Simon Chan

Ropivacaine undergoes slower systemic absorption from the caudal epidural space in children than bupivacaine.

We compared the systemic absorption of ropivacaine and bupivacaine after caudal epidural administration in children. Twenty ASA physical status I or II children aged 1–7 yr undergoing elective hypospadias repair were randomized after the induction of general anesthesia to receive a single caudal epi

Randomized, double-blinded, placebo-controlled trial of intravenously administered hyoscine N-butyl bromide in patients undergoing colonoscopy with patient-controlled sedation.

BACKGROUND A prospective, double-blinded, placebo-controlled randomized trial was conducted to investigate the effect of the antispasmodic hyoscine N-butyl bromide (Buscopan) during colonoscopy. METHODS A total of 120 patients undergoing colonoscopy were randomized to receive either 40 mg of hyoscine N-butyl bromide (n=60) or normal saline solution (n=60) intravenously as premedication. Colonoscopy was performed under patient-controlled sedation. Outcome measures included cecal intubation and total procedure time, demanded and administered doses of patient-controlled sedation, spasm score, pain score, endoscopist satisfaction score, patient willingness to repeat colonoscopy, and vital signs (blood pressure, pulse rate) during colonoscopy. RESULTS Mean cecal intubation time in the hyoscine N-butyl bromide group was significantly longer than the control group (12.20 vs. 9.74 minutes; p=0.04; but correction for multiple testing of data removed this significance). The use of hyoscine N-butyl bromide was associated with a significantly lower endoscopist mean satisfaction score (6.47 vs. 7.30; p=0.04; but correction for multiple testing of data removed this significance), higher demanded and administered mean doses of patient-controlled sedation (respectively, 34.80 and 7.25 vs. 24.20 and 5.87; p=0.045; p=0.04, respectively; but correction for multiple testing of data removed these findings of significance), fewer patients willing to repeat colonoscopy (60% vs. 83.9%; p=0.005), and more hemodynamic instability (p<0.001) when compared with the control group. No significant difference was found in the total procedure time, spasm score, or pain score. CONCLUSIONS Premedication with intravenously administered hyoscine N-butyl bromide impedes colonoscope insertion and causes greater patient discomfort, as well as hemodynamic instability.

The analgesic efficacy of continuous wound instillation with ropivacaine after open hepatic surgery.

The analgesic efficacy of continuous local anaesthetic wound instillation after open hepatic surgery was evaluated. Forty‐eight patients scheduled for elective liver surgery were assigned to receive either ropivacaine 0.25% or saline infusion at 4 ml.h−1 for 68 h via two multi‐orifice indwelling catheters placed within the musculo‐fascial layer before skin closure; plasma ropivacaine concentrations were measured during the infusion. Supplemental analgesia was provided by intravenous patient‐controlled analgesia morphine. Patients in the ropivacaine group had decreased mean (SD) total morphine consumption (58 (30) mg vs 86 (44) mg, p = 0.01) and less pain at rest as well as after spirometry at 4, 12, 24, 48 and 72 h postoperatively (p < 0.01). Forced vital capacity was reduced postoperatively in both groups, but the reduction was greater in the saline group at 12 and 24 h (p = 0.03). The mean plasma concentration of ropivacaine increased to 2.05 (0.78) μg.ml−1 at the point when the infusion was terminated.

Economic evaluations of acute pain service programs: a systematic review.

ObjectiveThe purpose was to review the literature on the economic benefits associated with Acute Pain Service (APS) programs systematically. APSs have received widespread acceptance and formal support from institutions and organizations, but little is known about its economic benefits. MethodsMEDLINE and other databases were searched for economic evaluations of APSs. The study characteristics and methodological quality was assessed using standardized tools. All costs were adjusted to 2005 US dollars. ResultsTen economic evaluations (involving 14,774 patients) were identified that met eligibility criteria. There were wide variations in study designs, methodological quality, and outcome measures. There was insufficient data to identify which APSs model (anesthesiologist-based/nursing support or nurse-based/anesthesiologist supervised) was more cost-effective. The cost of APSs for surgical patients from direct and indirect effects (improved pain management from education in patients not receiving APS) varied from

The costs and benefits of extending the role of the acute pain service on clinical outcomes after major elective surgery.

2.28 to

Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation

5.08/patient/d. The level of evidence to support the cost-savings associated with APSs (shorter duration of intensive care unit and hospital stays) were limited to partial economic analyses. There was insufficient evidence to draw conclusions about the cost-effectiveness and cost-benefit of APSs as the quality of life and patients willingness to pay for an APS intervention were not measured, respectively. The overall quality of published economic evaluations of APSs was poor. ConclusionsThere is a lack of high-quality economic studies to support the cost-effectiveness and cost-benefits of APSs.

Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

BACKGROUND:Acute pain services have received widespread acceptance and formal support from institutions and organizations, but available evidence on their costs and benefits is scarce. Although there is good agreement on the provision of acute pain services after many major surgical procedures, there are other procedures for which the benefits are unclear. Data are required to justify any expansion of acute pain services. In this randomized, controlled clinical trial we compared the costs and effects of acute pain service care on clinical outcomes with conventional pain management on the ward. Patients included in the trial were considered by their anesthesiologist to have either arm be suitable for the procedure. METHODS:Four hundred twenty-three patients undergoing major elective surgery were randomized either to an anesthesiologist-led, nurse-based acute pain service group with patient-controlled analgesia or to a control group with IM or IV boluses of opioid analgesia. Both groups were treated with medications to treat opioid-related adverse effects and received the usual care from health professionals assigned to the ward. The main outcome measures were quality of recovery scores, pain intensity measures, global measure of treatment effectiveness, and overall pain treatment cost. Cost-effectiveness acceptability curves were drawn to detect a difference in the joint cost-effect relationship between groups. RESULTS:There was no difference in quality of recovery score on postoperative day 1 between treatment and control groups (mean difference, 0; 95% confidence interval [CI], −0.7 to 0.7; P = 0.94) or in the rate of improvement in quality of recovery score (mean difference, −0.1; 95% CI, −0.4 to 0.1; P = 0.34). The proportion of patients with 1 or more days of highly effective pain management was higher in the acute pain service group than in the control group (86% vs. 75%; P < 0.01). Costs were higher in the acute pain service group (mean difference, US

Spectral analysis of sudden bradycardia during intrathecal meperidine anesthesia

46; 95% CI,

A Retrospective Evaluation of Wireless Capsule Endoscopy: Determination of Factors That Influence Transit Time

44 to

Renal dysfunction and CABG.

48 per patient; P < 0.001). A cost-effectiveness acceptability curve showed that the acute pain service was more cost effective than was control for providing highly effective pain management if the decision maker was willing to pay more than US