Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia

Background. The aim of this study was to assess postoperativepatient well-being after total i.v. anaesthesia compared withinhalation anaesthesia by means of validated psychometric tests. Methods. With ethics committee approval, 305 patients undergoingminor elective gynaecologic or orthopaedic interventions wereassigned randomly to total i.v. anaesthesia using propofol orinhalation anaesthesia using sevoflurane. The primary outcomemeasurement was the actual mental state 90 min and 24 h afteranaesthesia assessed by a blinded observer using the AdjectiveMood Scale (AMS) and the State-Trait-Anxiety Inventory (STAI).Incidence of postoperative nausea and vomiting (PONV) and postoperativepain level were determined by Visual Analogue Scale (VAS) 90min and 24 h after anaesthesia (secondary outcome measurements).Patient satisfaction was evaluated using a VAS 24 h after anaesthesia. Results. The AMS and STAI scores were significantly better 90min after total i.v. anaesthesia compared with inhalation anaesthesia(P=0.02, P=0.05, respectively), but equal 24 h after both anaesthetictechniques (P=0.90, P=0.78, respectively); patient satisfactionwas comparable (P=0.26). Postoperative pain was comparable inboth groups 90 min and 24 h after anaesthesia (P=0.11, P=0.12,respectively). The incidence of postoperative nausea was reducedafter total i.v. compared with inhalation anaesthesia at 90min (7 vs 35%, P<0.001), and 24 h (33 vs 52%, P=0.001). Conclusion. Total i.v. anaesthesia improves early postoperativepatient well-being and reduces the incidence of PONV. Br J Anaesth 2003; 91: 631–7     

Release by hypoxia of a soluble vasoconstrictor from rabbit small pulmonary arteries

Background. Soluble pulmonary vasoconstrictors released in responseto hypoxia have been reported in pig and rat preparations, butnot in rabbit preparations. Methods. We used myography to evaluate the contribution of asoluble factor to constriction in rabbit small pulmonary arteries(external diameter 300–475 µm) exposed to 45 minhypoxia (PO₂=9 mm Hg). Results. Hypoxia produced gradually intensifying constriction.Return to euoxia (PO₂=145 mm Hg) for 30 min relaxed onlyapproximately 30% of the constriction, whereas elution of themyograph bath yielded full relaxation. Reapplication of theeluent gradually restored the constriction to its pre-elutionlevel over a 30-min period. Conclusions. In this closed system, a soluble factor contributessubstantially to hypoxic pulmonary vasoconstriction. Br J Anaesth 2003; 91: 592–4     

Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 ml kg(-1)

Background. I.V. fluid administration has been shown to reducepostoperative nausea and vomiting (PONV). The optimum dose isunknown. We tested the hypothesis that administration of i.v.crystalloid of 30 ml kg^–1 would reduce the incidence ofPONV compared with 10 ml kg^–1 of the same fluid. Methods. A total of 141 ASA I female patients undergoing electivegynaecological laparoscopy were randomized, in double-blindfashion, to receive either 10 ml kg^–1 (n=71; CSL-10 group)or 30 ml kg^–1 (n=70; CSL-30 group) of i.v. compound sodiumlactate (CSL). Results. In the first 48 h after anaesthesia, the incidenceof vomiting was lower in the CSL-30 group than in the CSL-10group (8.6% vs 25.7%, P=0.01). Anti-emetic use was less in theCSL-30 group at 0.5 h (2.9% vs 14.3%, P=0.04). The incidenceof severe nausea was significantly reduced in the treatmentgroup at awakening (2.9% vs 15.7%, P=0.02), 2 h (0.0% vs 8.6%,P=0.04) and cumulatively (5.7% vs 27.1%, P=0.001). The numbersneeded to treat to prevent vomiting, severe nausea and antiemeticuse in the first 48 h were 6, 5 and 6, respectively. Conclusion. I.V. administration of CSL 30 ml kg^–1 to healthywomen undergoing day-case gynaecological laparoscopy reducedthe incidence of vomiting, nausea and anti-emetic use when comparedwith CSL 10 ml kg^–1.     

Gabapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation

Background. Laryngoscopy and tracheal intubation increase bloodpressure and heart rate (HR). The aim of the present study wasto investigate the effect of gabapentin when given before operationon the haemodynamic responses to laryngoscopy and intubation. Methods. Forty-six patients undergoing abdominal hysterectomyfor benign disease were randomly allocated to receive gabapentin1600 mg or placebo capsules at 6 hourly intervals starting theday (noon) before surgery. Anaesthesia was induced with propofoland cis-atracurium. Systolic, diastolic arterial blood pressures(SAP, DAP) and heart rate (HR) were recorded before and afterthe anaesthetic and 0, 1, 3, 5 and 10 min after tracheal intubation. Results. SAP was significantly lower in the gabapentin vs thecontrol group 0, 1, 3, 5 and 10 min after intubation [128 (27)vs 165 (41), P=0.001, 121 (14) vs 148 (29), P=0.0001, 115 (13)vs 134 (24), P=0.002, 111 (12) vs 126 (19), P=0.004 and 108(12) vs 124 (17), P=0.001 respectively]. DAP also was lowerin the gabapentin group 0, 1, 3, and 10 min after intubation[81 (18) vs 104 (19), P=0.0001, 77 (9) vs 91 (16), P=0.001,71 (10) vs 84 (13), P=0.001 and 67 (10) vs 79 (12), P=0.004].HR did not differ between the two groups at any time [82 (11)vs 83 (15), 79 (10) vs 80 (12), 86 (17) vs 92 (10), 82 (11)vs 88 (10), 81 (12) vs 81 (11), 77 (13) vs 79 (13), and 75 (15)vs 78 (12)]. Conclusion. Gabapentin, under the present study design attenuatesthe pressor response but not the tachycardia associated withlaryngoscopy and tracheal intubation.     

Effects of halothane on action potential configuration in sub-endocardial and sub-epicardial myocytes from normotensive and hypertensive rat left ventricle

Background. Halothane shortens ventricular action potentialduration (APD), as a consequence of its inhibitory effects ona variety of membrane currents, an effect that is greater insub-endocardial than sub-epicardial myocytes. In hypertrophiedventricle, APD is prolonged as a consequence of electrical remodelling.In this study, we compared the effects of halothane on transmuralAPD in myocytes from normal and hypertrophied ventricle. Methods. Myocytes were isolated from the sub-endocardium andsub-epicardium of the left ventricle of spontaneously hypertensive(SHR) and normotensive Wistar-Kyoto (WKY) rats. Action potentialswere recorded before, during, and after a 1-min exposure to0.6 mM halothane and APD measured from the peak of the actionpotential to repolarization at –50 mV (APD_{–50 mV}).Data are presented as mean (SEM). Results. In WKY myocytes, halothane reduced APD_{–50 mV}from 21 (2) to 18 (2) ms (P<0.001, n=15) in sub-epicardialmyocytes but abbreviated APD_{–50 mV} to a greater extentin sub-endocardial myocytes (37 (4) to 28 (3) ms; P<0.001,n=14). In SHR myocytes, APD_{–50 mV} values were prolongedcompared with WKY and APD_{–50 mV} was reduced by halothanefrom 36 (6) to 27 (4) ms (P<0.016) and from 77 (10) to 38(4) ms (P<0.001) in sub-epicardial and sub-endocardial myocytes,respectively. Conclusions. In the SHR, hypertrophic remodelling was not homogeneous;APD_{–50 mV} was prolonged to a greater extent in sub-endocardialthan sub-epicardial cells. Halothane reduced APD to a greaterextent in sub-endocardium than sub-epicardium in both WKY andSHR but this effect was larger proportionately in SHR myocytes.The transmural gradient of repolarization was reduced in WKYand effectively abolished in SHR by halothane, which might disturbnormal ventricular repolarization. Br J Anaesth 2003; 90: 501–3     

Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy

Background. Pregnancy is associated with a higher spread ofsubarachnoid anaesthesia and increased pain threshold. The studywas designed to assess the spread of subarachnoid block andthe intra- and postoperative analgesic requirements in pregnantvs non-pregnant women. Methods. We assessed the level of subarachnoid anaesthesia after1.8 ml of hyperbaric lidocaine 5% and the postoperative analgesicrequirements in women undergoing Caesarean section and undergoingabdominal hysterectomy (30 each group). Intraoperatively epiduralropivacaine was given as required. All patients received 10ml of ropivacaine 0.2% epidurally 2, 10, and 24 h after operationand the VAS pain score was assessed. They also had access topatient controlled analgesia i.v. morphine. Results. Duration of surgery was 64 (13.7) vs 127 (33.8) min(P<0.0001) in the pregnant and non-pregnant groups. Ten minutesafter subarachnoid injection, sensory block was higher by threedermatomes in the pregnant group (P<0.0001). Time to firstropivacaine dose was 37 (19.7) vs 19 (12.2) min (P<0.001)and the ropivacaine normalized for the duration of anaesthesiawas 0.8 (0.6) vs 1.3 (0.5) mg^–1 (P=0.001) in the pregnantand non-pregnant groups, respectively. The time between thefirst and second ropivacaine dose was similar in the two groups(P=0.070). Fewer pregnant women (81 vs 100%) required ropivacaineintraoperatively (P=0.017). The VAS scores were similar butparturients consumed more i.v. morphine (33 (14) vs 24 (12)mg, P=0.016) during the first 24 h after operation. Conclusions. Pregnant patients exhibited a higher level of subarachnoidsensory block and required more i.v. morphine after operation.     

Articaine versus lidocaine plus bupivacaine for peribulbar anaesthesia in cataract surgery

Background. We compared the efficacy and safety of articaine2% with a mixture of lidocaine 2% and bupivacaine 0.5% withouthyaluronidase for peribulbar anaesthesia in cataract surgery. Method. In this double-blind randomized clinical study, 58 cataractpatients were allocated to receive either articaine 2% withepinephrine 1:200 000 or a mixture of equal parts of lidocaine2% with epinephrine 1.25:100 000 and bupivacaine 0.5%. Ocularand eyelid movement scores, the number of supplementary injections,total volume of solution used and pain and complications duringinjection and surgery were used as clinical end-points. Results. Articaine produced greater akinesia after 5 min (P=0.03).Eighteen patients (60%) in the articaine group and 26 (93%)in the lidocaine/bupivacaine group required a second injection(P=0.003). A third injection was needed by two patients (7%)in the articaine group and 12 (43%) in the lidocaine/bupivacainegroup (P=0.001). The total mean volume of local anaestheticrequired to achieve akinesia was mean 9.4 (SD 1.7) ml in thearticaine group and 11.28 (1.86) ml in the lidocaine/bupivacainegroup (P<0.001). Median pain score was lower in the articainegroup than in lidocaine/bupivacaine group during injection (P=0.004)and surgery (P=0.014). There was no difference between the groupsfor the incidence of complications. Conclusion. Articaine 2% without hyaluronidase is more advantageousthan a mixture of lidocaine 2% and bupivacaine 0.5% withouthyaluronidase for peribulbar anaesthesia in cataract surgery. Br J Anaesth 2004; 92: 231–4     

The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy

Background. Although epidural opioids have excellent analgesicproperty, their side-effects limit its use in patient-controlledepidural analgesia (PCEA). This study was designed to compareside-effects of epidural sufentanil in ropivacaine with thatof morphine in ropivacaine focusing on lower urinary tract functionafter major abdominal surgery. Methods. In total 60 patients undergoing gastrectomy were randomlyallocated to receive either sufentanil in ropivacaine (GroupS, n=30) or morphine in ropivacaine (Group M, n=30) for theirPCEA. Epidural catheter was inserted between the 7th and 8ththoracic spine. Visual analogue pain score and side-effectssuch as nausea, vomiting, pruritus, hypotension and urinaryretention were evaluated during postoperative days (PODs) 1and 2 in the postanaesthetic care unit. Results. The incidence of serious to major micturition problemin Group S was lower than that in Group M (P<0.001). Theincidence of pruritus, nausea and vomiting was also lower inGroup S than in Group M on POD 1. Conclusions. The lower incidence of major/serious micturitionproblem in patients receiving sufentanil in ropivacaine thoracicepidural analgesia suggests that continuation of urinary drainagemay not be necessary from POD 1 onwards.     

