Pamela H. Lennox

Sedation and analgesia in the interventional radiology department.

Administration of sedation and analgesia in the interventional radiology suite is often necessary during painful diagnostic and therapeutic procedures. Although sedative and analgesic agents are generally safe, catastrophic complications related to their use can occur, often as a result of incorrect drug administration or inadequate patient monitoring. The incidence of adverse outcomes related to provision of sedation and analgesia can be reduced with improved understanding of the pharmacology of these medications, by providing adequate monitoring to sedated patients, by recognizing patients who are at increased risk of experiencing an adverse drug reaction, and by early and appropriate management of complications.

Small-Dose Selective Spinal Anesthesia for Short-Duration Outpatient Laparoscopy: Recovery Characteristics Compared with Desflurane Anesthesia

We conducted a randomized controlled trial to compare the recovery characteristics of selective spinal anesthesia (SSA) and desflurane anesthesia (DES) in outpatient gynecological laparoscopy. Twenty ASA physical status I patients undergoing gynecological laparoscopy were randomized to receive either SSA with lidocaine 10 mg + sufentanil 10 &mgr;g or general anesthesia with DES and N2O. Intraoperative conditions, recovery times, postanesthesia recovery scores, and postoperative outcomes were recorded. Intraoperative conditions were comparable in both groups. All patients in the SSA group were awake and oriented at the end of surgery, whereas patients in the DES group required 7 ± 2 min for extubation and orientation. SSA patients had a significantly shorter time to straight leg raising (3 ± 1 min versus 9 ± 4 min;P < 0.0001) and to ambulation (3 ± 0.9 min versus 59 ± 16 min;P < 0.0001) compared with the DES group. SSA patients had significantly less postoperative pain than DES patients (P < 0.05). We concluded that SSA was an effec-tive alternative to DES for outpatient gynecological laparoscopy.

Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: A pharmacoeconomic comparison

We compared the cost and effectiveness of selective spinal anesthesia (SSA) with a desflurane-based general anesthetic (DES) for outpatient gynecological laparoscopy. A prospective analysis was undertaken of 10 patients randomized to receive SSA and compared with 10 patients randomized to receive DES. The groups were well matched in their demographic characteristics. The mean cost (in 2000 Canadian dollar values) of anesthesia supplies, drugs, and nursing for the SSA group of

Herbal medicine use is frequent in ambulatory surgery patients in Vancouver Canada

62.31 was less than that for the DES group of

Selective spinal anesthesia for outpatient transurethral prostatectomy (TURP): randomized controlled comparison of chloroprocaine with lidocaine

92.31 (P < 0.01). Recovery costs of both groups were similar. Time to administer anesthesia and time spent in the postanesthetic care unit were also similar. Postoperative analgesia was required by 50% of the DES group but in no patient receiving SSA (P < 0.01). SSA is a cost-effective alternative to DES in these patients.

Pain and anxiety: two problems, two solutions.

