Anaesthetists should wear gloves--touch sensitivity is improved with a new type of thin glove.

BACKGROUND: Sterile gloves should be worn for all invasive procedures. However, loss of touch sensitivity when wearing gloves leads to poor compliance among anaesthetists in the UK. Our aim was to investigate whether new surgical glove types, such as extra-thin or latex-free gloves, offer any advantage in touch sensitivity. METHODS: The skin-pressure sensibility threshold of the gloved pulp of the dominant index finger was established in 24 anaesthetists using nine self-made modified von Frey hairs. The range of forces generated by nylon monofilaments was evenly distributed between 0.5 and 17 mN. The gloves tested were latex Biogel standard, latex-free Biogel Neotech, and extra-thin latex Ansell microthin surgical gloves. The different glove types were assessed in a counterbalancing algorhithm, the individual was blinded, and the filaments were applied in random order. RESULTS: The median threshold force to touch was significantly lower for the extra-thin surgical gloves in comparison to the standard latex (P = 0.014) and latex-free gloves (P = 0.001). There was no significant difference between the standard latex and latex-free gloves (P = 0.166). CONCLUSION: We have demonstrated that wearing extra-thin surgical gloves offers increased touch sensitivity. This may improve dexterity when carrying out delicate invasive procedures. Latex-free surgical gloves performed similar to standard latex gloves. Our findings should encourage more widespread glove use among anaesthetists.

A simple method for the fixation of armoured tubes for tracheostomy.

A simple adaptation of currently available equipment is described which facilitates the secure fixation of armoured tracheostomy tubes.

Leakage and absorption of isoflurane by different types of anaesthetic circuit and monitoring tubing.

Conductive rubber anaesthetic circuit tubing both absorbs volatile agents and leaks these agents through its walls. We quantified the leakage and absorption properties of the most commonly used plastic materials used to make breathing circuit tubing, relative to conductive rubber. We then compared two different types of plastic tubes used to carry gas to volatile agent monitors; one made of polyvinyl chloride, the other made of polyvinyl chloride lined internally with a thin layer of polyethylene. We found that the three commonly used plastic types used to make anaesthetic circuit tubing all leak less volatile anaesthetic through their walls than conductive rubber. Polyethylene and polypropylene tubing absorb significantly less volatile anaesthetic than conductive rubber; however, this is not the case with polyvinyl chloride tubing. Differences in the leakage and absorption properties of polyvinyl chloride monitoring tubing are not significantly changed by the addition of a thin internal layer of polyethylene. It is therefore not worthwhile incorporating this feature into production.

A comparison of the effect of rocuronium and vecuronium on heart rate during gynaecological laparoscopy.

The effect on intra-operative heart rate of two nondepolarising muscle relaxants, rocuronium and vecuronium, was compared in 116 fit out-patients undergoing gynaecological laparoscopic procedures. Both groups received an anaesthetic technique which differed only in the choice of muscle relaxant. Intra-operatively it was noted that patients given rocuronium (20 mg) had significantly fewer episodes of bradycardia (heart rate < 50 beat.min-1) than patients given vecuronium 4 mg (p < 0.05). Profound bradycardias (heart rate < 30 beat.min-1) did not occur in any of the patients in the rocuronium study group, whereas 5% of patients receiving vecuronium had a period of transient asystole. We conclude that, at the doses stated, rocuronium results in significantly fewer episodes of bradycardia than vecuronium when used as a muscle relaxant for laparoscopic gynaecological procedures.

The use of tramadol following day--case oral surgery.

This prospective, randomised double-blinded study was designed to assess the analgesic efficacy and occurrence of nausea when tramadol is added to a nonsteroidal anti-inflammatory drug to provide analgesia following day-case third molar teeth extraction. All patients received oral diclofenac pre-operatively and one of four treatments intra-operatively: fentanyl and metoclopramide, tramadol and metoclopramide, fentanyl and ondansetron, or tramadol and ondansetron. There were no significant differences between groups in scores for pain in the early postoperative period. However, there were significant differences in nausea scores at this time, with the fentanyl-ondansetron group having the lowest and the tramadol-ondansetron group having the highest scores. There were no significant differences in the incidence of pain or nausea in the following 24 h. We conclude that the addition of tramadol to diclofenac results in no useful improvement in analgesic effect, and that the use of ondansetron fails to reduce the nausea associated with tramadol.