Comparison of ropivacaine 0.5% (in glucose 5%) with bupivacaine 0.5% (in glucose 8%) for spinal anaesthesia for elective surgery

Background. Hyperbaric solutions of ropivacaine have been usedsuccessfully to provide spinal anaesthesia. This study was designedto compare the clinical efficacy of hyperbaric ropivacaine withthat of the commercially available hyperbaric preparation ofbupivacaine. Methods. Forty ASA grade I–II patients undergoing lower-abdominal,perineal or lower-limb surgery under spinal anaesthesia wererecruited and randomized to receive ropivacaine 5 mg ml^–1(with glucose 50 mg ml^–1), 3 ml or bupivacaine 5 mg ml^–1(with glucose 80 mg ml^–1), 3 ml. The level and durationof sensory block, intensity and duration of motor block, andtime to mobilize and micturate were recorded. Patients wereinterviewed at 24 h and at 1 week to identify any residual problems. Results. All blocks were adequate for the proposed surgery,but there were significant differences between the two groupsin mean time to onset of sensory block at T10 (ropivacaine 5min; bupivacaine 2 min; P<0.005), median maximum extent (ropivacaineT7; bupivacaine T5; P<0.005) and mean duration of sensoryblock at T10 (ropivacaine 56.5 min; bupivacaine 118 min; P=0.001).Patients receiving ropivacaine mobilized sooner (ropivacainemean 253.5 min; bupivacaine 331 min; P=0.002) and passed urinesooner (ropivacaine mean 276 min; bupivacaine 340.5 min; P=0.01)than those receiving bupivacaine. More patients in the bupivacainegroup required treatment for hypotension (>30% decrease insystolic pressure; P=0.001). Conclusions. Ropivacaine 15 mg in glucose 50 mg ml^–1 providesreliable spinal anaesthesia of shorter duration and with lesshypotension than bupivacaine. The recovery profile for ropivacainemay be of interest given that more surgery is being performedin the day-case setting. Br J Anaesth 2003; 90: 304–8     

Relevance of Anxiety and Stress Levels on Sleep Quality After Liver Transplantation

The goal of this study was to assess the effects of anxiety and stress on sleep quality in liver transplantation recipients. A prospective cross-sectional study was performed including 45 recipients enrolled at a liver transplantation program at Ribeirão Preto, State of São Paulo, Brazil. Anxiety and stress were evaluated by using a reduced version of the State-Trait Anxiety Inventory and the Perceived Stress Scale, respectively. Sleep quality and excessive daytime sleepiness were evaluated by using the Brazilian Portuguese versions of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. Thirty-two (71.11%) recipients presented with compromised sleep quality and 5 (11.11%) presented with excessive daytime sleepiness. Recipients with bad sleep quality had anxiety (mean, 26.91 points) and stress (mean, 17.88 points) levels that were higher than the levels of patients with normal sleep quality patterns, with anxiety levels presenting with statistically significant differences (P = .0420). Patients with above-average stress levels also had increased anxiety (mean, 28 points) and compromised sleep quality (mean, 7.03 points). In conclusion, a liver transplantation recipient who experiences bad sleep quality also has higher levels of anxiety and stress, suggesting a relationship between the sleep–wakefulness cycle and anxiety/stress. Planning strategies aimed at reducing such emotional shifts among recipients is of paramount importance. Therefore, new strategies focusing on improving the sleep pattern of patients are necessary because unhealthy sleep behavior may impair postoperative recovery.     

