Implementation of a quality assurance process for non-therapeutic infant male circumcision providers in North West England.

BACKGROUND: Infant male circumcision is practised by many groups for religious and cultural reasons. Prompted by a desire to minimize the complication rate and to help parents identify good quality providers, a quality assurance (QA) process for infant male circumcision providers has been developed in Greater Manchester. METHODS: Local stakeholders agreed a set of minimum standards, and providers were invited to submit evidence of their practice in relation to these standards. In participation with parents, community groups, faith groups, healthcare staff and safeguarding partners, an information leaflet for parents was produced. Engagement work with local community groups, faith groups, providers and healthcare staff was vital to ensure that the resources are accessible to parents and that providers continue to engage in the process. RESULTS: Providers that met the QA standards have been listed on a local website. Details of the website are included in the information leaflet distributed by maternity services, health visitors, primary care and community and faith groups. The leaflet is available in seven languages. CONCLUSIONS: Local QA processes can be used to encourage and identify good practice and to support parents who need to access services outside the remit of the National Health Service.

Comparison of vital capacity induction with sevoflurane to intravenous induction with propofol for adult ambulatory anesthesia.

UNLABELLED: We compared vital capacity inhaled induction (VC) with sevoflurane with i.v. induction with propofol for adult ambulatory anesthesia. Patients were randomly assigned to receive either 8% sevoflurane in 75% N2O/O2 from a primed circuit (VC, 32 patients) or propofol 2-mg/kg bolus (i.v., 24 patients). Times to loss of consciousness (response to command) and induction side effects (airway, hemodynamic, motor) were assessed. Anesthesia was maintained with sevoflurane/N2O via a face mask for both groups. At the end of surgery, recovery times were measured and psychomotor function tests were performed. Patients were also asked to assess the quality of their anesthesia. Of the VC patients, 59% lost responsiveness in one breath, taking 39 +/- 3 s. All VC patients completed the induction, and all measures of induction time were significantly shorter for VC than for i.v. Induction side effects were different in the two groups (cough and hiccough for VC versus movement and blood pressure changes for i.v.), but overall incidences were similar. There were no significant differences in any index of early or intermediate recovery. Mild nausea occurred more often with VC, but no antiemetics were needed, and discharge was not delayed. Patients' assessments of the quality of induction or wake up were not significantly different between VC and i.v. Thus, VC induction with sevoflurane is an acceptable alternative to propofol i.v. induction of general anesthesia for adult ambulatory surgical patients. IMPLICATIONS: A vital capacity induction with sevoflurane produced a faster loss of consciousness and had side effects, recovery times, and patient satisfaction similar to that of a propofol induction in adults undergoing ambulatory surgery.

A comparison of clinical and psychological effects of fentanyl and nalbuphine in ambulatory gynecologic patients.

Drug dosages, length of stay (LOS), and incidence of psychological side effects of fentanyl and nalbuphine were compared in a randomized, double-blind study using unpremedicated female day-surgery patients undergoing diagnostic laparoscopy. Patients received either fentanyl 1.5 micrograms/kg (F group; n = 142), low-dose nalbuphine 300 micrograms/kg (LN group; N = 103), or high-dose nalbuphine 500 micrograms/kg (HN group; n = 41), intravenously (IV) before anesthesia consisting of thiopental, N2O, O2, and a succinylcholine infusion. Additional IV intraoperative and IM postoperative opioids were given if required for signs of inadequate anesthesia or postoperative pain. The patients' clinical and psychological status was evaluated at 20-min intervals postoperatively by a team of trained interviewers. The low- and high-dose nalbuphine groups clinically resembled the fentanyl group in terms of dosing frequency and patients' self-ratings of postoperative analgesia. Length of stay and postoperative sedation were significantly greater with nalbuphine. The incidence of psychological side effects, including dreaming and postoperative anxiety, was also greater with nalbuphine. However, patient acceptance of nalbuphine was high and was similar to that observed in patients given fentanyl.

Hypermagnesaemia and anaesthetic management.

The anaesthetic management of a pre-eclamptic parturient who was treated with high doses of magnesium sulphate and who developed hypermagnesaemia before delivery by Caesarean Section, is presented. The pharmacology of magnesium, particularly its effects at the neuromuscular junction, and clinical considerations of magnesium administration are discussed.