Is fasting necessary before prilocaine Bier's block?

OBJECTIVE: To determine whether fasting is necessary before intravenous regional anaesthesia (Bier's block). METHODS: A questionnaire study was carried out to assess accident and emergency (A&E) departments' policies and opinions in relation to Bier's block anaesthesia. Questionnaires were sent to 282 A&E consultants, of whom 216 replied (77% response rate). RESULTS: About 5000 Bier's block procedures are carried out each year in the United Kingdom. Intravenous regional anaesthesia appears safe. Over one third of units did not fast their patients. The complication rate was similar in fasted and unfasted groups. CONCLUSIONS: Starvation of the patient before intravenous regional anaesthesia is not necessary and should be abandoned.

A multivariate analysis of factors related to the mortality of blunt trauma admissions to the North Staffordshire Hospital Centre.

OBJECTIVE: To identify characteristics of blunt trauma admissions associated with mortality and to derive a linear logistic model for predicting the probability of mortality. DESIGN: A prospective observational study. MATERIALS AND METHODS: Data were collected on blunt trauma patients admitted via the Accident and Emergency Department, North Staffordshire Hospital Centre. Univariate and multivariate analyses were performed of potential risk factors associated with mortality. MEASUREMENTS AND MAIN RESULTS: The main outcome variable was survival or death occurring in hospital within 30 days of admission. Injury Severity Score, age, Revised Trauma Score, and place of injury (road traffic, home, or elsewhere) were independently related to mortality. The effect of age on mortality was best described using three categories: 0-64 excluding 15-24, 15-24, 65+. The survival probability model suggests that a person whose injury occurs in the home has a lower probability of survival than a patient with similar age and trauma scores who is involved in a road traffic accident. A model validation check indicated good agreement between model predictions and patient outcomes. CONCLUSIONS: The authors propose that use of this model may provide a more accurate evaluation of the mortality of British trauma admissions than would be obtained using models based on data from American trauma cases.