[Utilization of a unit of ambulatory surgery]. / Utnyttelse av en dagkirurgisk operasjonsenhet.

The productivity in an operating theatre can be defined as surgical time divided by the total work hours of the operating room staff. This productivity factor is normally reduced in the case of operations that take only a short time to perform, since the time interval between operations is usually not reduced correspondingly. In the unit for outpatient surgery at Akershus Central Hospital, 4.6 operations were performed daily in 206 days in 1993, with a productivity factor of 42% and an operating theatre utilization of 66% (operating theatre time spent on specific patients/total operating theatre time). The mean interval from the time the surgeons finished one operation until they could start the next was 33 minutes (confidence interval 32-34), with a mean operating time of 44 minutes (42-46). The productivity seemed good compared with the central operating theatre suite at the same hospital, and with US standard.

[Productivity in a Norwegian department of surgery]. / Produktivitet i en norsk operasjonsavdeling.

There are few good methods of evaluating efficiency in the operating theatres. Data from four operating theatres (gynaecology, gastroenterology, thoracic/vascular-surgery and orthopaedics) during regular working hours (0730-1530) were evaluated for a period of 37 weeks in 1993. A record was made of duration of surgery and the time that elapsed from when the nurses received the patient until he or she was delivered to the postoperative ward. We also registered the time elapsing from the end of one operation to the start of the next. On average 2.2 (thoracic/vascular) to 3.2 (gynaecology) patients were operated on each day. The surgeons spent about 40% of their normal working hours actually operating. Preparations before start of anaesthesia took about 30 minutes, and before surgery 30-40 minutes. Another 30 minutes elapsed from the end of the operation until the patient was delivered to the postoperative ward. We conclude that there may still be a potential for increasing productivity in these operating theatres.

Effects of combined superoxide dismutase and deferoxamine on recovery of brainstem auditory evoked potentials and EEG after asphyxial cardiac arrest in dogs.

In a randomized study in 23 dogs, we tested the following anti-free radical combination therapy, administered at the beginning of CPR, following apnea-induced cardiac arrest of 7 min: a) ventilation with 100% nitrogen for 30 s to allow the delivery of therapy before oxygen; b) superoxide dismutase (10 mg/kg i.a. followed by 10 mg/kg i.v. over 1 h) to scavenge the superoxide anion radical; and c) deferoxamine (20 mg/kg i.v. over 1 h) to prevent membrane lipid peroxidation. We evaluated the effects of this treatment on the recovery of cardiovascular and cerebral variables short term (6 h) after resuscitation. We reported previously that this treatment mitigated the post-arrest cerebral blood flow changes and enhanced the recovery of somatosensory evoked potentials. This is a secondary report from the same study concerning the effects of this treatment on the recovery of brainstem auditory evoked potentials (BAEPs) and EEG. Compared to control (n = 10), the experimental treatment (n = 10) did not exert a clearcut, significant effect on the recovery of BAEP which normalized in both groups at 1 h post-arrest and enhanced the post-arrest recovery of EEG spectra total power by reducing the post-arrest increase in slow frequency bands. However, the relative distribution of EEG frequencies never recovered the pre-arrest pattern in either group, during the 6 h post-arrest observation period. We conclude that the combination treatment tested enhances the recovery but does not normalize cerebral function post-arrest, suggesting that other treatments should also be entertained or that, indeed, such an insult may not be completely ameliorated by any such treatments.

[Anaphylactic shock caused by suxamethonium (Curacit)]. / Anafylaktisk sjokk etter suxameton (Curacit).

We describe five cases of anaphylactic shock following the short-acting muscle relaxant succinylcholine (suxamethonium). All the patients recovered uneventfully. Skin prick testing identified succinylcholine as the probable causative agent in four cases. The incidence of anaphylaxis to succinylcholine in our material appears to be 1:1,000. Treatment consisted of volume substitution, adequate oxygenation and adrenergic agents. We discuss the routine use of succinylcholine for intubation in elective surgery, and conclude that the anaesthesiologist must always be prepared for a possible anaphylactic reaction.

