Summary
Key wordsInfection; Hepatitis B, acquired immune deficiency syndrome. Anaesthetists; complications.The Association of Anaesthetists advises all anaesthetists to wear gloves in the operating theatre for vessel cannulation and insertion or removal of airways and tracheal tubes.' The Expert Advisory Group on the acquired immune deficiency syndrome (AIDS) also recommends gloves to be worn, as a minimum protective measure, for any procedures where there is likely to be contact with blood.2 This advice was produced as a response to growing concern about the risk to operating theatre staff of infection from blood and secretions from patients with hepatitis or human immune deficiency virus (HIV) infection."This study has three objectives: to determine, the incidence of skin contamination of anaesthetic and related staff by patient's blood and saliva during a normal working week, the current Hepatitis B immunisation status of anaesthetists in Cardiff and the incidence of glove usage.
MethodsA questionnaire which asked about skin contamination by blood and saliva was attached to each anaesthetic record of every patient who received an anaesthetic in the main operating theatres at University Hospital of Wales and Cardiff Royal Infirmary for a 7-day working week in October 1989. The type of operation, nature of surgery (elective or emergency), grade of anaesthetist and occurrence of skin contamination by blood or saliva were recorded.Each anaesthetist in Cardiff was interviewed to determine whether he or she routinely wore gloves for oral or nasal tracheal intubation, the insertion of peripheral venous cannulae, arterial cannulae or central lines. Hepatitis B immunisation status was recorded. Comments were also sought as to the reasons why each did not routinely wear gloves in the operating theatre.
Results
Skin contamination by patients' blood and salivaTwo hundred and seventy anaesthetics were administered during the 7-day continuous period in the two hospitals, of which 252 (93%) forms were returned. Eighty-three percent (209) had elective surgery and 17% (43) emergency surgery. A total of 256 peripheral cannulae (some patients had more than one peripheral line while others had a venous cannula already in situ), 21 arterial lines and 20 central lines (nine drum catheters and 11 internal jugular lines) were inserted.Blood from 14% (35) patients caused skin Contamination of 65 people during 46 incidents (there was often more than one contamination incident per patient). Seventy-six percent (27) of the 35 patients involved in blood con-
We have compared, in 40 adult males, the effect on pain in the first 24 h after herniorrhaphy of preincisional ilioinguinal and iliohypogastric nerve block and wound infiltration with 0.5% bupivacaine or saline. After operation, patients received morphine i.v. via a patient-controlled analgesia machine and visual analogue pain scores (VAS) at rest and on movement were recorded. The bupivacaine group consumed less morphine in the first 6 h after operation. There was no difference in morphine consumption between the two groups in the next 18 h. The time to first analgesia was delayed in the bupivacaine group and was not followed by a rebound increase in requirement for analgesia. There was no significant difference in VAS scores at rest but there was a significantly higher pain score with movement in the saline group. We have shown that the combination of nerve block and wound infiltration reduces consumption of morphine in the first 24 h after herniorrhaphy. We have failed to show any effect of 0.5% bupivacaine beyond the first 6 h after operation.
Although he was not the first man to operate on the brain, Sir Victor Horsley was the world's first surgeon appointed to a hospital post to perform brain surgery, which happened in 1886 at the National Hospital for Neurology and Neurosurgery, Queen Square, London. The authors examined the patient records between 1886 and 1899 and found 151 operations performed by Sir Victor Horsley at the National Hospital, including craniotomies, laminectomies, and nerve divisions. The authors present the outcome data and case illustrations of cerebral tumor resections and laminectomies from the nineteenth century. Outcomes and notable pioneering achievements are highlighted.
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