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The quality and accessibility of anaesthesia-related information available to patients on the internet is a growing concern for the specialty. We sought to evaluate the quality of anaesthesia-related websites using a simple scoring system.The scoring system comprised quality and technical scores individually, and these were also combined into a total score. Test-retest reliability was assessed by calculating intraclass correlation coefficients. We employed the four most popular search engines and one meta-search engine, using the search term “general anaesthesia”. Only the first 10 sites retrieved were scored.The intraclass correlation coefficients for all terms demonstrated at least moderate agreement and the total scores demonstrated high consistency r=0.852, 0.774 (P <0.001, and P <0.003 respectively). There were 18 duplicate websites and 32 were scored. There was no difference between search engines for any of the three scores awarded. The majority of websites were rated as either ‘poor’ or fair’ across all scores.Our study indicates that quality anaesthesia-related information is unlikely to be retrieved by patients using the internet.

Background: Many patients still suffer severe acute pain in the postoperative period. Although guidelines for treating acute pain are widely published and promoted, most do not consider procedure-specific differences in pain experienced or in techniques that may be most effective and appropriate for different surgical settings. The procedure-specific postoperative pain management (PROSPECT) Working Group provides procedure-specific recommendations for postoperative pain management together with supporting evidence from systematic literature reviews and related procedures at http://www.postoppain.org Methods: The methodology for PROSPECT reviews was developed and refined by discussion of the Working Group, and it adapts existing methods for formulation of consensus recommendations to the specific requirements of PROSPECT. Results: To formulate PROSPECT recommendations, we use a methodology that takes into account study quality and source and level of evidence, and we use recognized methods for achieving group consensus, thus reducing potential bias. The new methodology is first applied in full for the 2006 update of the PROSPECT review of postoperative pain management for laparoscopic cholecystectomy. Conclusions: Transparency in PROSPECT processes allows the users to be fully aware of any limitations of the evidence and recommendations, thereby allowing for appropriate decisions in their own practice setting.

Abstract ObjectivesThe aim of this study was to compare morphine and pethidine in patients with clinically suspected renal colic with regard to analgesic efficacy, patient satisfaction and side effects. MethodsDouble blinded, randomised controlled trial. ResultsThere was no significant difference between morphine and pethidine with respect to any of the parameters measured. ConclusionBecause of the well known adverse effects that may be associated with pethidine use, the authors recommend that morphine should be the preferred agent in suspected renal colic, when an opioid analgesic is to be used.

Inadequately treated acute and chronic pain remains a major cause of suffering, in spite of enormous advances in pharmacology and technology. Opioids provide a powerful, versatile, widely available means of managing this pain, but their use is too often restrained by ignorance and mistaken fears of addiction. The management of postoperative pain (perhaps the most common form of acute pain) is traditionally attempted with fixed dosages of analgesics by relatively unpredictable routes (e.g. oral, rectal and intramuscular). Intravenous opioid infusions (an improvement) risk respiratory depression and require close monitoring and titration. Patient-controlled analgesia (PCA), by contrast, permits the most efficacious medication (pure opioid agonist) by the optimal route (intravenous) under direct control of the patient, and provides high levels of satisfaction and safety. Ideally, any opioid use should be integrated with a wide spectrum of other analgesic modalities in an anaesthesiology-based ‘acute pain service’. The use of opioids for chronic pain of nonmalignant origin remains controversial. There is a perceived conflict between patients’ interests and those of society. However, problems (such as tolerance, physical dependence, addiction and chronic toxicity), anticipated from experience with animal experiments and pain-free abusers, seldom cause difficulties when opioids are used appropriately to treat pain (so-called’ dual pharmacology’). With sensible guidelines, and in the context of a multidisciplinary pain clinic, opioids may provide the only hope of relief to many sufferers of chronic pain.

