Preoperative strategies for managing postoperative pain at home after day surgery.

Patients undergoing surgery, whether major or minor, require postoperative care and pain management. Most of the postoperative care for day surgery patients continues at home. The amount of care they will need, who will care for them, and the pain management strategies needed are important issues to address before surgery. The preoperative assessment nurse provides education and practical advice about pain management at home. Then, on the day of surgery, the day surgery staff reinforces written and verbal home care instructions with the patients and their home caregivers.

Failure of N-acetylcysteine to protect the mouse bone marrow against the clastogenicity of 7,12-dimethylbenzanthracene.

De Flora et al. (1991a) have demonstrated a marked protective effect afforded by N-acetylcysteine (NAC) to the liver and lung of rats exposed to benzo[a]pyrene (BP) by intratracheal injection. Due to the protocol used by De Flora et al., BP was inactive in the bone marrow micronucleus assay and, consequently, the possible protective effect of NAC in this tissue could not be assessed. In the present study, three daily administrations of 7,12-dimethylbenzanthracene (DMBA; 15 or 25 mg/kg/day via oral gavage) resulted in the expected increased in micronucleated polychromatic erythrocytes (MPE) in the bone marrow of male C57BL/6 mice 24 h after the final dose. Pretreatment of similar groups of mice with NAC (1 g/kg/day via oral gavage) 5 h before each administration of DMBA had no effect on MPE frequencies. It is concluded that NAC does not have a protective effect on the mouse bone marrow.

Assessment and selection of patients for day surgery in a public hospital.

OBJECTIVE: To describe methods used for adult patient assessment and selection for day case surgery at a major Australian teaching hospital. DESIGN: A prospective analysis of assessment data and information from the unit's computerised database. PATIENTS AND SETTING: Five thousand day patients consecutively admitted to the Day Surgical Unit, Royal Adelaide Hospital. MAIN OUTCOME MEASURES: The proportion of patients assessed only by trained nursing assessment staff was determined and compared with that for patients requiring additional anaesthetic assessment before surgery. The percentage of patients requiring preoperative investigations was established. Unanticipated hospital admission rates were calculated for surgical, anaesthesia-related and social reasons. RESULTS: After initial screening by a trained assessment nurse, 46% of patients required additional review by an anaesthetist before the day of surgery. The remaining 54% were assessed by an anaesthetist on the day of surgery. Preoperative investigations were ordered by anaesthetists in 8.5% of all day patients. The assessment methods outlined resulted in a 1.28% rate of unanticipated hospital admissions. This admission rate was mostly caused by complications of surgery (0.94%). Only 0.12% of patients were admitted for anaesthesia-related reasons and 0.14% were admitted for social reasons. CONCLUSIONS: This cost-effective system allows suitable patients and procedures to be identified, with a satisfactory unanticipated hospital admission rate. Satisfactory assessment also results in short preoperative waiting periods, fewer cancellations, reduced postoperative problems and more satisfied patients. The development of an efficient assessment system is aided by the use of a dedicated day surgery area with experienced nursing staff, the use of a comprehensive patient questionnaire and coordination by experienced day surgery anaesthetists.

Slow continuous hemodialysis for the management of complicated acute renal failure in an intensive care unit.

This paper describes a simple system for the performance of slow continuous hemodialysis (SCHD) as a means of treating difficult and complicated cases of oliguric acute renal failure. The method, which employs access to the circulation via a double-lumen central venous catheter and a BSM 22 blood systems module, can be performed safely in the intensive care unit of a general hospital if closely supervised by a trained nephrologist. The results of treating 16 consecutive cases of complicated acute renal failure in a large general hospital without a hemodialysis unit are described. The method, whose simplicity makes it suitable for intensive care unit nurses without previous hemodialysis training, was not associated with any serious accidents or complications, and was tolerated well by even the most critically ill and hemodynamically unstable patients. The advantages of this approach over more traditional continuous arteriovenous hemofiltration (CAVH) are discussed.