Effect of cold water immersion on repeated cycling performance and limb blood flow.

The purpose of the present study was to compare the effects of cold water immersion (CWI) and active recovery (ACT) on resting limb blood flow, rectal temperature and repeated cycling performance in the heat. Ten subjects completed two testing sessions separated by 1 week; each trial consisted of an initial all-out 35-min exercise bout, one of two 15-min recovery interventions (randomised: CWI or ACT), followed by a 40-min passive recovery period before repeating the 35-min exercise bout. Performance was measured as the change in total work completed during the exercise bouts. Resting limb blood flow, heart rate, rectal temperature and blood lactate were recorded throughout the testing sessions. There was a significant decline in performance after ACT (mean (SD) -1.81% (1.05%)) compared with CWI where performance remained unchanged (0.10% (0.71%)). Rectal temperature was reduced after CWI (36.8°C (1.0°C)) compared with ACT (38.3°C (0.4°C)), as was blood flow to the arms (CWI 3.64 (1.47) ml/100 ml/min; ACT 16.85 (3.57) ml/100 ml/min) and legs (CW 4.83 (2.49) ml/100 ml/min; ACT 4.83 (2.49) ml/100 ml/min). Leg blood flow at the end of the second exercise bout was not different between the active (15.25 (4.33) ml/100 ml/min) and cold trials (14.99 (4.96) ml/100 ml/min), whereas rectal temperature (CWI 38.1°C (0.3°C); ACT 38.8°C (0.2°C)) and arm blood flow (CWI 20.55 (3.78) ml/100 ml/min; ACT 23.83 (5.32) ml/100 ml/min) remained depressed until the end of the cold trial. These findings indicate that CWI is an effective intervention for maintaining repeat cycling performance in the heat and this performance benefit is associated with alterations in core temperature and limb blood flow.

Prospective, randomized, controlled trial of thoracic epidural or patient-controlled opiate analgesia on perioperative quality of life.

BACKGROUND: Perioperative epidural analgesia provides continuous pain control and may have advantages over parenteral opiate administration. This study assessed the impact of epidural analgesia on quality of life (QOL) of patients undergoing major surgery. METHODS: Sixty patients undergoing thoracic or thoraco-abdominal surgery were studied prospectively. Patients were randomly assigned to receive either thoracic epidural analgesia or patient-controlled i.v. opiate analgesia (PCA) after operation. Visual analogue pain and sedation scores were recorded for the period of the study. QOL health surveys at 24 h (SF-8 acute form) and at 1 week (SF-36) were recorded. Results were examined by uni- and multivariate analyses corrected for the effect of multiple comparisons. RESULTS: Mean pain scores were significantly lower in the epidural group at most time points. Physical and mental scores in the epidural group were significantly better than the PCA group for both SF-8 and SF-36 QOL health surveys (P<0.001). CONCLUSIONS: Epidural analgesia with local anaesthetic and opioid improves QOL and delivers better analgesia compared with PCA in patients undergoing major thoraco-abdominal surgery.

A novel approach to insertion of the Montgomery T-tube.

We describe a novel method of inserting a silicone tracheal Montgomery T-tube using a gum elastic bougie. The advantages of this method over previously described methods are discussed.

Exercise classes in rest homes: effect on physical function.

AIM: To determine if regular exercise classes, planned and supervised by a physiotherapist, improved physical function in a sample of frail institutionalised elderly. METHOD: Weekly one hour and twice weekly 10 minute exercise classes were given by a physiotherapist, to a group of 34 residents who consented from randomly selected rest homes. The study took place over a period of one year. At entry, 4, 9 and 12 months the physical function was compared with the matched control group who received regular rest home activities, without physiotherapy input. The study used a sit stand test to measure change in physical function. This was indicated by recording (a) the time taken and (b) the hand assistance required to stand up. RESULTS: Compared with the control group, the study group showed statistically significant improvement (p < 0.05) in physical function as measured by sit stand time. The sit stand hand assistance test was found to be too insensitive to measure improvement or to differentiate between the two groups. The programme was enjoyable and had no health complications. CONCLUSION: Regular exercise classes planned and supervised by a physiotherapist are safe and improve the physical functioning and daily activity levels of the frail, institutionalised elderly. They are a cost effective use of the physiotherapist's limited time.