TIME COURSE OF NEUROMUSCULAR EFFECTS AND PHARMACOKINETICS OF ROCURONIUM BROMIDE (ORG 9426) DURING ISOFLURANE ANAESTHESIA IN PATIENTS WITH AND WITHOUT RENAL FAILURE

We have studied the onset and duration of action and pharmacokineticsof rocuronium bromide (Org 9426) during anaesthesia with nitrousoxide, fentanyl and isoflurane after a single bolus dose ofrocuronium 0.6 mg kg^–1 in nine patients with chronic renalfailure requiring regular haemodialysis, and in nine healthycontrol patients. Blood samples were collected over 390 minand concentrations of rocuronium and its putative metabolitesmeasured using HPL C. Onset time for maximum block, durationof clinical relaxation (T1₂₅) and recovery index, were 61 (SD25.0) s and 65 (16.4) s, 55 (26.9) min and 42 (9.3) min and28 (12.3) min and 19 (8.8) min, respectively, for patients withand without renal failure. The time for TOF ratio to returnspontaneously to 0.7 was 99 (41.1) min and 73 (24.2) min, respectively,in the two groups. None of these differences was significant.The pharmacokinetic data were best described by a three-exponentialequation. There were significant differences between patientswith and without renal failure in the rates of clearance (2.5(1.1) ml kg^–1 min^–1 and 3.7(1.4) ml kg^–1 min^–1respectively) and the mean residence times (97.1 (48.7) minand 58.3(9.6) min) (P<0.05). The differences in other kineticparameters were not significant. We conclude that the effectsof rocuronium may be prolonged in patients with renal disease,because of a decreased clearance of the drug.     

EFFECT OF STIMULATION OF THE P6 ANTIEMETIC POINT ON POSTOPERATIVE NAUSEA AND VOMITING

The antiemetic action of stimulation of the P6 (Neiguan) acupuncture(ACP) point has been studied in women, premedicated with nalbuphine10 mg, undergoing minor gynaecological operations under methohexitonenitrousoxide-oxygen anaesthesia. Invasive ACP—manual or electricalat 10 Hz—applied for 5 min at the time of administrationof the premedication markedly reduced the incidence of vomitingand nausea in the first 6 h after operation, compared with untreatedcontrols. This did not occur with stimulation of a "dummy" ACPpoint outside the recognized ACP meridians. Non-invasive methods(stimulation via a conducting stud or by pressure) were equallyas effective as invasive ACP during the early postoperativeperiod. However, both these non-invasive approaches were lesseffective than invasive ACP in the 1–6 h postoperativeperiod, although each was as effective as two standard antiemetics(cyclizine 50 mg, metoclopramide 10 mg). In view of the totalabsence of any side effects in more than 500 ACP procedures,the clinical applications of this finding are worthy of furtherstudy.     

TRANSITION QUESTIONS TO ASSESS OUTCOMES IN RHEUMATOID ARTHRITIS

The importance of patient-based assessments of outcomes of carein RA is increasingly recognized. There are a number of methodsof gaining such data. One method is to request patients to assesschange in health status by means of transition questions. Thisis considered advantageous to other methods because it directlyaddresses perceptions of change over time and is short and simple.One hundred patients with RA completed a range of clnical, laboratoryand health status assessments on two occasions 3 months apart.On the second occasion they also completed a transition question.Results show the question to be valid and to correlate witha number of different changes obtained from assessments. Psychologicalmood did not appear to iniluence transition judgements. A smallminority of patients experienced changes for specific dimensionsof health status in the opposite direction of the transitionitem. Transition judgements may have an important role in evaluationstudies and audit. KEY WORDS: Outcome, Health status, Functional status, Rheumatoid arthritis     

Registered nurse empowerment and intent to leave current position and/or profession

Aim  This study explored the relationship between Registered Nurses' (RN) empowerment and intent to leave their current position and/or profession.
Background  While there is documentation of the relationship between job satisfaction and retention, little is known about the relationship between empowerment and intent to leave either the current position and/or profession.
Methods  A web-based survey was conducted in which 1355 respondents completed measures of personal demographics, empowerment, intent to leave their current position and the profession.
Results  Relationships were found between empowerment and intent to leave the current position ( F  = 80.08, P  < 0.001) and intent to leave the profession ( F  = 75.99, P  < 0.001).
Implications for nursing management  The results of this study contribute to the limited body of knowledge in this area. It is suggested that nursing leaders utilize empowerment and intent to leave the position and/or profession as new concepts to measure future retention within the nursing workforce.
Conclusion  Retention strategies need to focus on strategies for nurse empowerment.     

Transeptal Approach to Ablation of Left-Sided Arrhythmias Does Not Lead to Persisting Interatrial Shunt: A Transesophageal Echocardiographic Study

In experienced hands, antegrade left heart catheterization via a transeptal puncture is a safe and effective method of performing radiofrequency ablation on the left side of the heart. Persistence of atrial septal defect following transeptal puncture for mitral valvuloplasty has been widely reported although hemodynamically significant shunts are rare. To investigate the persistence of interatrial shunt following transeptal puncture in patients undergoing left-sided electrophysiological procedures using TEE. Fifty-one adult patients, 20 men, aged 19–82 (mean 42.4) years underwent 55 transeptal punctures. Either an 8 Fr Mullins or 8 Fr Swartz transeptal sheath was deployed in all cases. Of these, 28 consecutive patients were approached and 26 consented to undergo TEE. TEE was performed at least 3 weeks post transeptal puncture using a single-plane transducer for the first 18 patients, superseded by a multiplane transducer for the later cases. Both color flow Doppler and microcavitation contrast imaging of the interatrial septum were performed. One patient in the single-plane transducer group was excluded as she failed to swallow the TEE probe. In the remaining 25 patients studied, 9 men aged 21–82 (mean 44.1) years, TEE was performed at a mean of 12.2 (range 3–52) weeks post procedure. No evidence of interatrial shunt was detected by either color flow or contrast studies. Transeptal puncture used in electrophysiological procedures does not result in interatrial shunts persisting > 3 weeks post procedure.