The analgesic effect of lornoxicam when added to lidocaine for intravenous regional anaesthesia

Background. The aim of the study was to evaluate the effectof lornoxicam (L) on sensory and motor block onset time, tourniquetpain, and postoperative analgesia, when added to lidocaine inintravenous regional anaesthesia (IVRA). Methods. Forty-five patients undergoing hand surgery were randomlyand blindly divided into three groups as to receive either i.v.saline and IVRA with lidocaine 0.5% (Control group, n=15), i.v.saline and IVRA lidocaine 0.5% with lornoxicam (L-IVRA group,n=15), or intravenous lornoxicam and IVRA lidocaine 0.5% (L-IVgroup, n=15). Sensory and motor blocks onset time, and tourniquetpain was measured after tourniquet application at 5, 10, 20,and 30 min, and analgesic use were recorded during operation.After the tourniquet deflation, at 1, 30 min, and 2, 4 h, visualanalogue scales score, the time to first analgesic requirement,total analgesic consumption in first 24 h, and side effectswere noted. Results. Sensory and motor block onset times were shorter andthe recovery time prolonged in the Group L-IVRA compared withthe other group (P=0.001). A decreased tourniquet pain, a prolongedtime first analgesic requirement [229 (85) min vs 28 (20) and95 (24) min, P=0.0038) and less postoperative analgesic requirementsduring 24 h were found in Group L-IVRA compared with the othergroups (P<0.05). Conclusions. The addition of lornoxicam to lidocaine for intravenousregional anaesthesia shortens the onset of sensory and motorblock, decreases tourniquet pain and improves postoperativeanalgesia without causing any side effect.     

Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement

Background. Total knee arthroplasty (TKA) is often carried outusing a tourniquet and shed blood is collected in drains. Tranexamicacid decreases the external blood loss. Some blood loss maybe concealed, and the overall effect of tranexamic acid on thehaemoglobin (Hb) balance is not known. Methods. Patients with osteoarthrosis had unilateral cementedTKA using spinal anaesthesia. In a double-blind fashion, theyreceived either placebo (n=24) or tranexamic acid 10 mg kg^–1(n=27) i.v. just before tourniquet release and 3 h later. Thedecrease in circulating Hb on the fifth day after surgery, aftercorrection for Hb transfused, was used to calculate the lossof Hb in grams. This value was then expressed as ml of bloodloss. Results. The groups had similar characteristics. The medianvolume of drainage fluid after placebo was 845 (interquartilerange 523–990) ml and after tranexamic acid was 385 (331–586)ml (P<0.001). Placebo patients received 2 (0–2) unitsand tranexamic acid patients 0 (0–0) units of packed redcells (P<0.001). The estimated blood loss was 1426 (1135–1977)ml and 1045 (792–1292) ml, respectively (P<0.001).The hidden loss of blood (calculated as loss minus drainagevolume) was 618 (330–1347) ml and 524 (330–9620)ml, respectively (P=0.41). Two patients in each group developeddeep vein thrombosis. Conclusions. Tranexamic acid decreased total blood loss by nearly30%, drainage volume by     

Emergence delirium in adults in the post-anaesthesia care unit

Background. Emergence delirium in the post-anaesthesia careunit (PACU) is poorly understood. The goal of this prospectivestudy was to determine frequency and risk factors of emergencedelirium in adults after general anaesthesia. Methods. In this prospective study, 1359 consecutive patientswere included. Contextual risk factors and occurrence of deliriumaccording to the Riker sedation scale were documented. Groupswere defined for the analysis according to the occurrence ornot of agitation, then after exclusion of patients with preoperativeanxiety and neuroleptics, or both, and antidepressants or benzodiazepinestreatments. Results. Sixty-four (4.7%) patients developed delirium in thePACU, which can go from thrashing to violent behaviour and removalof tubes and catheters. Preoperative anxiety was not found tobe a risk factor. Preoperative medication by benzodiazepines(OR=1.910, 95% CI=1.101–3.315, P=0.021), breast surgery(OR=5.190, 95% CI=1.422–18.947, P=0.013), abdominal surgery(OR=3.206, 95% CI=1.262–8.143, P=0.014), and long durationof surgery increased the risk of delirium (OR=1.005, 95% CI=1.002–1.008,P=0.001), while a previous history of illness and long-termtreatment by antidepressants decreased the risk (respectively,OR=0.544, 95% CI=0.315–0.939, P=0.029 and OR=0.245, 95%CI=0.084–0.710, P=0.010). Conclusions. Preoperative benzodiazepines, breast and abdominalsurgery and surgery of long duration are risk factors for emergencedelirium.     

