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Biomedical subjects
Publications and source records attributed to C S Cairns.
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In a double-blind study forty-two children scheduled for elective adenotonsillectomy were randomized to receive peritonsillar infiltration, following induction of anaesthesia, with either 0.25% plain bupivacaine or 0.9% saline, 0.5 ml/kg to a maximum of 10 ml. The children were assessed on awakening, and then 10 minutes, 1 hour, 4 hours and 24 hours later. On each occasion the observer gave the child a pain score from 1 (no pain) to 5 (severe pain). The scores on awakening and after 10 minutes were significantly lower in the bupivacaine group (P < 0.05, Mann-Whitney U test). Thereafter there was no difference between the groups. The authors conclude that peritonsillar infiltration with bupivacaine is only moderately useful as analgesia for children having tonsillectomy.
Preventable mishaps in an intensive therapy unit were studied over 12 months by the critical incident technique. Staff were encouraged to complete confidential questionnaires describing incidents in which they had participated or had observed. This allowed classification of the events and examination of the views of staff on causes, detection, and prevention. 110 (80%) of 137 events were felt to have been due to human error; the remainder were due to equipment failure. Inexperience with equipment and shortage of trained staff were the factors most often felt to contribute to incidents. The critical incident technique is a useful way of improving standards of clinical care.