Background. Pain is known to alter the electrogalvanic properties of the skin. The aim of this pilot study was to investigate the influence of postoperative pain on skin conductance (SC) readings. Methods. After obtaining ethical approval and written informed consent, 25 postoperative patients were asked to quantify their level of pain on a numeric rating scale (NRS, 0–10) at different time points in the recovery room. As a parameter of SC, the number of fluctuations within the mean SC per second (NFSC) was recorded. Simultaneously, the NRS was obtained from patients by a different observer who was blinded to the NFSC values. Results. Data from 110 readings of 25 patients (14 female, 11 male; 21–67 yr) were included. NFSC showed a significant correlation with the NRS (r=0.625; P<0.01), whereas heart rate and blood pressure showed no or very weak correlation with the NRS. NFSC was significantly different between patients with no (NRS=0), mild (NRS=1–3), moderate (NRS=4–5) and severe (NRS=6–10) pain (no: 0.047, mild: 0.089, moderate: 0.242, severe: 0.263; P<0.0001). Post hoc, a cut-off value for NFSC (0.1) was calculated above which a pain score >3 on the NRS was predicted with sensitivity of 89% and specificity of 74%. Conclusions. The severity of postoperative pain significantly influences SC. Using cut-off values, NFSC may prove a useful tool for pain assessment in the postoperative period.

Background. Arousal after sevoflurane anaesthesia has been detectable by monitoring changes in skin conductance (SC) with similar accuracy as monitoring Bispectral Index (BIS®). As SC monitoring detects changes in sympathetic tone, the measurements might be confounded by the sympatholytic properties of propofol, a component of total i.v. anaesthesia (TIVA). Therefore in this study, monitoring of SC during emergence from TIVA was compared with the monitoring of BIS®. Methods. Twenty-five patients undergoing plastic surgery were investigated. The number of fluctuations of SC per second (NFSC), BIS® and haemodynamic variables [systolic blood pressure (SBP) and heart rate (HR)] were recorded simultaneously. The performance of the monitoring devices in distinguishing between the clinical states ‘steady-state anaesthesia’, ‘first clinical reaction’ and ‘extubation’ were compared using the method of prediction probability (Pk) calculation. Results. BIS® showed the best performance in distinguishing between ‘steady-state anaesthesia’ and ‘first reaction’ (Pk BIS® 0.99 vs NFSC 0.80; P<0.01), and ‘steady-state anaesthesia’ and ‘extubation’ (Pk BIS® 1.00 vs NFSC 0.91; P<0.05); the time from first change of BIS® or NFSC to a first clinical reaction was significantly longer for NFSC (median BIS® 135 s vs NFSC 191 s; P<0.05). BIS® and NFSC performed better in distinguishing between the investigated clinical states than SBP and HR. Conclusions. In this study, BIS® was found to predict arousal with a higher probability but slower response times than NFSC in patients waking after TIVA.

Background. Changes in skin conductance have previously been reported to correlate well with plasma levels of stress hormones and awakening stimuli. In this study, monitoring of skin conductance during emergence from general anaesthesia was compared with the monitoring of bispectral index (BIS). Methods. Twenty-five patients undergoing minor elective surgery were investigated. The number of fluctuations in mean skin conductance (NFSC), BIS and haemodynamic parameters were recorded simultaneously. The performance of the monitoring devices to predict and distinguish between the clinical states ‘steady-state anaesthesia’, ‘first reaction’ and ‘extubation’ were compared using the method of prediction probability (PK) calculation. Results. Both monitors showed similar performance in distinguishing between ‘steady-state anaesthesia’ vs ‘first reaction’ (PK NFSC 0.89; BIS® 0.94) and ‘steady-state anaesthesia’ vs ‘extubation’ (PK NFSC 0.96; BIS® 0.96). The response times of the monitors, to indicate the likelihood of ‘first reaction’, were not significantly different. Conclusions. NFSC, as a parameter of skin conductance, performed similarly to BIS in patients waking after a general anaesthetic.