RAPID ADMINISTRATION OF CRYSTALLOID PRELOAD DOES NOT DECREASE THE INCIDENCE OF HYPOTENSION AFTER SPINAL ANAESTHESIA FOR ELECTIVE CAESAREAN SECTION

Twenty parturients undergoing elective Caesarean section wereallocated randomly to receive crystalloid preload 20 ml kg^–1over either 20 min or 10 min before spinal anaesthesia. Significanthypotension (systolic arterial pressure <100mm Hg and <80% of baseline value) occurred in six of the 10 patients inthe 20-min preload group and seven of 10 patients in the 10-minpreload group (ns). Both groups had a significant (P < 0.05)increase in central venous pressure during the preload period.The mean central venous pressure in the 10-min group was 11.9mm Hg (range 6–19 mm Hg), which was significantly greater(P < 0.05) than that in the 20-min group (mean 7.3 mm Hg,range 2–13 mm Hg). Three patients in the 10-min grouphad clinically unacceptable increases in central venous pressure.This study has demonstrated that rapid administration of crystalloidpreload before spinal anaesthesia did not decrease the incidenceor severity of hypotension, and questions the role of crystalloidpreload.     

JOB STRESS AMONG BRITISH GENERAL PRACTITIONERS: PREDICTORS OF JOB DISSATISFACTION AND MENTAL ILL-HEALTH

Questionnaires assessing levels of job satisfaction, mental well-being and sources of stress were distributed to a random sample of 850 general practitioners (GPs) in England. The final sample size was 414. Compared to a normative sample, male GPs exhibit significantly higher levels of anxiety, whereas female GPs compare favourably to the population norms. Job satisfaction levels among male and female GPs were significantly lower than when they were measured in 1987. Multivariate analysis revealed five major stressors that were predictive of high levels of job dissatisfaction and negative mental well-being; these were practice administration and demands of the job, interference with family and social life, routine medical work, interruptions and working environment. In addition, emotional involvement and type A behaviour were predictive of lack of mental well-being. It is concluded that there may be substantial benefit in providing training in management skills and introducing a stress management programme for GPs.     

Job Satisfaction, Mental Health and Job Stress Among General Practitioners Before and After the New Contract--a Comparative Study

In order to compare measures of job satisfaction, mental healthand job stress among general practitioners (GPs), the resultsof a 1993 survey were compared with that obtained in the previousstudy in 1987) ¹Eight hundred and fifty GPs were selected atrandom by seven Family Health Service Authorities in England,380 of whom returned questionnaires suitable for statisticalanalysis. There were significant differences between the 1987and 1993 surveys. GPs experienced less job satisfaction, poorermental health and more stress in 1993 than in 1987. These changesmay have occurred as a result of the introduction of the newcontract.     

N-3多不饱和脂肪酸促进小鼠骨再生的实验研究

目的 探讨n-3多不饱和脂肪酸对小鼠骨折愈合的影响。 方法 构建了Fat-1转基因小鼠与野生小鼠的长骨骨折模型并使用髓内针固定。分别在造模后的2、3、4周通过组织学、影像学评估分析各组小鼠骨折愈合情况。 结果 结果显示,在造模后的2、3、4周,Fat-1转基因小鼠的骨折愈合速度显著快于野生小鼠对照组。此外,X线及小动物CT扫描结果显示,Fat-1转基因小鼠造模后的骨痂生长、骨重构均早于野生对照组小鼠。 结论 内源性的n-3多不饱和脂肪酸可以加速小鼠的骨折愈合。n-3多不饱和脂肪酸极有可能是促进骨折愈合的营养因素之一。       

EFFECTS OF ALFENTANIL AND FENTANYL ON INDUCTION OF ANAESTHESIA IN PATIENTS WITH SEVERE PREGNANCY-INDUCED HYPERTENSION

Forty patients with severe pregnancy-induced hypertension presentingfor Caesarean section under general anaesthesia were allocatedrandomly to receive either fentanyl 2.5 µg kg^–1or alfentanil 10 µg kg^–1 as part of the anaestheticinduction sequence. In all patients, the cardiovascular responseto tracheal intubation was measured. Both drugs attenuated theresponse equally but did not abolish it in all patients. Alfentanil10 µg kg^–1 is a suitable alternative to fentanyl2.5 µg kg^–1 for patients with pregnancy-inducedhypertension.     

