Ethnicity and prescription of analgesia in an accident and emergency department: cross sectional study.
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Biomedical subjects
Publications and source records attributed to P Yate.
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We have assessed the influence of age and preoperative mental status score on postoperative mental function, using a choice reaction time test. One hundred and twelve patients (mean age 70 yr, range 48-88 yr) were given a standardized general anaesthetic for transurethral procedures. Mental status before anaesthesia was measured with the Clifton Assessment Procedure for the Elderly (CAPE). Reaction time was measured before anaesthesia and for up to 3 days after anaesthesia. Variability in reaction time performance was increased 24 h after anaesthesia in transurethral patients, but not in a control group of orthopaedic patients (P = 0.0006). Factors contributing to increased variability of reaction time after operation in a multiple regression analysis were reduced CAPE score before operation (P less than 0.0001), extent of surgery (P = 0.023), postoperative pain (P = 0.007) and postoperative sedative drugs (P = 0.009). Factors not contributing included age, diagnosis of cancer, number of previous operations in past 5 years, duration of anaesthesia, minimum mean arterial pressure, minimum and maximum perioperative PCO2 values, postoperative pyrexia and poor sleep.
One hundred and forty-five men were randomly allocated on a double-blind basis to receive either temazepam 20 mg, diazepam 10 mg or placebo as premedication. Temazepam produced more sedation than either diazepam or placebo. Postoperative recovery was assessed by a simple visuo-motor co-ordination test and was best in the placebo group. Two hours into recovery, temazepam patients could almost match their baseline performance whereas the performance of the diazepam patients was still significantly worse than pre-operatively. Temazepam is suggested as a suitable premedicant for elderly patients undergoing minor surgery.