Ethics Committee Approval (ethics + committee_approval)

Distribution by Scientific Domains

Selected Abstracts

The braun thermoscan thermometer: validation of normal ranges in a paediatric practice

C.A. Streets
Introduction Pyrexia is a common cause of operative cancellation in paediatric practice, and so the accurate determination of temperature is of paramount importance. Recently the Braun ThermoScan infrared aural thermometer has been introduced to Derriford Hospital as a safe and non-invasive technique for measuring temperature. Initially the published upper limits of normal for this technique appeared to be higher than expected. Initial experiences with the thermometer in Derriford Hospital produced high temperature readings in children who were otherwise clinically well. The aim of this study was to compare the manufacturer's published normal ranges with those obtained from a general paediatric population. Methods Ethics Committee approval was obtained. The study was conducted between July and November 2001. Patients less than 16 years of age, and admitted to either the Day Surgical Unit or the general paediatric wards for elective surgery were included. Each child had its temperature measured on admission using the Braun ThermoScan aural thermometer. The ages and temperatures were recorded, and the values compared with the manufacturer's normal ranges using standard error of the means. Results Preliminary data are reported from 248 children: 1,2 years (n = 30), 3,10 years (n = 159), and 11,15 years (n = 59). The table demonstrates that there is no significant statistical difference between the manufacturer's ranges and those of the Derriford Hospital paediatric elective surgical population. Discussion The Braun ThermoScan infrared aural thermometer is considered to be a safe, hygienic, and convenient technique for measuring temperature. Despite initial misgivings that a temperature approaching 38°C could not be considered normal, this study has confirmed that the manufacturer's published normal ranges are indeed compatible with those obtained from a district general hospital paediatric population. Conclusion This study validates the manufacturer's published normal range for the Braun ThermoScan thermometer. This therefore leaves a clinical dilemma , does a child with a temperature of 37.9°C have a pyrexia or not? [source]

Peribulbar blockade with a short needle for phacoemulsification surgery

Background: Peribulbar blockade is still widely used for phacoemulsification surgery. The potential complications of this technique include central spread, globe perforation and retrobulbar hemorrhage. The 25 mm needle is the most common needle used to perform the block. The aim of this study was to demonstrate the efficacy of a 12.5 mm needle in performing peribulbar blockade for phacoemulsification surgery. Methods: After obtaining the hospital research and the Human Ethics Committees' approval, 200 patients undergoing the phacoemulsification procedure under local anesthesia were enrolled in this descriptive study. Peribulbar blockade was performed with a 27 G, 12.5-mm-long needle. The needle was inserted transcutaneously through the lower eyelid into the inferotemporal quadrant. Digital pressure was applied by the thumb and index fingers around the needle hub during injection. After negative aspiration, a local anesthetic solution was injected until total drop of the upper eyelid was achieved. Ocular akinesia was assessed 10 min after the block using the simple akinesia score. A score of 3 or less was accepted to provide adequate analgesia for the surgical procedure to be performed. If the block was inadequate for surgery after 10 min, supplementary anesthesia was provided using the same needle. Results: Adequate analgesia after the first injection was reported in 90.5% of the patients while 9.5% required supplementary anesthesia. There were no major sight or life-threatening complications. Conclusion: Using a 12.5-mm-long needle for peribulbar blockade produced satisfactory results. This technique is effective for phacoemulsification surgery. [source]

Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic

Stuart Watkins
Abstract Objective:, Patients presenting to the ED with obstructive nephropathies benefit from early detection of hydronephrosis. Out of hours radiological imaging is expensive and disruptive to arrange. Emergency physician ultrasound (EPU) could allow rapid diagnosis and disposition. If accurate it might avert the need for formal radiological imaging, exclude an obstruction and improve patient flow through the ED. Methods:, This was a prospective study of a convenience sample of all adult non-pregnant patients with presumed ureteric colic attending the ED with prior ethics committee approval. An emergency physician or registrar performed a focused ultrasound scan and were blinded to the patient's other management. A computerized tomography scan was also performed for all patients while in the ED or within 24 h of the EPU. The accuracy of EPU detection of hydronephrosis was determined; using computerized tomography scans reported by a senior radiologist as the ,gold-standard'. Results:, Sixty-three patients with suspected ureteric colic were enrolled of whom 57 completed both EPU and computerized tomography imaging. Forty-nine had confirmed nephrolithiasis by computerized tomography with 39 having evidence of hydronephrosis. Overall prevalence of hydronephrosis was 68% (95% confidence interval [CI] 56,79%); compared with computerized tomography, EPU had a sensitivity of 80% (95% CI 65,89%); specificity of 83% (95% CI 61,94%); positive predictive value of 91% (95% CI 75,98%) and negative predictive value of 65% (95% CI 43,83%). The overall accuracy was 81% (95% CI 69,89%). Conclusion:, Although the accuracy of detection of hydronephrosis after focused training in EPU is encouraging, further experience and training might improve the accuracy of EPU and allow its use as a screening tool. [source]

Femoral nerve block with ropivacaine or bupivacaine in day case anterior crucial ligament reconstruction

