Nurse‐controlled analgesia (NCA) following major surgery in 10 000 patients in a children’s hospital
ABSTRACT Background and Objectives: Patients who received NCA with morphine following major surgery between 1996 and 2008 at Great Ormond Street Hospital, London, UK, were prospectively studied in the postoperative period to determine effectiveness, morphine requirements, incidence of common side effects, and serious adverse events.Methods: The morphine NCA regimen and monitoring was according to standard hospital protocols. Data were collected prospectively and subsequently entered by trained personnel into a secure database. Patient demographics, effectiveness and satisfaction rates, morphine requirements, side effects, and serious complications were recorded.Results: 10 079 patients were included. The average age was 4 years old (range 1 day to 20.5 years, median 2.3 years). There were 510 neonates. The average NCA duration was 43.7 h. 1.8% of morphine NCAs were replaced by other methods because analgesia was unsatisfactory. Satisfaction ratings were ‘good’ or ‘very good’ for 98% of the remainder. Average daily morphine requirement (mcg·kg−1·h−1) was related to age, surgical category, and postoperative time. Side effects included PONV (25%), itching (9.4%), depression of respiration, and sedation (4.5%); incidences varied with age, morphine dose, and type of surgery. Serious, potentially life-threatening adverse effects (SAE) were 0.4%. There were no deaths. SAE were significantly greater in neonates (2.5%), relative risk 9.4, P < 0.001. Morphine dose in neonates who experienced SAE was not significantly different from other neonates.Conclusion: NCA with morphine is an acceptable, safe, and effective method of postoperative analgesia for a wide range of ages and types of surgery in our practice. Morphine requirements increase with age, but there was also considerable inter-individual variation within age groups. PONV, itching, sedation, and respiratory depression are expected side effects. SAE are uncommon but the incidence is greatest in neonates.
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ABSTRACT: This paper presents a versatile full wave analysis tool in which isolation pockets in IC's are readily introduced to perform intensive EM simulation including efficient introduction of via interconnects through metal levels. The obtained results are favorably compared to recent experimental published resultsMicrowave Symposium Digest, 2002 IEEE MTT-S International; 02/2002
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ABSTRACT: The quantity and quality of evidence available for the management of acute pain has grown rapidly over the last 20 years. Rather than listing current evidence related to specific acute pain treatments, the purpose of this review is to look at recent evidence in terms of its availability and ease of access, synthesis and incorporation into clinical practice as well as some of its limitations. An increasing number of evidence-based medicine tools are available to assist clinicians in the provision of acute pain treatments. However, integration of this population-based evidence with clinical expertise, different patient factors and resource availability in different practice settings is still required if the best outcome is to be achieved for each patient. It is difficult for clinicians to remain updated and synthesize all the evidence available relating to the treatment of acute pain. Assistance is available, but there may be limitations to some of the evidence presented and its application to different aspects of clinical practice and different patient groups.Current opinion in anaesthesiology 10/2010; 23(5):623-8. DOI:10.1097/ACO.0b013e32833c33ed · 2.53 Impact Factor