The 'Hemocue' devicefor rapid estimation of haemoglobin concentration was evaluated in a clinical setting. Repeatable accuracy of capillary, venous and arterial samples was examined and then compared with standard laboratory venous haemoglobin estimates using a 'Coulter JT' analyser in 42 patients. The mean values for haemoglobin (g/l) and coefficient of variation were capillary 108.2 (8.0); venous 104.9 (2.2); arterial 1 05.9 (2.0); and laboratory venous 104.6 (1.3). Although the mean haemoglobin values were similar, capillary samples were significantly less repeatable than venous or arterial samples (Pit man test, P < 0.001). Comparison of variance between the laboratory sample and each sampling technique demonstrated that capillary samples were significantly more variable than venous or arterial samples. Peripheral skin temperature did not influence the accuracy of capillary samples. Hemocue estimations of venous samples were found to be as accurate as laboratory estimations. The lack of repeatable accuracy of capillary estimations was sufficiently large that their use cannot be recommended in clinical practice.

P. P. Chen et al (1996) European Journal of Anaesthesiology, 13, 485-491 Comparison of ondansetron and metoclopramide for the prevention of post-operative nausea and vomiting after major gynaecological surgery Summary ondansetron group (n=25) and eight patients (33%) in the metoclopramide group (n=24) vomited, The efficacy of ondansetron 4 mg was compared with whereas at 4-12 h, this increased to 11 patients (44%) metoclopramide 10 mg for the prevention of postand nine patients (37.5%) respectively. The incidence operative nausea and vomiting in patients after major was 52 and 37.5% respectively in the subsequent gynaecological abdominal surgery. Anaesthesia was 12-24 h. The highest incidence of nausea was in the standardized using thiopentone, atracurium and methfirst 4 h after surgery, being 56 and 37.5% in the adone for induction followed by isoflurane in nitrous ondansetron and the metoclopramide groups reoxide-oxygen mixture. Fifty patients were randomized spectively. This decreased to less than 25% in both groups in the 12-24 h period. Ondansetron 4 mg and in a double-blind fashion to either receive intravenous metoclopramide 10 mg had similar but short lasting (i.v.) ondansetron 4 mg or metoclopramide 10 mg durefficacy for the prevention of vomiting in patients ing closure of the pelvic peritoneum. The incidence who received continued opioid analgesia after major and frequency of vomiting, and the incidence of severe gynaecological surgery. nausea was recorded for 24 h after surgery. One patient was excluded because of respiratory depression. In the first 4 h after surgery, five patients (20%) in the macology, ondansetron, metoclopramide.

SummaryIncident reporting is an effective tool for continuous quality improvement in clinical practice. A prospective study on voluntary incident reporting in pain management was conducted at a major teaching hospital in Hong Kong. Over a 12-month period, 53 incidents were reported in 1275 patients who received pain relief treatments which were supervised by the acute pain service. The majority of the incidents were first detected by the pain team. The most common incidents involved delivery circuits, delivery pump and drug administration. A large proportion (81.4%) of the incidents were thought to be preventable. Human factors were involved in 41.9% of the patients reported, most commonly associated with unfamiliar technique/inexperience, inattention and inadequate communication. Four patients developed major morbidity of which two were attributed to inadequate analgesia, while three others had major physiological changes without morbidity. Strategies have been formulated to prevent further occurrence of these incidents. We propose that incident reporting is a potentially useful tool in identifying and preventing adverse events in postoperative pain management.