Purpose: A eutectic mixture of local anesthetics (EMLA) is commonly used to provide topical anesthesia for intravenous (iv) cannulation. One of its side effects is vasoconstriction, which may render cannulation more difficult. A gel formulation of amethocaine (Ametop") is now commercially available. The aim of this study was to compare EMLA and Ametop TM with regard to the degree of topical anesthesia afforded, the incidence of vasoconstriction and the ease of iv cannulation. Methods: Thirty two ASAI adult volunteers had a # 16 gauge iv cannula inserted on two separate occasions using EMLA and Ametop TM applied in a double blind fashion for topical anesthesia. Parameters that were recorded after each cannulation included visual analogue pain scores (VAPS), the presence of vasoconstriction and the ease of cannulation, graded as: I = easy, 2 = moderately difficult, 3 = difficult and 4 = failed. Results: The mean VAPS + SD after cannulation with Ametop'~ M was 12 + 9.9 and with EMLA was 25.3 -+ 16.6 (P = 0.002). Vasoconstriction occurred after EMLA application on 17 occasions and twice after Ametop TM (P = 0.001). The grade of difficulty of cannulation was 1.44 _+ 0.88 following EMLA and 1.06 _+ 0.25 with Ametop TM (P = 0.023). Conclusions: Intravenous cannulation was less painful following application of Ametof" than EMLA. In addition, Ametop TM caused less vasoconstriction and facilitated easier cannulation. Its use as a topical anesthetic agent is recommended, especially when iv access may be problematic.Objectif : Un m~lange eutectique d'anesth&iques Iocaux (MEAL) est souvent utilis6 pour I'anesth6sie topique Iors d'une canulation intraveineuse (iv). La vasoconstriction, qui est I'un des effets secondaires du MEAL, peut compliquer la mise en place d'une canule. Une pr&entation en gel d'am&hocaine (Ametop TM) est maintenant offerte dans le commerce. Le but de la pr&ente 6tude &ait de comparer le MEAL et I'Ametop TM en regard du degrE d'anesth&ie topique foumi, de rincidence de la vasoconstriction et de la facilitE de la canulation iv. M&hode : On a ins&E, en deux occasions s6par&s chez 32 volontaires adultes d'&at physique ASA I, une canule iv de calibre 16 en utilisant en double aveugle le MEAL et Ametop TM pour rEaliser ranesth6sie topique. Apr& chaque canulation, on a enregistr6 les param&res suivants : les scores de douleur ~ I'&helle visuelle analogue (EVA), la presence de vasoconstriction et la facilit6 de canulation notEe I = facile, 2 = mod&Ement difficile, 3 --di~cile et 4 = impossible. l~uJ.tats : Les scores moyens ~ I'E--VA + I'&art type ont ~t~ de 12 -9,9 ~ la suite de la canulation avec Ametop TM Met de 25,3 _+ 16,6 apr& le MEAL (P = 0,002). La vasoconstriction est survenue en 17 occasions apr& I'application du MEAL et deux fois plus souvent apr& Ametop TM (P --0,00 I). Le degr6 de difficult6 de canulation a 6t6 de 1,44 _+ 0,88 apr& le MEAL et de 1,06 +_ 0,25 apr& Ametop TM (P = 0,023). Conclusion : La canulation intraveineuse est moins douloureuse apr& I'application d'Ametop TM que celle du MEAL. D...
With the caveats of a small sample size, first experience of high-fidelity simulation, the 'halo' effect in the evaluation, and with possible omissions from our evaluation, the students reported predominantly positively on the experience. We believe that the use of high-fidelity simulation in patient safety is a promising, safe and low-cost curricular development in undergraduate medical education. It is transferable worldwide and has the potential to improve patient safety outcomes by reducing medical error.
At clinically relevant concentrations, volatile anaesthetic agents influence neutrophil function. Our hypothesis was that sevoflurane would inhibit neutrophil apoptosis and consequently influence the postoperative pro-inflammatory state. In order to identify selectively the effect of the anaesthetic agent sevoflurane, we studied patients undergoing minimally stimulating (cataract) surgery randomly allocated to receive either sevoflurane (n = 11) or local anaesthesia (n = 12). Venous blood samples were taken immediately prior to anaesthesia and at 1, 8 and 24 h thereafter. The rate of neutrophil apoptosis, plasma concentration of cytokines and differential white cell count were measured. The rates of neutrophil apoptosis and plasma concentrations of IL-1beta, TNF-alpha and IL-8 at each time point were similar in the two groups. IL-6 concentrations increased significantly and to a similar extent compared to preanaesthetic levels at 8 and 24 h. This study demonstrates that sevoflurane does not influence the rate of neutrophil apoptosis, cytokine concentrations and neutrophil count following cataract surgery.
• Introduction: The requirement for pre-hospital practitioners to perform additional interventions is ever increasing. In Ireland the training of prehospital practitioners is currently developing and evolving to meet this demand. This requires the use of simulators with the capability to simulate more advanced interventions. • Objectives: We wished to explore the views of pre-hospital care practitioners post participation in a pilot high fidelity simulation in emergency care, to gauge its acceptability, relevance and application. • Method: Pre-hospital care practitioners' participated in 12 full immersion high-fidelity simulated scenarios, over three consecutive days. Live video recording was during the scenarios and replayed during debriefing sessions. The participants completed a voluntary and anonymous evaluation of the training using six statements on a five point Likert scale and free text written comments to three open-ended questions. • Results: The overall response to the training was overwhelming positive with 94.4 % of the participants either strongly agreed or agreed that the course met their learning needs. All agreed that they found the course relevant to their stage of training and that the course will impact beneficially on their clinical practice. • Conclusion: This pilot study has shown that high-fidelity simulation is both applicable and relevant to pre-hospital practitioner.
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