SummaryIn a prospective, double-blind, randomised controlled trial, we compared the efficacy of patientcontrolled analgesia using remifentanil (25-30 lg per bolus) with intramuscular pethidine (50-75 mg) for labour analgesia in 69 parturients. Parturients receiving patient-controlled analgesia reported less pain than those receiving intramuscular pethidine throughout the study period (p < 0.001), with maximal reduction in visual analogue pain score at 2 h after commencement of analgesia (mean (SD) 20 (17) in the patient-controlled analgesia group and 36 (22) in the intramuscular pethidine group. The median (95% CI) time to the first request for rescue analgesics was significantly longer with patient-controlled analgesia (8.0 (6.8-9.2) h) compared with intramuscular pethidine (4.9 (3.8-5.4) h, p < 0.001). Maternal satisfaction scores were also higher with remifentanil compared with intramuscular pethidine (p = 0.001). There was no report of sedation, aponea or oxygen desaturation in either group, and Apgar scores were similar between groups. We conclude that patient-controlled analgesia with remifentanil provides better labour analgesia and maternal satisfaction than intramuscular pethidine. At this dose, maternal and fetal side effects were uncommon.
Handheld personal digital assistants (PDA) are increasingly being used by physicians for a variety of information and data management purposes. We evaluated a PDA-based data management system for our acute pain service. A structured questionnaire survey was conducted to assess staff experience and attitude towards the paper system before the introduction of the PDA, and three months after introduction of the PDA system. We compared the time taken to conduct the acute pain round before and after the implementation of the PDA. The time saved in data management and the amount of paper saved were estimated. Data from 177 patients with a total of 635 acute pain follow-up visits were entered over a three-month period. User satisfaction, ease of access to drug reference and clinical guidelines were similar between the two systems. The respondents found that the PDA was easy to use but less so than the paper system (P=0.007), in particular, when accessing a patient's cumulative data (P=0.007). There was no missed follow-up or data entry with the use of PDA. The time taken to attend follow-up visits was similar for the two systems (Paper: 8.8±3.2 compared to PDA: 7.0±2.0 minutes, P=0.151). The estimated annual amount of paper and time saved in data management was 650 sheets and 130 man-hours respectively. Our experience with the use of the PDA in APS was satisfactory. The PDA system can potentially reduce time and paper use and missed data entry and patient follow-up.
We conducted a crossover randomised study to evaluate the performance of a novel optical stylet, the InnoScope, for tracheal intubation in simulated normal and difficult airways. Twenty-five anaesthetists attempted tracheal intubation on a SimMan 3G simulator using the InnoScope first followed by the Macintosh laryngoscope or vice versa. Three airway scenarios were tested: (1) normal airway; (2) difficult airway with swollen pharynx; and (3) limited neck movement. In each scenario, the laryngeal view, duration of and success rate for tracheal intubation were recorded. Compared with the Macintosh laryngoscope, the use of InnoScope increased the percentage of glottic opening seen by 17% in normal airway, 23% in the difficult airway and 32% with limited neck movement, p < 0.01. Despite this better laryngeal view, successful tracheal intubation achieved with the InnoScope (88.0%) was lower than that for the Macintosh laryngoscope (98.7%), p = 0.008. Using the InnoScope, tracheal intubation during the first attempt was only successful in 48% of cases with difficult airway. In this scenario, the median (interquartile range [range]) duration of tracheal intubation was significantly longer with [corrected] InnoScope compared with the Macintosh laryngoscope, (70 (19-120 [15-120)] s vs 30 [21-58 (15-120)] s, [corrected] p = 0.01. We conclude that an improved laryngeal view with the use of the InnoScope did not translate into better conditions for tracheal intubation.
In the Summary of this paper [1], the sentence:
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Objective To report the clinical experience in using the Airtraq® in awake tracheal intubation in patients with known or potential difficult airway, or unstable cervical spine. Methods Case series study. Twenty patients with known or potential difficult airway, or unstable cervical spine who underwent elective operations and might require awake fibreoptic intubation were recruited. After standardised topical anaesthesia of the airway, awake intubation was performed using the Airtraq®. The duration of the intubation procedure, the intubation difficulty scale (IDS), the rate of successful placement of endotracheal tube and patient's satisfaction were recorded. Results Fifteen out of the twenty patients were successfully intubated with the Airtraq® under awake condition leading to an overall success rate of 75%. Eleven of them were intubated in the first attempt. The mean duration of intubation was 1 min 33 s. Concerning the degree of difficulty of intubation using the Airtraq®, as evaluated with the IDS, 20% was ranked as easy and 80% was slightly difficult. Excessive secretion, patient gagging, inability to cooperate and inadequate view of larynx were the major reasons of failed intubation. Eighty percent of the patients considered the intubating procedure with the Airtraq® under awake condition acceptable. In general, patients felt mild pain and discomfort and were satisfied with the intubation process. Conclusion Airtraq® may be a useful alternative of flexible bronchoscope for awake intubation with low rate of minor complications in the elective operation setting. (Hong Kong j.emerg.med. 2015;22:248-255)
Penicillin is the most commonly reported drug allergy. The association between drug allergy and other atopic diseases (such as eczema or IgE mediated food allergies) remains poorly understood. METHODS: The Gastrointestinal Microbiome and Allergic Proctocolitis (GMAP) study is a prospective observational cohort study designed to look at the development of food allergies, including food protein induced allergic proctocolitis (FPIAP), in 1003 healthy newborn infants. The current project expands upon the previously collected data by retrospectively chart reviewing the incidence of amoxicillin and penicillin allergy in the GMAP cohort. Active subjects were retrospectively chart reviewed to determine their incidence of documented drug allergy. Statistical analyses were performed using chi-square tests and logistic regression. RESULTS: Of the 823 actively enrolled participants 83 were diagnosed with an amoxicillin and or penicillin allergy, giving a cumulative incidence of 10.4%. We found a significant association between FPIAP and penicillin allergy, odds ratio 2.1 (95% CI: 1.3, 3.5; p<0.005). We did not find an association between penicillin allergy and eczema or IgE mediated food allergy. CONCLUSIONS: In this healthy infant cohort, the development of penicillin allergy appears to be increased among infants with FPIAP compared to unaffected participants. Ongoing research with this cohort may offer a unique longitudinal perspective about associations between atopic dermatitis, IgE mediated food allergies and Allergic Proctocolitis with penicillin allergy over time.
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