Objective. To gain better understanding of the work-preparedness of new interns and identify areas where further training and education should be provided. Design. Surveys of new interns assessing self-reported confidence and preparedness for tasks commonly undertaken without direct supervision. The first survey was undertaken before the cohort had started work, the second once they had completed their second intern rotation. Setting. A large metropolitan Victorian health service. Participants. All interns starting in 2009 at Southern Health. Of the total 66 interns, 52 (84%) completed the first survey and 37 (56%) completed the second. Main outcome measure(s). Self-reported confidence and preparedness for common intern tasks. Results. The surveys identified tasks that interns undertake frequently, their preparedness for these and their confidence in completing them. Although most felt reasonably well prepared by their university training for many tasks they commonly undertake as interns, this was not the case for all tasks. In particular, they did not feel well prepared for the following: preoperative patient review, handover, fluid and medication management, patient admissions, assessment of unstable patients, communication with patients and families, and pain management. Conclusions. There are particular domains of work-readiness for interns that could be improved. For best results, the training of interns in these common tasks should be undertaken jointly by hospitals and universities to ensure smooth transition from medical student to intern. What is known about the topic?Transition from student to intern requires a range of skills and attributes. Previous publications have demonstrated a link between the number of times a procedural task has been completed by junior medical staff and confidence in completion. What does this paper add?This paper documents interns' own views about the tasks commonly undertaken during internship, and their views on how well they were prepared for these tasks by university training and organisational orientation. It considers non-procedural tasks (such as communication and escalation) as well as common intern procedures. It also documents the intern hopes and concerns regarding internship immediately pre-employment and after 20 weeks of employment. What are the implications for practitioners?Later-year university training experiences and organisational orientation planning should at least in part be geared by the requirements for work-readiness at intern level.

BACKGROUND:Phaxan™ (PHAX, Chemic Labs, Canton, MA) is an aqueous solution of 10 mg/mL alphaxalone and 13% 7-sulfobutylether β-cyclodextrin (betadex). In preclinical studies, PHAX is a fast onset–offset IV anesthetic like propofol, but causes less cardiovascular depression. This first-in-man study was designed to find the anesthetic dose of PHAX and to compare it with an equivalent dose of propofol for safety, efficacy, and quality of recovery from anesthesia and sedation.METHODS:The study adhered to compliance with Good Clinical Practices regulations (clinical trials registry number, ACTRN12611000343909). This randomized, double-blind study compared PHAX and propofol using a Bayesian algorithm to determine dose equivalence for effects on the bispectral index (BIS). Male volunteers, ASA physical status I, gave written informed consent (n = 12 per group; PHAX or propofol). Parameters assessed for 80 minutes after drug injection (single bolus dose) were pain on injection, involuntary movement, BIS, blood pressure, need for airway support, and, as measures of recovery from sedation, the Richmond Agitation and Sedation Scale and the Digit Symbol Substitution Test. Arterial blood was withdrawn for biochemistry, hematology, and complement levels.RESULTS:No subject complained of pain on injection with PHAX, whereas 8 of the 12 subjects given propofol did. Nine PHAX and 8 propofol subjects reached BIS values of ≤50: median (interquartile range [IQR]) mg/kg dose = 0.5 (0.5–0.6) for PHAX and 2.9 (2.4–3.0) for propofol. The lowest median BIS reached was 27 to 28 for both agents with no significant differences between them for timing of onset and recovery of BIS. The concomitant median changes in systolic and diastolic blood pressures were −11% vs −19% for systolic and −25% vs −37% for diastolic in PHAX- and propofol-treated subjects, respectively. Nine of the 12 propofol-treated subjects and none of 12 PHAX-treated subjects required airway support. For subjects reaching an equivalent BIS of ≤50: a Richmond Agitation and Sedation Scale score of 0 was reached at a median of 5 (IQR, 5–10) and 15 (IQR, 10–20) minutes after PHAX and propofol, respectively; BIS returned to 90 at a mean of 21 (SD, 10.1) and 21 (SD, 9.2) minutes after PHAX and propofol, respectively; and Digit Symbol Substitution Test scores returned to predrug injection values at median of 50 (IQR, 35–72.5) and 42.5 (IQR, 35–76.3) minutes after PHAX and propofol, respectively. There was no increase in C3 and C4 complement fractions after either drug.CONCLUSIONS:PHAX causes fast-onset, short-duration anesthesia with fast cognitive recovery similar to propofol, but with less cardiovascular depression, or airway obstruction and no pain on injection.

Laparoscopic procedures have previously been shown to interfere little with respiratory homeostasis. This study was designed to determine whether respiratory homeostasis, as well as temperature, is maintained with longer laparoscopic procedures and cold carbon dioxide insufflation. This study examined 21 American Society of Anesthesiologists status I and II patients undergoing laparoscopic cholecystectomy. A constant minute ventilation (80mL/kg per min) was instituted prior to peritoneal insufflation and end‐tidal carbon dioxide measurements were followed throughout the procedure. Although they showed a small statistically significant increase (32.3 ± 3.8 to 38.9 ± 6.0 mmHg, P= 0.0001) they were not of clinical significance. Similarly, rectal temperature measurements showed a statistically. but not clinically, significant fall in temperature over the course of the procedures (36.4 ± 0.46 to 36.2 ± 0.35°C, P = 0.0001). The changes in end‐tidal carbon dioxide and temperature showed no correlation with the volume of carbon dioxide used. The above findings will, however, require further investigation in both longer procedures and patients with more significant disease.

Peri-operative nausea and vomiting (PONV), remain a considerable problem. Ondansetron is being promoted currently as the drug of choice for the prevention and treatment of PONV. Experiments to investigate efficacy of ondansetron in PONV have been made with placebo or single doses of other drugs, e.g. metoclopramide, and often with different anaesthetic regimes with different emetic potential. This study investigated the relative benefits, in the prevention of PONV, of ondansetron compared with metoclopramide used at a dose higher than used in previous studies. Ninety-six patients undergoing minor gynaecological surgery were randomized to receive either ondansetron 4 mg or metoclopramide 0.4 mg kg-1. The patients were then assessed in the recovery room, in the day ward prior to discharge and the following day for the occurrence of PONV. Emetic symptoms occurred in similar proportions of patients who received ondansetron and metoclopramide. Nausea scores were similar between the groups in the recovery ward and 24-h follow-ups but there were higher post-operative nausea scores in the ondansetron group in the day ward (P = 0.001). There were no significant side effects due to either drug. We conclude that moderate dose metoclopramide is an effective alternative to ondansetron in the control of PONV.