PurposeTo determine the incidence and nature of herbal medicine use among patients in a busy Canadian surgical day care unit.MethodsWe undertook a prospective survey of 575 patients attending our surgical day care unit. The questionnaire inquired as to basic demographics, herbal medicine use, the name and number of herbal medicines used, reason, whether it was self prescribed or not, and if the patient’s family physician was aware of the use. In the second part of the study, 44 anesthesiologists were asked to answer a questionnaire of 27 yes/no questions to determine their knowledge of herbal medicines.ResultsFour hundred eighty-five of 575 patients completed the questionnaire (84%). Thirty-four percent of patients surveyed in our unit responded affirmatively to herbal medicine use. Of these, 39% took them on a daily basis. Forty-five different identifiable herbs were being taken in total, with echinacea being the most common. Less than half of the patients told their family physicians that they were using herbal medicines and only one-third of patients were taking them on the advice of their physician. In the assessment of anesthesiologists’ knowledge of herbal medicine, only 32% of the questions were answered correctly.ConclusionThe incidence of herbal medicine ingestion by patients coming to our unit was higher than previously reported. A large variety of preparations were being taken, many without the knowledge of the patient’s family physician. The basic knowledge of anesthesiologists with respect to herbal medicine is limited.RésuméObjectifDéterminer l’incidence et la nature des plantes médicinales utilisées par les patients d’une unité canadienne de chirurgie d’un jour très occupée.MéthodeNous avons réalisé une enquête prospective auprès de 575 patients traités à notre unité de chirurgie d’un jour. Le questionnaire recherchait les caractéristiques de base des patients, l’usage de plante médicinale, le nom et le nombre de plantes utilisées ainsi que la raison de leur emploi. On demandait si elles avaient été prescrites ou non et si le médecin de famille du patient était au courant de leur usage. Dans la seconde partie de l’étude, 44 anesthésiologistes ont répondu à un questionnaire de 27 questions par oui ou non pour tester leur connaissance des plantes médicinales.RésultatsQuatre cent quatre-vingt-cinq (485) des 575 patients ont rempli le questionnaire (84 %). Trente-quatre pour cent des patients enquêtés ont répondu avoir utilisé des plantes médicinales. Parmi eux, 39 % les prenaient quotidiennement. Quarante-cinq plantes différentes et identifiables étaient prises dont l’échinacée surtout. Moins de la moitié des patients avaient mis leur médecin de famille au courant et seulement un tiers suivait un avis de leur médecin. Les anesthésiologistes n’ont fourni que 32 % de réponses correctes au questionnaire sur les plantes médicinales.ConclusionL’incidence de prise de plantes médicinales par les patients fréquentant notre unité de chirurgie ambulatoire a été plus élevée que prévu. Une grande variété de préparations a été prise dont beaucoup n’étaient pas connues du médecin de famille du patient. Les connaissances de base des anesthésiologistes sur les plantes médicinales sont limitées.

Relevance of the postoperative quality recovery score to discharge readiness.

This is a study comparing two short‐acting local anesthetics lidocaine and 2‐chloroprocaine in combination with fentanyl, to provide selective spinal anesthesia for outpatient transurethral resection of the prostate (TURP).

A Pulsatile Pressure Waveform Is a Sensitive Marker for Confirming the Location of the Thoracic Epidural Space

tional radiology patients. In this issue of JVIR, Schupp and colleagues (7) describe the administration of a questionnaire to determine preprocedural anxiety levels and demonstrate the impact of anxiety on drug requirements, pain, and anxiety during the procedure and the effectiveness of differing methods of supportive care. The knowledge provided by this study will hopefully improve the ability of interventional radiology practitioners to administer anxiolysis and analgesia (pharmacologic and nonpharmacologic) in a more effective and patientdriven manner.

A continuous perineural infusion of local anesthetic provides effective post-operative pain management after lower limb amputation

To the Editor: The study by Royse et al. on the postoperative quality recovery score is interesting because it attempts to address the patient’s perspective in some manner. Researchers have not paid much attention to the patient’s opinion in the development of postoperative assessment tools. This may be important because, for instance, after laparoscopic cholecystectomy, most patients believed that they were not ready for discharge while nursing staff had the opposite view. In a prospective study of 194 outpatients, when patients determined their own discharge readiness, the time they felt discharge ready was significantly shorter than the actual time they were discharged based on nursing assessments. In light of these findings, we suggest that perhaps the patients’ input should be considered with a view to improving the relevance of the postoperative quality recovery score. We believe that the patient’s opinion is crucial and deserves a greater weighting in the “physiology domain” of the postoperative quality recovery score. In addition, we question the relevance of items that assess functional recovery from actual surgery as being too simplistic. The surgical literature has more sophisticated tools that are surgery specific (e.g., the Constance score for shoulder surgery). Perhaps consideration should be given to underweighting items that pertain to functional recovery from surgery.