The reduction in anxiety in the intervention group indicates that preoperative information videos are an effective method of reducing anxiety in parents. Furthermore, the reduction in need for information score in the intervention group indicates that preoperative videos may be a useful tool for providing parents with information.
SummaryAn 82-year-old ASA 2 patient underwent routine sub-Tenon's block for cataract surgery. One minute after injection of the local anaesthetic, the patient had a generalised tonic-clonic seizure and developed refractory ventricular fibrillation; subsequent resuscitation was unsuccessful. With no evidence for intravascular injection, the lack of structural brain abnormalities, and the most striking feature on post mortem examination being severe triple vessel coronary artery disease, it was concluded that this was primarily cardiac in origin; however, the possibility of brainstem anaesthesia should also be considered. The use of sub-Tenon's block for cataract surgery is becoming increasingly popular in the UK and it is felt to be a safer alternative to other anaesthetic techniques, despite the lack of a randomised double-blind study to validate conclusions regarding its relative safety [1]. 'Brainstem anaesthesia' is a complex phenomenon which may result from local anaesthesia entering the central nervous system, and it is a recognised complication of ophthalmic regional blocks, with various postulated and debated mechanisms and variable presentation [2]. To date there have been no reported deaths in connection with a sub-Tenon's block. The following is a case report of a death potentially secondary to inadvertent subarachnoid injection. Case historyAn 82-year-old female presented for an elective cataract operation. On a routine pre-operative visit she was found to be a known hypertensive on 2.5 mg bendrofluazide once daily. She denied having any history of myocardial infarction, angina, epilepsy or allergic reactions. Her blood pressure was 178 ⁄ 94 mmHg and her pulse rate 76 beats.min . She had undergone general anaesthesia previously, but she had not had cataract surgery. Her left axial globe length was 25.83 mm. No pre-operative ECG was performed.In the anaesthetic room she was calm and was happy to proceed with the sub-Tenon's block.She was monitored using pulse oximetry and electrocardiography, and following venous cannulation with a 22G cannula in her left hand, 1% amethocaine was instilled followed by 5% povidine eye drops.A 19G 25-mm (1-inch) sub-Tenon's metal cannula was used to perform a left sub-Tenon's block in the inferior nasal quadrant. After a negative aspiration, 3 ml of the injectate, which contained 750 IU hyalase in a 50 : 50 mix of 2% lidocaine and 0.5% bupivacaine, was injected over 3-4 min. She complained of a little discomfort, but no change in heart rate was noted.Within 1 min of performing the sub-Tenon's block, in mid sentence, the patient stopped talking and had a generalised tonic-clonic seizure.She was immediately turned to her right, ventilated with 100% oxygen via a Bain's circuit and given 2 mg midazolam intravenously. She was then discovered to have no pulse and to be in ventricular fibrillation.Adrenaline 1 mg was administered intravenously whilst the paddles of the defibrillator were attached, and three stacked shocks were administered: 200 J, 200 J, 360 J. She remained in ...
Introduction: It has long been recognised that parents of children scheduled for elective surgery experience high levels of pathological anxiety (1). Providing parents with information about anaesthesia, surgery and postoperative recovery has been identified as a tool for reducing anxiety (2–4). The purpose of this study was to determine whether audiovisual information, describing the process of undergoing and recovering from anaesthesia, could reduce anxiety levels and desire for information in parents before their child's induction of anaesthesia. Methods: The study was approved by our local ethics committee. 111 Parents were recruited into this study. Of these 56 were randomised to a control group and 55 to an intervention group. All parents completed the Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire on admission to hospital on the day of surgery and then again just before accompanying their child to the anaesthetic room. This is a tool for assessing preoperative anxiety and need for information, which has previously been validated in the parents of children presenting for surgery (5). In addition to the normal preoperative preparation, parents randomised into the intervention group watched a short 8 min information video after completing the first questionnaire. The video illustrated the events and procedures surrounding a child's admission to hospital for day‐case surgery, including the induction of anaesthesia. Results: There was no statistically significant difference in child demographics, type of surgical procedure, parental demographics, parental experience or STAI‐Trait scores between the two groups (P > 0.1). A repeated measures ANOVAfor APAIS scores revealed a significant group × time interaction for all three measures, Anxiety Scale (F (1,109) = 6.2; P < 0.05), Need for Information Scale (F (1,109) = 7.7; P < 0.01) and total score (F (1,109) = 11.1; P < 0.001). Further analysis revealed that the intervention group demonstrated a reduction in anxiety (effect size 0.47), need for information (effect size 0.53) and total scores (effect size 0.63) as measured by the APAIS, compared with controls (Figure 1). 1 APAIS scores: means and standard error bars for anxiety, desire for information and total, pre and postvideo. Discussion: We postulated that audiovisual information has a role in parental education and reducing parental anxiety before paediatric surgery. However few studies have been carried out examining the efficacy of audiovisual information and all published studies have been carried out in institutions in the USA. Our study is the first to examine the usefulness of videotaped information in a childrens hospital in the UK. In this study we demonstrated that a preanaesthetic educational videotape can reduce parental anxiety before paediatric day case surgery. Our study also suggests that an information video may reduce a parents desire for information. However as the APAIS score does not formally measure the effectiveness of information transfer we cannot dis...
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