Ultrasonography guided rectus sheath catheters versus epidural analgesia for open colorectal cancer surgery in a single centre.

INTRODUCTION: Epidural anaesthesia (EA) has been the accepted standard for postoperative analgesia in open abdominal surgery. However, it is not without significant risk. This study aimed to audit the effect of EA and ultrasonography placed rectus sheath catheters (RSCs) on analgesia as well as the incidence of postoperative complications following open colorectal cancer surgery. METHODS: A three-year retrospective case note review was undertaken of all patients undergoing open colorectal cancer surgery at the Royal Devon and Exeter Hospital NHS Foundation Trust who received either EA or RSC for postoperative analgesia under the care of the senior authors. A single surgeon and single anaesthetist were practitioners. RESULTS: The case notes of 120 patients were reviewed retrospectively: 85 patients had EA and 24 RSC while 11 patients were excluded from the study. The EA group experienced a significantly higher incidence of hypotension (systolic blood pressure <130 mmHg) than the RSC group on the first postoperative day (p=0.0001). There was no significant difference in pain score or opiate sparing properties between the groups (p=0.92). There was no significant difference in postoperative respiratory tract infection, anastomotic leak or wound complications between the groups (p=0.2, p=1.0 and p=0.5 respectively). The RSC group had a higher incidence of ileus than the EA group (4/24 vs 2/85, p=0.026). However, the numbers were too small to draw a reliable conclusion. CONCLUSIONS: The use of ultrasonography guided RSCs has demonstrated effective postoperative analgesia equivalent to EA with the potential benefits of a reduced incidence of hypotension. A prospective randomised trial is now underway to compare RSC and EA in open abdominal and pelvic surgery.

Study examining attitudes of staff, patients and relatives to witnessed resuscitation in adult intensive care units.

BACKGROUND: Witnessed resuscitation is widely accepted in paediatric practice and is becoming more common in adult emergency departments, but information on this topic is sparse. METHODS: We gave a questionnaire to 50 intensive care medical and nursing staff and 55 patients and next of kin before elective postoperative admission to the intensive care unit to examine staff opinion about witnessed resuscitation, patient and relatives' demand for witnessed resuscitation, and their perception of the benefits. RESULTS: We found that 56% of doctors and 66% of nurses favoured giving relatives the option to stay. If relatives requested to be present, 70% of doctors and 82% of nurses would allow this if the relatives were escorted. The role of the escort was felt to explain, prevent interference, and to provide emotional support. We found that 29% of patients and 47% of relatives wanted to be together during resuscitation, the commonest reasons being to provide support and to see that everything was done. We found that 95% of patients and 91% of relatives felt their views should be formally sought before ICU admission. CONCLUSIONS: Intensive care staff support witnessed resuscitation. Many intensive care personnel have experienced witnessed resuscitation and the majority felt that relatives gained benefit. Almost all agree that the views of both patient and relatives should be sought formally before admission to intensive care.

Multiple acyl-CoA dehydrogenase deficiency: a rare cause of acidosis with an increased anion gap.

Metabolic acidosis is encountered frequently in intensive care and common causes include lactic acidosis, ketoacidosis, or renal failure. We describe a patient presenting to intensive care with a rare cause of metabolic acidosis associated with an increased anion gap: multiple acyl-CoA dehydrogenase deficiency. The pathophysiology of this condition is discussed along with potential treatment options.

Sequence conservation of the major outer capsid glycoprotein of human group C rotaviruses.

Several outbreaks of Group C rotavirus infection have occurred in the United Kingdom, in one instance infection was associated with the death of a 4-month-old infant in the Bristol area. The origin of human group C rotavirus is unknown although there has been some speculation that porcine species may be a possible source of human infection. Direct reverse transcription-polymerase chain reaction sequencing of VP7 genes from two UK outbreaks (Bristol and Preston) and sequence analysis from a sporadic case of infection from Brazil (Belém) showed that each of these genes was identical in size (1,063 bp) and has revealed a surprising level (97.8-99.8%) of gene sequence conservation. Sequence comparisons with an isolate from Japan imply that the human group C rotaviruses so far characterised originate from a recent common ancestor with a worldwide distribution.