Postoperative urinary retention following hip or knee arthroplasty under spinal anaesthesia with intrathecal morphine: a retrospective cohort study.

Introduction: Postoperative urinary retention (POUR) frequently complicates the course of patients following hip and knee arthroplasty. Intrathecal morphine (ITM) was identified as a significant risk factor for POUR. The objective of this study was to investigate the incidence and risk factors for POUR in fast-track total joint arthroplasty (TJA) under spinal anaesthesia (SA) with ITM.

Thiamine Administration and the Prevalence of Delirium in the Intensive Care Unit: A Retrospective Before and After Interventional Study.

Background: Thiamine is an essential co-factor for aerobic intracellular respiration, nerve conduction, and muscle contraction. Thiamine deficiency is common in the intensive care unit (ICU). Delirium is a frequent unwanted symptom among critical ill patients.

Hypertriglyceridemia Induced Pancreatitis: plasmapheresis or conservative management?

Introduction: Hypertriglyceridemia-induced acute pancreatitis (HIAP) may result in severe morbidity and mortality. The most effective management strategy is unknown. While plasmapheresis is often performed, it is possible that a conservative approach which includes fasting, intravenous fluids and high-dose insulin, may be successful.

Drug allergy in hospitalized perioperative patients: the contribution of a structured questionnaire for accurate diagnosis.

Aims: History of drug allergy is a major cause for deviation from standard of care, as well as prescribing expensive medications. We aimed to evaluate drug allergy-related history taking by surgery interns and compare it with history taking by an allergist and an anesthetist using a simple, structured questionnaire.

Methods: Patients with a declared drug allergy were prospectively recruited from surgical wards.

Perioperative patient safety: correct patient, correct surgery, correct side--a multifaceted, cross-organizational, interventional study.

Background: It is important to ensure a patient-safe environment in the perioperative setting. With this in mind, a "patient-safety first" philosophy was adopted within our operating room service.

Methods: During the first phase of the interventional study (2001-2002), we defined and executed the organizational and educational aspects of the intervention.

Intrathecal anesthesia for elderly patients undergoing short transurethral procedures: a dose-finding study.

One hundred elderly men (> or =65 yr) undergoing transurethral procedures (<45 min) received bupivacaine 7.5 mg, or bupivacaine 5 mg + fentanyl 20 mug, or bupivacaine 4 mg + fentanyl 20 mug, or bupivacaine 3 mg + fentanyl 20 mug, intrathecally. Intraoperative "rescue" fentanyl requirements were higher (P < 0.

Postcesarean analgesia: the efficacy of bupivacaine wound instillation with and without supplemental diclofenac.

Study Objective: To assess the analgesic efficacy of diclofenac when administered as an adjuvant to bupivacaine wound instillation.

Design: Prospective, randomized, double blind, placebo-controlled study.

Setting: Large referral hospital.

Failure of conservative treatment for lumbar spinal stenosis in elderly patients.

Spinal stenosis syndrome affects mainly patients at their 5th-6th decades of life. There is a strong debate in the literature whether patients with spinal stenosis should be operated or treated conservatively. Our aim was to evaluate patients with lumbar spinal stenosis who were treated conservatively.

The hyponatramia of multiple myeloma is true and not pseudohyponatramia.

The hyponatremia found in multiple myeloma and which is associated with a reduced anion gap (ag) is considered to be pseudohyponatremia due to the displacement of water by the high globulin content in the blood. Serum proteins participate in acid-base balance. Stewart and other authors in their approach to acid-base interpretation acknowledge electrical neutrality as a fundamental characteristic of body fluids.

Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures.

Purpose: To assess if titration of sevoflurane using the bispectral index (BIS) monitor improves the early and intermediate recovery in geriatric outpatients undergoing brief urologic procedures under general anesthesia without muscle relaxants.

Methods: After a standardized induction with propofol and fentanyl, a laryngeal mask airway was inserted and sevoflurane was administered in combination with 60% nitrous oxide in oxygen for maintenance of anesthesia in spontaneously breathing outpatients. In the Control group (n = 25), sevoflurane and fentanyl were titrated according to standard clinical practice.

The frequency and timing of respiratory depression in 1524 postoperative patients treated with systemic or neuraxial morphine.

Study Objective: To describe the frequency and timing of intravenous patient-controlled analgesia (IV-PCA) or neuraxial morphine-induced postoperative respiratory depression.

Design: Audit of data captured by routine quality assurance of the acute pain protocols that were implemented by nurses performing routine postoperative care.

Setting: The surgical wards of a university-affiliated, 700-bed, tertiary hospital.

The effects of general vs spinal anesthesia on frontal cerebral oxygen saturation in geriatric patients undergoing emergency surgical fixation of the neck of femur.

