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In a double-blind study forty-two children scheduled for elective adenotonsillectomy were randomized to receive peritonsillar infiltration, following induction of anaesthesia, with either 0.25% plain bupivacaine or 0.9% saline, 0.5 mllkg to a maximum of 10 ml. The children were assessed on awakening, and then ID minutes, I hour, 4 hours and 24 hours later. On each occasion the observer gave the child a pain score from 1 (no pain) to 5 (severe pain). The scores on awakening and after 10 minutes were significantly lower in the bupivacaine group (P< 0.05, Mann-Whitney U test). Thereafter there was no difference between the groups. The authors conclude that peritonsillar infiltration with bupivacaine is only moderately useful as analgesia for children having tonsillectomy.

Organisation of critical care services affects patient outcomes, as does the quality of care preceding intensive care unit (ICU) admission. Opportunities for improvement in both these spheres were identified in a district hospital high dependency unit (HDU). Changes were made to the medical and nursing leadership and staffing in HDU including enhanced ICU clinician and nursing responsibility for patient care, admission and discharge, development of a common critical care nursing pool, dedicated daytime supervised trainee medical staff and the option for ward staff to refer patients for an HDU evaluation. Data evaluating the number of patients admitted to ICU, requiring invasive ventilatory support and requiring renal replacement therapy were collected in real time on the existing Scottish Intensive Care Society database and retrospectively analysed using statistical process control (SPC) chart methodology. Organisational changes in HDU care were associated with SPC evidence of statistically significant reductions in patients receiving invasive ventilation, number of patient ventilation days, level 3 care days and renal replacement therapy days. Changing the organisation of HDU care in our setting was associated with marked changes in the pattern of intensive care use. It reduced the number of people receiving invasive ventilation and reduced number of ventilation, level 3 and renal replacement therapy days.

Background: The provision of palliative care is an evolving and expanding issue, with the inclusion and management of non-malignant conditions gaining increasing focus. This has seen provision of palliative care expand into increasingly acute settings, an example of which is the rising recognition of the need for good quality end-of-life-care in intensive care units (ICU). Methods: This qualitative interview-based study aimed to explore in depth the Stirling Royal Infirmary ICU team’s views and experiences of the difficulties of providing palliative care in an intensive care setting, and identification of the dying patient. Results: The ICU team reported there to be a number of advantages to providing end-of-life care in the ICU in terms of access to nursing and medical care. They also reported there to be issues surrounding training, identification of palliative care patients and over-aggressive management. Further collaboration between ICU and palliative medicine is required to develop understanding between the two specialties and expand provision of palliative care in this unique clinical setting.