Background/Objective: Our aim was to evaluate analgesia, motor block and pharmacokinetics of ropivacaine 0.2% and 0.75% in a femoral nerve block (FNB) in day case patients for anterior crucial ligament (ACL)-reconstruction compared with bupivacaine 0.25% and placebo. Methods: Following ethics committee approval and informed consent, 280 patients were randomly allocated to four groups for single-shot FNB [30 ml ropivacaine 0.2% (group RO2.0), 0.75% (RO7.5), bupivacaine 0.25% (BU2.5) and NaCl 0.9% (NaCl)]. Analgesia (pain scores, primary outcome) and motor block were assessed at 4 h (dismissal) and up to 24 h. Plasma concentration was determined up to 240 min thereafter. Results: Pain scores at 4 h were significantly higher for NaCl 4 (0,8) (median, range) (vs.) BU2.5 2 (0,8), RO2.0 3 (0,9) and RO7.5 2 (0,8) (NS within the LA groups). Patients of the NaCl group needed analgesics significantly more often (93%) within 4 h after surgery vs. 16% of group RO2.0, 19% of group RO7.5 and 19% of group BU2.5. Motor block was significantly increased with all local anesthetics without a significant difference within the LA groups 3 (0,5) in RO2.0, 3 (0,5) in RO7.5 and 3 (0,4) in BU2.5 vs. 0 (0,3) in group NaCl (median (range); scale from 0=full strength to 5=complete paralysis). Peak plasma concentrations differed significantly: RO7.5: 1.4 ± 0.4 (0.73,2.6) [,g/ml, mean ± SD (range)] after 33 ± 14 (10,40) min, RO2.0: 0.6 ± 0.3 (0.13,1.0) after 22+17 (10,60) and BU2.5: 0.3 ± 0.16 (0.05,0.62) at 31 ± 17 (10,60), respectively. Conclusion: FNB for ACL reconstruction with ropivacaine or bupivacaine provided better post-operative analgesia than placebo without reaching toxic plasma concentrations. Significant motor block was observed after 4 h in all groups including the lowest concentration of ropivacaine but occurred even with placebo. [source]

Effects of etomidate on free intracellular amino acid concentrations in polymorphonuclear leucocytes in vitro

J. Mühling
Background: Previous studies have shown the inhibitory effects of etomidate on polymorphonuclear leucocyte (PMN) function. No reports exist, however, regarding free intracellular amino acid metabolism, although physiological cell metabolism and basic cell functions rely upon a balanced intracellular amino acid content and the cell membrane-mediated separation of cellular amino acids from the extracellular plasma amino acid pool. Thus, in the current study, we evaluated the effects of etomidate on free intracellular amino acid metabolism in PMN. Methods: With ethics committee approval, blood was withdrawn from 35 healthy volunteers and incubated (1 h) either with 0 ,g/ml, 0.0156 ,g/ml, 0.0625 ,g/ml or 0.5 ,g/ml of etomidate as well as with its additives (propylene glycol and Lipofundin MCT® 10%). The PMN were separated using standardized Percoll® -gradient and centrifugation procedure before deep-freezing and lyophilization techniques were employed. All PMN samples were dissolved in methanol/H2O, and the concentrations of free intracellular amino acids were monitored using both novel advanced PMN-separation and high-performance liquid chromatography techniques. Results: Etomidate influenced important free amino acid profiles in PMN in a dose-dependent manner, indicating complex changes of cellular amino acid turnover. Neither propylene glycol nor Lipofundin MCT® 10% changed free amino acid concentrations in PMN. Conclusions: For the first time, the effects of etomidate on free intracellular amino acid metabolism in PMN have been investigated. Our results draw attention to the biochemical pathways which may be involved in etomidate-induced alterations in PMN function and cellular immunocompetence. [source]

Tramadol for pain relief in children undergoing tonsillectomy: a comparison with morphine

Thomas Engelhardt MD
SummaryBackground: Pain control for paediatric patients undergoing tonsillectomy remains problematic. Tramadol is reported to be an effective analgesic and to have a side-effect profile similar to morphine, but is currently not licensed for paediatric use in the UK. Methods: We conducted a prospective, double-blind, randomized controlled trial in children who were scheduled for elective tonsillectomy or adenotonsillectomy at the Royal Aberdeen Children Hospital. Following local ethics committee approval and after obtaining a drug exemption certificate from the Medicines Licensing Agency for an unlicensed drug, we recruited 20 patients each into morphine (0.1 mg·kg,1), tramadol (1 mg·kg,1) and tramadol (2 mg·kg,1) groups. These drugs were given as a single injection following induction of anaesthesia. In addition, all patients received diclofenac (1 mg·kg,1) rectally. The postoperative pain scores, analgesic requirements, sedation scores, signs of respiratory depression and nausea and vomiting, as well as antiemetic requirements, were noted at 4-h intervals until discharge. Results: There were no statistically significant differences in age, weight, type of operation or induction of anaesthesia, 4-h sedation and pain scores and further analgesic requirements. There were no episodes of respiratory depression. Morphine was associated with a significantly higher incidence of vomiting following discharge to the wards (75% versus 40%, P=0.03) compared with both tramadol groups. Conclusions: Tramadol has similar analgesic properties, when compared with morphine. The various pharmaceutical presentations and the availability as a noncontrolled substance may make it a useful addition to paediatric anaesthesia if it becomes licensed for paediatric anaesthesia in the UK. [source]

Preparation of parents by teaching of distraction techniques does not reduce child anxiety at anaesthetic induction.