Effect of three anaesthetic techniques on isometric skeletal muscle strength

Background. Our aim was to quantify human involuntary isometricskeletal muscle strength during anaesthesia with propofol, sevoflurane,or spinal anaesthesia using bupivacaine. Methods. Thirty-three healthy patients undergoing anaesthesiafor elective lower limb surgery were investigated. Twenty-twopatients received a general anaesthetic with either propofol(n=12) or sevoflurane (n=10); for the remaining 11 patientsspinal anaesthesia with bupivacaine was used. We used a non-invasivemuscle force assessment system before and during anaesthesiato determine the contractile properties of the ankle dorsiflexormuscles after peroneal nerve stimulation (single, double, triple,and quadruple stimulation). We measured peak torques; contractiontimes; peak rates of torque development and decay; times topeak torque development and decay; half-relaxation times; torquelatencies. Results. Males elicited greater peak torques than females, medians6.3 vs 4.4 Nm, respectively (P=0.0002, Mann-Whitney rank-sumtest). During sevoflurane and propofol anaesthesia, muscle strengthdid not differ from pre-anaesthetic values. During spinal anaesthesia,torques were diminished for single-pulse stimulation from 3.5to 2.0 Nm (P=0.002, Wilcoxon signed rank test), and for double-pulsefrom 7.6 to 5.6 Nm (P=0.02). Peak rates of torque developmentdecreased for single-pulse stimulation from 113 to 53 Nm s^–1and for double pulse from 195 to 105 Nm s^–1. Torque latencieswere increased during spinal anaesthesia. Conclusions. At clinically relevant concentrations, propofoland sevoflurane did not influence involuntary isometric skeletalmuscle strength in adults, whereas spinal anaesthesia reducedstrength by about 20%. Muscle strength assessment using a devicesuch as described here provided reliable results and shouldbe considered for use in other scientific investigations toidentify potential effects of anaesthetic agents. Br J Anaesth 2004; 92: 367–72     

Touch contamination levels during anaesthetic procedures and their relationship to hand hygiene procedures: a clinical audit

After different methods of hand preparation, volunteers rolledsegments of sterile central venous catheter between their fingertips,and bacterial transfer was evaluated by standardized quantitativeculture. The number of bacteria transferred differed betweenmethods (P<0.001). Comparisons were made with the controlgroup (no preparation at all; median, third quartile and maximumcount=6.5, 24, 55). Bacterial transfer was greatly increasedwith wet hands (1227, 1932, 3254; P<0.001). It was reducedwith a new rapid method, based on thorough drying with a combinationof 10 s using a cloth towel followed by either 10 or 20 s witha hot-air towel (0, 3, 7 and 0, 4, 30, respectively; P=0.007and 0.004, respectively). When asked to follow their personalroutines, 10 consultant anaesthetists used a range of methods.Collectively, these were not significantly better than control(7.5, 15, 55; P=0.73), and neither was an air towel alone (2.5,15, 80; P=0.176) nor the hospital’s standard procedure(0, 1, 500; P=0.035). If hand preparation is needed, an adequateand validated method should be used, together with thoroughhand drying. Br J Anaesth 2001; 87: 291–4     

Randomized,double-blind comparison of different inspired oxygen fractions during general anaesthesia for Caesarean section