Extent and practicalities of filter use in anaesthetic breathing circuits and attitudes towards their use: a postal survey of UK hospitals.

A postal survey of 120 UK hospitals was conducted to assess the current use of filters in anaesthetic breathing systems and consultant anaesthetists' opinion of their value; 76% of the questionnaires were returned complete. The survey showed that 77.2% of anaesthetic departments use a new filter for every case, a variety of different filter types being used. A connector distal to the filter was used in 78.3% of patients, providing a possible route for cross infection. Anaesthetists rated the prevention of bacterial infection and gross contamination as being higher priorities than the prevention of viral infection. Of those surveyed, 66.3% believed filters were worthwhile whereas only 35.9% thought they were cost effective. Only 34.8% of anaesthetists believed that the supposed extra efficiency of pleated hydrophobic membrane filters over electrostatic filters merited their extra cost.

Intravenous tenoxicam for analgesia following laparoscopic cholecystectomy.

In a double-blind, placebo-controlled clinical trial (power of 80% to detect a 30% reduction in morphine consumption, P < 0.05) we have determined that intraoperative intravenous administration of tenoxicam 40 mg during laparoscopic cholecystectomy, when compared with placebo, was associated with a significant reduction in consumption of morphine at 6 hours and 12 hours (P < 0.05) but not at 24 hours, when assessed by patient-controlled analgesia. Furthermore there was a significantly greater requirement for "rescue" analgesia with intramuscular morphine in the placebo group during the period of the study. There was no difference between the groups in pain scores, either at rest or on movement, nor in the incidence of nausea and vomiting. No patient in either group suffered a respiratory rate less than 8/min or oversedation at any time, and there were no other adverse effects.

Postoperative analgesia with transdermal fentanyl following lower abdominal surgery.

In a randomised, placebo-controlled, double-blind study involving 81 patients undergoing total abdominal hysterectomy, the postoperative analgesia provided by transdermal fentanyl given at 25, 50, or 75 micrograms.h-1 for 72 h was compared with a placebo group. The efficacy of the Transdermal Therapeutic System was related to the rate of fentanyl delivery, higher rates being associated with significantly lower visual analogue pain scores (24, 20, 17 and 13, for placebo, 25, 50 and 75 micrograms.h-1 respectively) and reduced patient controlled analgesia morphine requirements (44, 38, 33 and 31 mg respectively). Patients' overall sedation scores were not increased by transdermal fentanyl, but respiratory rates decreased with higher transdermal fentanyl dosage.

Effectiveness and sequelae of very low-dose suxamethonium for nasal intubation.

We have studied the effectiveness and sequelae of low-dose suxamethonium in 60 day-case oral surgery patients requiring nasal intubation. Anaesthesia was induced with propofol and alfentanil; 60 patients were allocated randomly to three groups of 20 patients and received no suxamethonium, suxamethonium 0.25 mg kg-1 or 0.5 mg kg-1. All patients received i.v. fentanyl and diclofenac 100 mg rectally for analgesia. Good intubating conditions were produced in all 20 patients receiving suxamethonium 0.25 mg kg-1, in 19 patients receiving suxamethonium 0.5 mg kg-1 and in 11 patients not receiving a neuromuscular blocker. The incidence of postoperative myalgia after suxamethonium 0.25 mg kg-1 (20%) did not differ significantly from the incidence after propofol and alfentanil alone (28%).

A comparison of postoperative analgesia following spinal or epidural anaesthesia for caesarean section.

Postoperative analgesia, using a patient-controlled analgesia system, was studied in 32 women after elective Caesarean section performed under either spinal or epidural anaesthesia. Patients who had spinal anaesthesia had significantly higher pain scores and morphine consumption during the first 4 h postoperatively than patients who had epidural anaesthesia. This situation was reversed between 4 to 8 h postoperatively with patients who had had epidurals having significantly higher pain scores despite higher morphine consumption. After 8 h there was little difference in pain scores or morphine use between the two groups. Total morphine consumption in the first 24 h postoperatively was not significantly different between the two groups.