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The mortality of critically ill patients who develop acute renal failure (ARF) is persistingly high. We reviewed all patients who developed ARF that required dialysis in a single intensive care unit (n = 167) during the period 1977 to 1989, in order to identify variables with possible influence on outcome. Overall mortality within hospital was 75%. Age above 60 (p < 0.02), requirement for mechanical ventilation (p < 0.0005), requirement for inotropic drugs (p < 0.0005) and increased levels of P-bilirubin (p < 0.005) had negative impacts on survival. Mortality increased significantly from 63% in the early period (1977-1985) to 84% in the late period (1986-1989) (p < 0.001), a rise that could not be explained by a single variable. The patients in the later period were, though, characterized by a higher morbidity with a higher frequency of additional organ failure.

A randomized, double-blind trial was conducted to compare the efficacy of preincisional and postincisional wound infiltration with 1% lidocaine (40 ml) on postoperative pain. Thirty-seven patients scheduled for elective inguinal herniotomy participated. The demand for additional postoperative analgesics occurred earlier in those who received lidocaine infiltration after incision (165 min) than in those who received preincisional lidocaine (225 min), p < 0.05). The preincisional lidocaine infiltration group also had fewer patients requiring supplemental analgesics (58%) than the postincisional group (94%) (p < 0.05). We conclude that preincisional infiltration of the surgical wound with lidocaine is a more effective method for postoperative analgesia than postincisional infiltration.