Study Objective: To assess the effect of regional vs general anesthesia on transcranial cerebral oxygen saturation (rSo2).

Design: Prospective, randomized, open-label study.

Setting: Large referral hospital.

The role of sonography in detecting radial head subluxation in a child.

Injuries around the elbow joint in children can be difficult to diagnose on the basis of findings on physical examination and radiographs. We present the case of a 4-year-old girl with a probable subluxation of the radial head, based on the findings on physical examination and radiographs. Radiography raised the possibility of a radial head subluxation.

Establishing a nurse-based, anesthesiologist-supervised inpatient acute pain service: experience of 4,617 patients.

Study Objective: To describe our nurse-based Acute Pain Services (APS) and present the results of 4617 patients treated by our service.

Design: Descriptive audit.

Setting: Large referral hospital.

The postoperative analgesic efficacy of wound instillation with ropivacaine 0.1% versus ropivacaine 0.2%.

Study Objectives: To assess the influence of ropivacaine concentration on wound instillation-induced postoperative analgesia following total abdominal hysterectomy with bilateral salpingo-oophorectomy.

Design: Prospective, randomized, double-blind study.

Setting: Large referral hospital.

The postoperative blood-sparing efficacy of oral versus intravenous tranexamic acid after total knee replacement.

To assess the blood-sparing efficacy of tranexamic acid (TA) administered orally or via a variable IV infusion, 80 healthy patients undergoing elective total knee replacement were studied according to a prospective, controlled, randomized, single-blinded study design. Patients were allocated to one of four treatment groups. In group TA-long, 30 min before deflation of the limb tourniquet, an IV bolus dose of TA 15 mg/kg was administered over 30 min.

Anaesthesia for caesarean delivery: low-dose epidural bupivacaine plus fentanyl.

To determine the acceptability of epidural bupivacaine-induced sixth thoracic (T6) sensory blockade and the analgesic efficacy of epidural fentanyl 50 microg, 24 parturients undergoing elective caesarean section were given a test dose of lidocaine 60 mg plus epinephrine followed by 10 ml of either 0.5 % bupivacaine (control group) or 0.5 % bupivacaine plus 50 microg fentanyl (fentanyl group) in a randomized double-blind manner.

Alternating patient position following the induction of obstetric epidural analgesia does not affect local anaesthetic spread.

To assess the influence of gravity on epidural-induced sensory blockade during the first stage of labour, 60 parturients were recruited to a randomized, controlled, single-blinded study. In all cases an epidural catheter was placed with the patient in the left lateral position. Thereafter, patients were randomized to one of three groups.

Delivery room analgesia: an analysis of maternal satisfaction.

On the first post-partum day, 324 mothers completed a questionnaire designed to assess maternal perception of delivery room experience. Antenatal pain expectation, actual pain severity, analgesia received, as well as maternal satisfaction and choice of analgesia for future deliveries were recorded. Forty-five percent of primiparae and 36% of multiparae reported that they anticipated suffering extreme pain during delivery.

Operative treatment for hip fractures in patients 100 years of age and older: is it justified?

Objectives: To evaluate a unique group of elderly patients over 100 years of age who had hip fractures.

Design: Retrospective database analysis.

Settings: Academic teaching hospital.

Rehabilitation after knee immobilization in octogenarians with patellar fractures.

Between January 1990 and December 1999, 14 octogenarians (8 women and 6 men) underwent surgery for comminuted patellar fracture. Average patient age was 83 years (range: 80-88 years). Follow-up ranged from 1-8 years (mean: 3.

Surgical treatment of lumbar spinal stenosis in patients aged 65 years and older.

Spinal stenosis syndrome affects mainly patients at their 5th-6th decades of life. The main goals of surgical treatment in the elderly are to allow the individual to walk longer distances, maintain the activities of daily living (ADL) and social life. Our aim was to evaluate the results of surgical treatment for lumbar spinal stenosis in elderly patients.

Does the combination of a simultaneous subcapital fracture of humerus and hip fracture in elderly patients carry a prognostic value?

The most important factor to cause hip fractures in elderly is probably osteoporosis. Other factors are the increase in fall frequency and the protective response to trauma. Osteoporotic fractures occur most commonly, at the hip, vertebra, distal radius and proximal humerus.

Economic consequences of operative delay for hip fractures in a non-profit institution.

This retrospective study evaluated the economic consequences of delaying hip fracture surgery in 191 elderly patients. Data was collected regarding fracture type, surgery, timing of surgery, background diseases, postoperative hospital stay, and complications. In addition, calculation of the drugs administered to the patients, cost of the surgery, blood transfusion, physiotherapy, laboratory examinations, radiographs, and any financial data were evaluated.