A randomized, placebo-controlled study was conducted in 60 ASA Class I, II, and III patients to determine the dose response of alfentanil in moderating the cardiovascular and catecholamine response to tracheal intubation (INT). Patients were randomly allocated into one of four groups to receive either 15 micrograms/kg alfentanil (A15), 30 micrograms/kg alfentanil (A30), 45 micrograms/kg alfentanil (A45), or normal saline (control), given intravenously (i.v.) before induction of anesthesia. One minute after administration of 4.0 mg/kg thiopental and 1.5 mg/kg succinylcholine i.v., tracheal intubation was performed using direct laryngoscopy. In response to INT, increases in heart rate, systolic blood pressure, and systemic vascular resistance occurred in the control group. These changes were significantly more than corresponding changes of heart rate, systolic blood pressure, and systemic vascular resistance in all three alfentanil groups (P < 0.05). In contrast, cardiac index and ejection fraction decreased moderately in every group during the study period, but there were no differences among groups with respect to either cardiac index or ejection fraction at corresponding times following INT. In the control group, epinephrine and norepinephrine serum concentrations increased by 152 +/- 52% and 58 +/- 62%, respectively, following INT (different from A30 and A45, P < 0.05). However, up to a dose of 30 micrograms/kg (A30), a dose-dependent decrease in the maximum percent changes of both epinephrine and norepinephrine occurred in response to INT. A larger dose of alfentanil was no more efficacious as the catecholamine response to tracheal intubation was not significantly different when comparing the A45 and A30 groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Le feedback (ou rétro-action) : un élément essentiel de l'intervention pédagogique en milieu clinique Heather V. O ' B R I E N ,* Meredith B. M A R K S ,* Bernard C H A R L I N* * In t ro d u c t i o nComment informons nous au mieux les étudiants à propos de la qualité de leur performance clinique et comment les motivons nous pour qu'ils l' a m é l i o rent en p e r m a n e n c e ? Dans une perspective éducationnelle, la pratique de la médecine est souvent vue comme étant l' a p p l i- • Un feedback efficace est donné en temps voulu. Il porte sur des comportements spécifiques et re m é-diables, il implique l'étudiant et il identifie à la fois les forces et les faiblesses. Il est objectif sans porter de jugement de valeur et il offre des suggestions de changement. • Donner du feedback implique toujours un respect de l' é t udiant. • Le feedback n'est pas une habileté innée. Il peut s' a p p re n d re. Avec un peu de feedback vos habiletés de feedback peuvent s' a m é l i o re r. Mots clés Fe e d b a c k, éducation médicale, méthodes d' e n s e i g n e m e n t . Key learning points • Presenting feedback to learners is a complex but necessary skill for educators.• Keywords Fe e d b a c k; medical education; teaching methods.

Jamal A Alhashemi M~ aS, Donald R Miller MD FRCVC, Heather V O'Brien MD FRC~, Kathryn A Hull m~ Purpose: A randomized, blinded clinical trial was undertaken to compare recovery characteristics and cost-benefrts associated with three general anaesthetic techniques for arthroscopic knee surgery in an ambulatory care setting. Methods: Ninety three, ASA Physical Status I-II patients were randomly allocated to receive one of three types of general anaesthesia: isofluraneA~entanyl/N20 (Group INH); alfentanil/N20 (Group BAL); or propofol/alfentanil/O, (Group TIVA). Postoperative recovery profiles were evaluated at 30, 60, 90 and 120 min after emergence from anaesthesia, and direct and indirect costs of each anaesthetic were compared. Results: The most rapid emergence was observed in Group BAL (2.2 + 1.5 min, P<0,0001 compared with groups INH and TIVA), although the incidence of post-operative nausea and vomiting was also highest in this group (P= 0.02 compared with groups INH and TIVA). However, overall patient satisfaction, and mean times to discharge from the Post Anaesthesia Recovery Unit and hospital, were rapid and similar in all three groups. During anaesthesia which lasted 40-45 mtn, nearly a four-fold difference was observed in the direct costs of anaesthetic drugs: $16.4 + 4.4 (Group INH), $45.3 + 11.4 (Group BAL) and $63.4 _+ 17.9 (Group TIVA, P <0.001 between groups); while ind,rect costs were similar. Conclusions: For arthroscopic knee surgery, INH anaesthesia with isoflurane/fentanyt/N20 is associated with s,milar hospital discharge times, and comparable levels of patient satisfaction as either BAL or TIVA. While indirect costs were s,milar, lower direct costs suggest that there may be a pharmacoeconomic benefit associated with the use of a "standard" isoflurane/Tentanyl/N~O anaesthetic in certain day care surgery procedures.

It is possible to measure feedback skills in a clinical setting. Although traditional outcome measures show a significant effect, demonstrating change in teaching behaviors used in practice will require larger scale studies than typically undertaken currently.

Butorphanol: an opioid for day-care paediatric surgeryThe purpose of this study was to compare the side effects and efficacy of equianalgesic doses of morphine (M) and butorphanol (B)

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