A. Watson
Introduction For those children having surgery, induction of anaesthesia is one of the most stressful procedures the child experiences perioperatively. Current work has failed to show a benefit of parental presence at induction of anaesthesia for all children. The reasons for lack of effect may include the high anxiety levels of some parents and also that the role for parents at their child's induction is not delineated. The main aim of this study was to see if parental preparation by teaching of distraction techniques could reduce their child's anxiety during intravenous induction of anaesthesia. Methods After ethics committee approval 40 children aged 2,10 years old, ASA status I or II undergoing daycase surgery under general anaesthesia were enrolled into the study. To avoid possible confounding factors children with a history of previous, surgery, chronic illness or developmental delay were excluded form participation. No children were given sedative premedication. After written informed consent by the parent, each child and parent was randomly assigned to an intervention or control group. Parents in the intervention group received preparation from a play specialist working on the children's surgical ward. It involved preparation for events in the anaesthetic room and instruction on methods of distraction for their child during induction using novel toys, books or blowing bubbles appropriate to the child's age. Preoperative information collected included demographic and baseline data. The temperament of the child was measured using the EASI (Emotionality, Activity, Sociability, Impulsivity) instrument of child temperament(l). In the anaesthetic room all children were planned to have intravenous induction of anaesthesia after prior application of EMLA cream. Anxiety of the child was measured by the modified Yale Preoperative Anxiety Scale (mYPAS)(2) by a blinded independent observer at three time points: entrance to the anaesthetic room, intravenous cannulation and at anaesthesia induction. Cooperation of the child was measured by the Induction Compliance Checklist (ICC) by the same observer (3). Postoperative data collected included parental satisfaction and anxiety scores measured by the Stait Trait Anxiety Inventory (STAI)(4) and at one week the behaviour of the child was measured Using the Posthospitalisation Behavioural Questionnaire (PHBQ)(5). Normally distributed data were analysed by a two-sample t-test, categorical data by Pearson's Chi-squared test and non-parametric data by the Wilcoxon rank-sum test. Results One parent withdrew after enrolment. This left 22 children in the control group and 17 in the intervention group. There were no significant differences in demographic and baseline data of the children between the two groups including ethnic origin, number of siblings, birth order of the child, recent stressful events in the child's life, previous hospital admissions and the temperament of the child. Parent demographics were also similar between groups including parent's age, sex, relationship to child and level of education. There were no significant differences in child anxiety or cooperation during induction measured by mYPAS and ICC between the control and intervention groups. More parents in the preparation group distracted their child than those without preparation but this did not reach significance. Parental anxiety immediately postinduction was similar between groups as was the level of parental satisfaction. The incidence of development of new negative postoperative behaviour of the child at one week was not significantly different between groups. Discussion This study shows that giving an active role for parents in the induction room, particularly by instructing them on distracting techniques for their child, does not reduce their child's anxiety compared to conventional parental presence. We conclude resources should not be directed at this type of parental preparation. Further work should examine the usefulness of distraction by nursing staff or play specialists during anaesthetic induction. [source]

The prevalence and related risk factors of anxiety and depression symptoms among Chinese pregnant women in Shanghai

Yong-Xia QIAO
Objective: To investigate the prevalence of anxiety and depression of the pregnant women during the prenatal period, and provide information for further epidemiological study. Methods: With ethics committee approval, a total of 527 recruited pregnant women from the Department of Obstetrics and Gynecology, Tongji University Medical School were selected at four hospitals that affiliated to the University. By applying a self-designed questionnaire for hospital anxiety and depression (HAD) scale, we evaluated anxious and depressive symptoms in these women. Results: The prevalence rates of anxiety and depression in these Chinese pregnant women during prenatal period were 6.8% and 4.8%, respectively, whereas the co-prevalence rate of both anxiety and depression was 3.4%, and anxiety and/or depression 15.0%. The relationship between the prevalence rate of anxiety/depression and the age distribution was proven negatively correlated (,2 = 1.478, P = 0.016) by the trend chi-squared test. Among all three groups, the prevalence rate of anxiety and depression was highest in the group of below 20 years old, lowest in the group of over 30 years old, and in-between in the group of 20 to 30 years old. Logistic regression analysis showed that lower age was a risk factor (odds ratio (OR) = 10.094, 95% confidence interval (CI): 1.418~71.838). Meanwhile, poor educational background (OR = 1.929, 95%CI: 1.101~3.379) was a relevant risk factor as well. Conclusions: We suggest that introduction of psychological health instruction programs for pregnant women, especially the younger ones, should be strengthened. Besides, the essential intervention measures may be applied if necessary. [source]