Only as strong as the weakest link

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The 'fifth vital sign'

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The knowledge and perceptions of nurses and interns regarding acute pain and postoperative pain control

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EVAR fever: minimally invasive, maximally inclusive?

Editorialpostprin

Anaesthesia for urological surgery

Anaesthesia is commonly used to facilitate urological procedures and many patients are elderly with multiple co-morbidities. Urological procedures range from minor day case to major surgery in which extensive resources are needed both intra- and postoperatively. For simple day case procedures like cystoscopy or ureteroscopy, general anaesthesia is most commonly used because it allows for early ambulation. Transurethral resection of the prostate (TURP) needs special attention. TURP syndrome due to excessive absorption of the irrigation fluid can be catastrophic if not managed early. Avoiding contributing factors and choosing regional anaesthesia which allows for early detection are key. Careful perioperative planning and risk stratification is important in major urological cancer surgery. Most of these procedures will require general anaesthesia (due to longer operative time and more extensive surgical trauma). Postoperative pain management in the form of epidural or patient controlled multimodal analgesia are essential. Postoperative high-dependency care is beneficial.postprin

Review of Anesthesia for Middle Ear Surgery

Special considerations for middle ear surgery include a bloodless surgical field, attention to patient head positioning, facial nerve monitoring, and management of postoperative nausea and vomiting. Middle ear surgery can be done under local or general anesthesia; each has advantages and disadvantages. © 2010 Elsevier Inc.postprin

Poisoning with illicit substances: toxicology for the anaesthetist

The consumption of illicit substances represents a considerable threat to the health and wellbeing of particular sectors of our communities. Hospitalisation is sometimes required for the treatment of the direct toxic effects of the drugs as well as for injuries sustained while under their influence. Although poisoning with ‘traditional‘ substances of abuse such as opioids, cocaine and cannabis still predominate in terms of numbers, the availability and use of new psychoactive substances are on the rise. These latter agents, some of which began life as failed pharmaceutical products, have enjoyed renewed status as recreational stimulants, entactogens or hallucinogens, properties that originally precluded them from legitimate use. These drugs may act by enhancing endogenous release of neurotransmitters, inhibiting their reuptake back into neurons or having direct effects on receptors, and may involve adrenergic, dopaminergic or serotonergic systems. The use of intravenous lipid emulsion for the symptomatic treatment of drug overdose has become a fertile ground for research and may hold promise as a non-specific treatment for poisoning with illicit substances. Dexmedetomidine, an α2-receptor agonist with a central sympatholytic effect, may be able to counteract the cardiovascular and central nervous system overstimulation that may accompany stimulant toxicity.postprin

Quantifying and communicating peri-operative risk

Editorialpublished_or_final_versio

Adjuvant analgesics in neuropathic pain

Conventional analgesics have limited efficacy in the management of neuropathic pain. An adjuvant analgesic is a drug that has a primary nonpain indication but which may be analgesic in certain circumstances, and many of these have established a role in the pharmacological treatment of neuropathic pain. The number needed to treat is an indirect statistical measure that can be used to compare relative efficacy of different adjuvant analgesics and, from this, there is currently insufficient evidence to suggest that any one adjuvant analgesic has absolute advantages over another. Analgesic efficacy, tolerability, safety/toxicity, drug interactions, ease of use, and cost-effectiveness are essential factors that guide the selection of an adjuvant analgesic. Cost-effectiveness data are absent for the vast majority of these drugs. Pharmacological treatments should be used as part of a multimodal therapeutic programme for the management of neuropathic pain. © 2009 Copyright European Society of Anaesthesiology.published_or_final_versio

A profile of anaesthesia trainees in Hong Kong

Objectives. To examine the demographics, professional background, progress, and aspirations of anaesthesia trainees in Hong Kong. Design. Anonymous questionnaire consisting of 56 items grouped into the areas of demographics, and anaesthetic and postanaesthetic training. Eight of the items were open questions. Descriptive analyses were undertaken for the closed items. Setting. Hong Kong College of Anaesthesiologists, Hong Kong. Participants. All trainees. Main outcome measures. Demographic data, aspects of training, supervision, working environment, career aspirations, job satisfaction, and morale. Results. The response rate was 77%. The various problems highlighted by respondents included the need for more input and feedback into individual training programmes, the lack of senior support, and the need for more relevant and examination-orientated courses and workshops. Unsatisfactory aspects of the specialty reported were the lack of control over work routines, relationships with surgeons, boredom, and the poor public image of the specialty. Eighty-four percent of respondents reported having reasonable to good job satisfaction. Conclusions. Ongoing benefits could be derived from enhancing communication between trainees and the Hong Kong College of Anaesthesiologists, through appropriate channels for trainee feedback.published_or_final_versio