Low-dose sufentanil dœs not potentiate intra-thecal morphine for perioperative analgesia after major colorectal surgery

Purpose: Both intrathecal sufentanil (ITS) and intrathecal morphine (ITM) improve analgesia in obstetrical or cardiac procedures. From a pharmacokinetic standpoint, combining these two opioids may improve perioperative analgesia. We performed a prospective randomized double-blind study to compare the analgesic efficacy of ITM alone vs a mixture of a low dose of ITS plus ITM for perioperative pain relief in colorectal surgery. Methods: Eighty adult patients undergoing colorectal surgery were randomly allocated to receive either 0.4 mg ITM alone or 10 µg ITS plus 0.4 mg ITM before general anesthesia. Intraoperative intravenous sufentanil consumption, postoperative morphine consumption delivered with a patient controlled analgesia device, pain scores, patient satisfaction and adverse effects were recorded for the first 48 hr postoperatively. Results: No differences were observed between groups with respect to intraoperative sufentanil consumption (39 ± 23 µg in group ITM and 40 ± 25 µg in group ITS plus ITM, P = 0.85) and in postoperative morphine consumption in postanesthesia care unit (6 ± 5 mg vs 6 ± 5 mg, P = 0.59), at 24 hr (26 ± 17 vs 24 ± 15 mg, P = 0.59) and at 48 hr (47 ± 31 vs 44 ± 22 mg, P = 0.58). Similarly, no differences were observed in regards to pain relief, patient satisfaction and incidence of adverse effects. Conclusions: These results do not support the addition of 10 µg ITS to 0.4 mg ITM for colorectal surgery, as low dose sufentanil dœs not improve intraoperative and postoperative analgesia in this settin

The predictive validity of the aptitude test for the performance of students starting a medical curriculum

Selection of medical students varies between German- and French-speaking Swiss faculties. Geneva introduced an aptitude test in 2010, aimed at helping decision making among students. The test was compulsory: it had to be taken by those who intended to register for medical studies. But it was not selective: there was no performance threshold under which registration would have been denied

Education, teaching & training in patient safety

Patient Safety is not a side-effect of good patient care by skilled clinicians. Patient safety is a subject on its own, which was traditionally not taught to medical personnel. This must and will dramatically change in the future. The 2010 Helsinki Declaration for Patient Safety in Anaesthesiology states accordingly "Education has a key role to play in improving patient safety, and we fully support the development, dissemination and delivery of patient safety training". Patient safety training is a multidisciplinary topic and enterprise, which requires us to cooperate with safety experts from different fields (e.g. psychologists, educators, human factor experts). Anaesthesiology has been a model for the patient safety movement and its European organisations like ESA and EBA have pioneered the field up to now: Helsinki Patient Safety Declaration and the European Patient Safety Course are the newest establishments. But Anaesthesiology must continue in its efforts in order to stay at the top of the patient safety movement, as many other disciplines gain speed in this topic. We should strive to fulfill the Helsinki Declaration and move even beyond that. As the European Council states: "Education for patient-safety should be introduced at all levels within health-care systems

Clonidine combined with a long acting local anesthetic does not prolong postoperative analgesia after brachial plexus block but does induce hemodynamic changes

Clonidine in brachial plexus block prolongs analgesia of local anesthetics of short and intermediate duration. We performed a prospective randomized double-blinded study to determine the efficacy and adverse effects of clonidine mixed with a long-acting local anesthetic on postoperative analgesia. Sixty adult patients underwent elective rotator cuff repair using interscalene brachial plexus block combined with general anesthesia and were randomly divided into one of the following three groups. Placebo (n = 20): interscalene block with 40 mL of 0.5% bupivacaine with epinephrine (1/200000) and 1 mL of 0.9% saline, completed by 1 mL of 0.9% saline IM in the controlateral shoulder; Control (n = 20): interscalene block with 40 mL of 0.5% bupivacaine with epinephrine and 1 mL of 0. 9% saline, completed by 150 microg (=1 mL) of clonidine IM; Clonidine (n = 20): interscalene block with 40 mL of 0.5% bupivacaine with epinephrine and 150 microg (=1 mL) of clonidine, completed by 1 mL of 0.9% saline IM. During anesthesia hemodynamic variables and fractional expired isoflurane concentration (FeISO) were recorded. The following postoperative variables were assessed: duration of interscalene block, quality of pain relief on a visual analog scale, side effects, and consumption of morphine with a patient-controlled analgesia device over 48 h. Patient characteristics were comparable. During anesthesia mean arterial pressure, heart rate, and FeISO were significantly decreased in Clonidine and Control groups compared with Placebo group. Duration of analgesia, defined as the time elapsed from interscalene injection to the first morphine request, was 983 +/- 489 min in the Placebo, 909 +/- 160 min in the Control, and 829 +/- 159 min in the Clonidine groups. Pain scores and consumption of morphine at 24 h and 48 h showed no differences among the three groups. We conclude that adding 150 microg of clonidine in interscalene block does not prolong analgesia induced by 40 mL of bupivacaine 0.5% with epinephrine, but decreases mean arterial blood pressure and heart rate