subanaesthetic doses of propofol were examined in 28 healthy male volunteers. A computer model was used to predict the infusion profiles necessary to obtain steady state propofol plasma concentrations of0.3μg.ml‐1, 0.6 μg.ml‐1, 0.9 μg.ml‐1. Objective measures of sedation from saccadic eye movement and choice reaction time gave significant dose responses at each level but a battery of psychometric tests failed to show dose‐related subjective responses. Of particular note in the subjective data is the lack of a difference between groups or even of a consistent trend within the data. This suggests that a low concentration of propofol in plasma does not induce euphoria or a sense of well‐being. The anecdotal evidence available for mood changes with propofol therefore remains unsubstantiated.

Interaction of H2-receptor antagonists and benzodiazepine sedation : a double-blind placebo-controlled investigation of the effects of cimetidine and ranitidine on recovery after intravenous midazolam

H2‐receptor antagonists differentially inhibit cytochrome P450 and this may affect the rate at which benzodiazepines are metabolised. However, it is not known whether this delayed clearance results in prolonged psychomotor impairment. In a randomised double‐blind trial 28 healthy volunteers received two single doses of midazolam (0.07 mg.kg−1) at an interval of one week during which they took cimetidine 400 mg, ranitidine 150 mg or placebo, each twice daily. Recovery from the benzodiazepine was monitored on each occasion over a 12 h period using a battery of psychometric tests. There was wide individual variation in performance; however, an overall measure of impairment indicated a significant difference at 2.5 h (p < 0.05), the cimetidine group having a high impairment score. This decrement appeared to be in cognitive and psychomotor functions and was not reflected in the subjective assessment.

Propofol-induced anaesthesia: double-blind comparison of recovery after anaesthesia induced by propofol or thiopentone

Postoperative psychomotor and cognitive recovery were assessed after anaesthesia induced by either propofol or thiopentone, and maintained with nitrous oxide and halothane in 40 unpremedicated dental patients. Performance was shown to be impaired one hour postoperatively for the whole sample in hand–ye coordination (p < 0.001), reaction time (p < 0.001) and digit span (p < 0.05). There was evidence of impairment at 3 hours postoperatively in reaction time (p < 0.05) and ataxia (p < 0.01). Performance also deteriorated in the dexterity and aiming tasks. Patients reported significantly less clumsiness by 24 hours in blurred vision and shivering (p < 0.05) and by 48 hours less coughing (p < 0.05). However, there was no significant difference between groups. No evidence showed that recovery in the propofol group was faster, so it was concluded that induction with propofol offered no advantage when anaesthesia is maintained with nitrous oxide and halothane for the periods of time reported in this study.

Reducing smoking : the effect of suggestion during general anaesthesia on postoperative smoking habits

In a double‐blind randomised trial, 122 female smokers undergoing elective surgery were allocated to receive one of two prerecorded messages while fully anaesthetised. The active message was designed to encourage them to give up smoking whilst the control message was the same voice counting numbers. No patient could recall hearing the tape. Patients were asked about their postoperative smoking behaviour one month later. Significantly more of those who had received the active tape had stopped or reduced their smoking (p < 0.01). This would suggest a level of preconscious processing of information.

Gender, Psychology Students and Higher Education:

Our interest in gender differences in orientation to academic study was prompted by an accumulation of anecdotal data that male and female students seem to behave differently in relation to their academic studies. In this paper, we will introduce some provoking pilot survey data from our Level 1 students (N = 126), set against a background literature which together suggest that Level 1 male undergraduate students in a psychology degree tend to have a different orientation to their studies from that of their female colleagues, a difference that is also perceived by their peers. From this, the implications for teaching psychology will be considered.

The impact of the appearance of the anaesthetist on the patient's perception of the pre-operative visit.

The clinicians appearance is often considered a symbol which identifies and defines specific characteristics of the individual. Opinion of both lay and medical personnel on appropriate clothing inclines towards formal dress. Our aim was to assess the effect of the anaesthetists appearance during a ward visit on the patients evaluation of either the visit or the anesthetist himself. In our sample of 66 patients we found no evidence that the style of dress (formal: suit and tie, informal: jeans and open‐necked shirt) affected that evaluation. However, when 138 patients were asked to rate the desirability of items of clothing for a male hospital doctor they expressed a preference for traditional clothing; a suit was rated as desirable and jeans as one of the four most undesirable items. We conclude that despite the conservatism of expressed opinions, the clothing worn by the anaesthetist is irrelevant to the patients satisfaction with the visit.

Detecting uncertainty, predicting outcome for first year students

Purpose – The purpose of this paper is to evaluate the use of two psychometric measures as predictors of end of year outcome for first year university students. Design/methodology/approach – New undergraduates (n=537) were recruited in two contrasting universities: one arts based, and one science, in different cities in the UK. At the start of the academic year, new undergraduates across 30 programmes in the two institutions were invited to complete a survey comprising two psychometric measures: Academic Behavioural Confidence scale and the Performance Expectation Ladder. Outcome data were collected from the examining boards the following summer distinguishing those who were able to progress to the next year of study without further assessment from those who were not. Findings – Two of the four Confidence subscales, Attendance and Studying, had significantly lower scores amongst students who were not able to progress the following June compared to those who did (p < 0.003). The Ladder data showed the less...