Background. The optimal inspired oxygen fraction FI_O2 for fetaloxygenation during general anaesthesia for Caesarean sectionis not known. Methods. We randomized patients having elective Caesarean sectionto receive one of the following: FI_O2 0.3, FI_N2O 0.7 and end-tidalsevoflurane 0.6% (Group 30, n=20); FI_O2 0.5, FI_N2O 0.5 and end-tidalsevoflurane 1.0% (Group 50, n=20), or FI_O2 1.0 and end-tidalsevoflurane 2.0% (Group 100, n=20) until delivery. Neonataloutcome was compared biochemically and clinically. Results. At delivery, for umbilical venous blood, mean PO₂ wasgreater in Group 100 (7.6 (SD 3.7) kPa) compared with both Group30 (4.0 (1.1) kPa, P<0.0001) and Group 50 (4.7 (0.9) kPa,P=0.002) and oxygen content was greater in Group 100 (17.2 (1.6)ml dl^–1) compared with both Group 30 (12.8 (3.6) ml dl^–1,P=0.0001) and Group 50 (13.8 (2.6) ml dl^–1, P=0.0001).For umbilical arterial blood, PO₂ was greater in Group 100 (3.2(0.4) kPa) compared with Group 30 (2.4 (0.7) kPa, P=0.003),and in Group 50 (2.9 (0.8) kPa) compared with Group 30 (2.4(0.7) kPa, P=0.04); oxygen content was greater in Group 100(10.8 (3.5) ml dl^–1) than in Group 30 (7.0 (3.0) ml dl^–1,P<0.01). Apgar scores, neonatal neurologic and adaptive capacityscores, and maternal arterial plasma concentrations of epinephrineand norepinephrine before induction and at delivery were similaramong groups. No patient reported intraoperative awareness. Conclusions. Use of FI_O2 1.0 during general anaesthesia forelective Caesarean section increased fetal oxygenation. Br J Anaesth 2002; 89: 556–61     

Influence of working conditions on job satisfaction in anaesthetists

Background. We studied job satisfaction, physical health, emotionalwell-being and working conditions in 125 Austrian and Swissanaesthetists. Methods. Responses to self-reporting questionnaires were evaluated.Dependent variables included job satisfaction, emotional well-beingand physical health. Independent variables included age, sex,marital status, position and working conditions as assessedby the Instrument for Stress-related Job Analysis. Results. Control over work shows a strong effect on job satisfactionin anaesthetists, for example influence on handling tasks (P=0.001),time control (P=0.002) and participation (P=0.001), whereastask demands and task-related problems did not have any effect.Anaesthetists in leading positions and specialists reportedlower job satisfaction (P=0.012) than did anaesthetists in non-leadingpositions. Job satisfaction was associated with better physicalhealth (P=0.001) and better emotional well-being (P=0.005). Conclusions. Our results suggest that a high level of job satisfactionin anaesthetists correlates with interesting work demands andthe opportunity to contribute skills and ideas. To improve jobsatisfaction, more attention should be paid to improving workingconditions, including control over decision-making, and allowinganaesthetists to have more influence on their own work paceand work schedule.     

Adjunctive analgesia with intravenous propacetamol does not reduce morphine-related adverse effects

Background. Propacetamol is widely used in the management ofpostoperative pain. It decreases morphine requirements but itseffect on the incidence of morphine-related adverse effectsremains unknown. Methods. Patients (550) were randomly assigned to receive propacetamolor a placebo over the first 24 h after operation in a blindedstudy. Intravenous morphine titration was performed, after whichmorphine was administered s.c. every 4 h according to theirpain score. Pain was assessed using a visual analogue scale(VAS). The primary end-point was the incidence of morphine-relatedadverse effects. The main secondary end-points were morphinerequirements and VAS score. Results. After morphine titration, the VAS score and the numberof patients with pain relief did not differ between groups.Morphine requirements were decreased in the propacetamol group(21 vs 14.5 mg, P<0.001) but the incidence of morphine-relatedadverse effects did not differ between groups (42 vs 46%, notsignificant). In patients with moderate pain (n=395), morphinerequirements decreased by 37% (P<0.001) and the percentageof patients requiring no morphine was greater (21 vs 8%, P=0.002)in the propacetamol group. In patients with severe pain (n=155),morphine requirements decreased by 18% (P=0.04) in the propacetamolgroup and the number of patients who did not require morphine(3 vs 8%) did not differ significantly. Conclusions. Although propacetamol induced a small morphine-sparingeffect, it did not change the incidence of morphine-relatedadverse effects in the postoperative period. Moreover, no benefitcould be demonstrated in patients with severe postoperativepain. Br J Anaesth 2003; 90: 314–19