Alleviation of labor pain in Norway. An interview investigation in 1969 and 1986.

In 1969 the Scan-Gallup institution interviewed a random sample of 503 women from all parts of Norway who had given birth during the last 24 months. Cesarean sections and forceps deliveries were excluded. The interviews revealed that 69% of the women were left unattended for a considerable part of the delivery, that their husbands were present at only 6% of the births, and only 31% of the women received any kind of analgesia. None were given an epidural block. Nevertheless, 80% of the mothers subsequently said they were satisfied with the treatment and care. Of the 20% dissatisfied, 70% complained of lack of attention, but only 17% drew attention to lack of analgesia. The same investigation has been repeated in 1986 by the same institution and using the same questions. This time the interviews disclosed a completely different picture. 83% of the women were attended by someone all the time during their births, the child's father was present at 86% of the births, 75% of the mothers had received some kind of analgesia, and 14% received epidural block. Nevertheless, the number of satisfied mothers was no greater than in 1969. In 1986 the dissatisfied complained of unfriendly midwives, and lack of sympathy, reassurance and support. Only 15% complained of lack of analgesia, similar to the 1969 finding.

Protective effects of combined superoxide dismutase and deferoxamine on recovery of cerebral blood flow and function after cardiac arrest in dogs.

Oxygen free radicals generated during reoxygenation after cardiac arrest may impair recovery of cerebral blood flow and function. In a randomized study in vivo, we tested the following anti-free radical combination therapy administered at the beginning of cardiopulmonary resuscitation after apnea-induced cardiac arrest of 7 minutes: 1) ventilation with 100% nitrogen for 30 seconds to allow the delivery of therapy before oxygen, 2) 10 mg/kg i.a. superoxide dismutase followed by 10 mg/kg i.v. over 1 hour to scavenge the superoxide anion radical, and 3) 20 mg/kg i.v. deferoxamine over 1 hour to prevent membrane lipid peroxidation. We evaluated the effects of this combined treatment on the recovery of cardiovascular variables, cerebral blood flow and oxygen consumption, and somatosensory evoked potentials in 20 dogs 6 hours after resuscitation. Compared with standard treatment (n = 10), the combined treatment (n = 10) did not affect cardiovascular variables, significantly mitigated cerebral blood flow changes after cardiac arrest, and enhanced recovery of somatosensory evoked potentials. We conclude that oxygen free radicals play a role in the pathogenesis of the arrest-related derangements of cerebral blood flow and function that are effectively reduced by this combined treatment; we recommend evaluation of its components in outcome studies.

Local reactions after i.v. injections of diazepam, flunitrazepam and isotonic saline.

Local reactions after i.v. injection of diazepam, flunitrazepam and isotonic saline were studied in patients who received extradural analgesia or general anaesthesia. The frequency of thrombophlebitis on the 1st, 3rd and 5th days after the injection of diazepam was 2.1%, 17.0% and 14.9% respectively, after flunitrazepam 10.0%. 10.0% and 14.0%, and after saline 0%, 6.7% and 4.4%. The differences between the groups were not statistically significant (P > 0.05). One month after the injection 15.6% in the diazepam group, 8.5% in the flunitrazepam group and 9.3% in the saline group had pain or tenderness in the arm used for the injection.

Epiglottis acuta treated with nasotracheal intubation.

Twenty children, ranging in age from 1--9 years, and one adult suffering from epiglottis acuta were treated with nasotracheal intubation performed under general anaesthesia and with ampicillin. Clinical cure was obtained in all cases with a mean intubation time of 34 hours. The diagnosis, epiglottis acuta, was suspected by the referring physician in 10 cases. The incidence of epiglottis acuta compared to laryngitis acuta was found to be 1:30. The mean hospital stay was 5.4 days. It is concluded that treatment of acute epiglottis by nasotracheal intubation in the hands of experienced anaesthesiologists and with close observation in an intesnive care unit, is a safe method of management with negligible morbidity and mortality.