Occupational stress amongst care staff working in nursing homes: an empirical investigation

• ? A questionnaire survey of care staff in nursing homes examined staff stress. Staff completed questionnaires covering Type A behaviour, job satisfaction, psychological well-being, relaxation behaviour, coping skills and demographic details.
• ? A specific measure of nursing home stress was developed following a pilot study. From a total sample of 375, 112 (30%) responses were obtained. On the stress questionnaire the major stressors were found to be ‘unsatisfactory wages’, ‘shortage of essential resources’, ‘not enough staff per shift’, ‘feeling undervalued by management’, ‘lifting heavy patients’ and ‘working with colleagues who are happy to let others do the work’.
• ? Factor analysis of stress questionnaire responses identified five major stress groupings. These were, ‘differing expectations about patient care’, ‘management factors’, ‘lack of support from other staff’, ‘feeling inadequately trained to deal with job demands’ and ‘home–work conflicts’.
• ? Examination of stress outcomes showed that many staff were under pressure, with high levels of smoking and alcohol intake.
• ? Given the increasing importance of nursing home care for the elderly the present study is timely. The implications of the findings for further research, and for the training of staff in nursing homes are considered.

     

INFLUENCE OF PREOPERATIVE GASTRIC ASPIRATION ON THE VOLUME AND pH OF GASTRIC CONTENTS IN OBSTETRIC PATIENTS UNDERGOING CAESAREAN SECTION

Aspiration of gastric contents, the most common anaestheticcause of maternal mortality, is decreased by emptying of thestomach and the use of antacids and H₂-receptor antagonists.One hundred and eighty-three mothers presenting for emergencyCaesaren section were allocated to three groups. In group 1,the stomach was emptied before operation via an orogastric tubeand thereafter 30 ml of sodium citrate 0.3 mol litre^–1was ingested 5–15 min before induction of general anaesthesia(our usual practice). Group 2 received only 30 ml of sodiumcitrate 0.3 mol litre^–1. Group 3 received ranitidine 50mg i.v. before operation, 5–15 min before induction ofanaesthesia, in addition to sodium citrate. Our results showthat preoperative gastric emptying with an orogastric tube followedby sodium citrate is preferred if anaesthesia should be induced15–20 min later. However, the use of ranitidine and sodiumcitrate is preferred at subsequent times. Although our datashow that preoperative gastric emptying decreased the mean intragastricvolumes before Caesarean section, the number of patients atrisk of acid aspiration was not reduced. In view of these findingsand the unpleasantness of orogastric intubation, we suggestthat routine preoperative gastric aspiration via an orogastrictube is not justified, although the manoeuvre should still beused following a recent meal.     

Prevention of hypertension during trans-sphenoidal surgery — the effect of bilateral maxillary nerve block with local anaesthetics

Background: Severe cardiovascular responses are known to occur during trans-sphenoidal excision of the pituitary gland despite adequate depth of anaesthesia. This study was undertaken to evaluate the effects of bilateral maxillary nerve block with local anaesthetics on the cardiovascular responses to various stimuli during this procedure.
Methods: In a group of 32 patients, 5–10 ml of a mixture of bupivacaine 0.5% and lignocaine 2% (1:1) was injected in the pterygopalatine fossa after induction of general anaesthesia. Seven control group patients did not receive any nerve block. In all the patients, general anaesthesia was induced with thiopentone and maintained with nitrous oxide-oxygen, pentazocine, boluses of thiopentone and halothane. Pancuronium was used for neuromuscular blockade.
Results: In both the groups, maximum hypertension occurred on opening the blades of the bivalve nasal speculum. In the study group, hypertensive response was signify cantly less following nasal infiltration with adrenaline containing solution (10.26% increase vs. 23.08% in the control group, P < 0.05), nasal dissection (2.82% vs. 9.45%, P < 0.01) and on application of the nasal speculum (14.93% vs. 35.16%, P < 0.01). The effect on heart rate response was not significant.
Conclusion: The described technique is a useful adjunct to general anaesthesia for suppressing the haemodynamic responses during trans-sphenoidal surgery.