Pouch of Douglas block for laparoscopic sterilisation

Abstract

SummaryWe assessed the hourly occupancy of our intensive care unit by high dependency patients over an 8-week period using the criteria established by the Working Group on Guidelines on Admission to and Discharge from Intensive Care and High Dependency Units published by the National Health Service Executive. High dependency patients accounted for 1914 bed hours (21.6%) out of a potential available total of 8880 hours. Measurement of Therapeutic Intervention Scoring System points and Acute Physiology and Chronic Health Evaluation II scores confirmed that categorising patients according to the new guidelines produced significantly different populations of patients. Mean (standard deviation) Therapeutic Intervention Scoring System points for intensive care status patients were 38.57 (10.40) compared to 21.66 (5.98) points for high dependency status patients (p`0.001). Median (range) Acute Physiology and Chronic Health Evaluation II score for intensive care status patients was 16 (1-45) compared to 11 (1-27) for high dependency status patients (p`0.0001). Calculating bed occupancy with different definitions for the whole of our intensive care unit population during the 8 weeks revealed a range of occupancies between 85.3% and 107.3%. We recommend that intensive care unit bed occupancy should be calculated in a standard manner nationally to allow comparison between units. We suggest that hourly occupancy be adopted as the universal method.Keywords Intensive care. ...................................................................................... Correspondence to: Dr P. Spiers Accepted: 2 October 1997 Following much adverse publicity about the transfer of patients needing intensive care between hospitals, the National Health Service (NHS) Executive has issued 'Guidelines on the Admission to and Discharge from Intensive Care and High Dependency Units' [1]. The authors felt that many patients remain on an intensive care unit (ICU) longer than necessary and that the development of high dependency units (HDUs) would mean that ICU resources would be used more appropriately. This sentiment has been echoed by other authors [2] who felt that the existence of an HDU would reduce the numbers of premature discharges from their ICU. We undertook this study in order to evaluate the amount of ICU resources that may be freed if an HDU were available, using the new guidelines [1] to categorise patients as either HDU or ICU status.Different ICUs use different definitions to calculate bed occupancy. A recent report of the British Transplantation Society Working Party on Organ Donation [3] collected information on bed occupancy from 173 units in the United Kingdom. Occupancy ranged from 25 to 137%, but the definition of bed occupancy was not stated and we suspect that each ICU had applied its own definitions, as we had done when completing the survey form. We are also aware that some ICUs include patients managed by the ICU team in other parts of the hospital in their occupancy figures. We therefore applied three different de...

Psychological preparation for patients undergoing day surgery

“…Both Edwards et al (1991) and Mackintosh and Bowles (1998) reported female patients undergoing gynaecological surgery experienced a great deal of pain although patients undergoing a variety of gynaecological surgery were included in the survey. Haldane et al (1998), Codd (1991) and Agboola et al (1998) all reported higher pain levels following gynaecological surgery and therefore made specific recommendations for this group i.e. greater use of analgesia and improved information.…”

Anesthesia for laparoscopy: a review

“…Pouch of Douglas block.A catheter can be placed in the pouch of Douglas under direct vision using an epidural needle inserted through the abdominal wall. Local anesthetic placed into the pouch of Douglas provides effective pain relief after tubal ligation, whereas the use of a catheter technique permits repetition of the dose to prolong analgesia[59]. 5.2.1.5.…”

Reducing Postoperative Pain After Tubal Ligation With Rings or Clips

“…We subsequently excluded one paper as a result of our inability to calculate a variance estimate, 7 leaving 20 papers for the analysis (Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Only one author 10 provided useful additional information (regarding the timing of pain measurements).…”

“…Seven studies 18,[20][21][22][23][24]26 reported results only as medians, and 13 [8][9][10][11][12][13][14][15][16][17]19,25,27 reported results as means. For the purposes of the meta-analysis, we included all studies (means and medians), but we also examined them separately.…”

“…Seventeen studies [8][9][10][11][13][14][15][16][17][18][19][20][21][22][24][25][26] reported results using visual analog scale (VAS), whereas three studies 12,23,27 used McGill. In brief, VAS quantifies pain intensity using a 10-cm line with ends anchored at 0 cm (no pain) and 10 cm (maximal pain).…”