Purpose: To determine, retrospectively, the age of packed red blood cell (PRBC) units transfused to patients admitted to the ICU with the diagnosis of severe sepsis and to correlate this variable with outcome. Methods: All patients admitted to the ICU during 1992 with a diagnosis of severe sepsis were selected retrospectively. The criteria for the diagnosis of severe sepsis and septic shock were based on established guidelines. For each patient the total number of PRBC units transfused, the number of units transfused before, during and after the septic episode, and the age of each PRBC unit transfused were recorded.Results: Of the 31 patients admitted to the ICU with severe sepsis, 19 died and 12 survived. No statistical differences between survivors and nonsurvivors were found with respect to age, sex, number of days in ICU, duration of sepsis, incidence of septic shock, admission Apache II score or total number of PRBC units transfused. During sepsis the median age of PRBC units transfused to survivors was 17 days (range 5-35) vs 25 days (range 9-36) for nonsurvivors (P < 0.000 I). A negative correlation (r = -0.73) was found between the proportion of PRBC units of a given age transfused to survivors and increasing age of PRBC.Conclusion: This is the first study to report a correlation of mortality with the age of PRBC transfused. The cause of this association is unclear. If this association is confirmed by a prospective randomised trial it would have major implications for the use of PRBC in severe sepsis.Objectif : DEterminer rEtrospectivement I'~ge des concentrEs Erythrocytaires (CE) transfuses ~ des patients admis ~ I'unitE des soins intensifs (USI) avec un diagnostic de sepsis grave et vEriJier si cette variable a une correlation avec le devenir des patients.M&hodes : Tousles patients admis ~ I'USI en 1992 avec un diagnostic de sepsis grave ont fait I'objet de cette recherche retrospective. Les signes et sympt6mes usuels ont servi ~ Etablir les critEres de sepsis grave et de choc septique. Pour chacun des patients la quantitE totale des CE transfuses, le nombre de CE transfuses avant, pendant et aprEs I'Episode septique et I'~ge de chaque CE transfuse ont EtE enregistrEs. R~ultats : Parmi les 31 patients admis ~ I'USI pour sepsis grave, 19 sont dEcEdEs et 12 ont surv&u. II n'y avait pas de difference statistique entre survivants et non survivants en rapport ~ I'~ge, le sexe, la durEe du sEjour I'USI, la durEe du sepsis, I'incidence du choc septique, le score APACHE II ~ I'admission et le nombre de CE transfuses. Au cours du sepsis, I'~ge median des CE transfuses Etait de 17 jours (Ecart 5--35) vs 25 jours (&art 9-39) pour les non survivants (P < 0,0001). On a trouvE une correlation negative (r = -0,73) entre la proportion de CE d'un ~ge dEterminE transfuse aux survivants et I'accroissement de I'~ge des CE. Conclusion : II s'agit ici de la premiere Etude concluant ,~ une correlation avec I'~-ge des CE transfuses. La raison de cette association n'est pas claire. Si une Etude alEatoire prospective parvient ~...

A new lateral approach to blocking the sciatic nerve in the popliteal fossa is described. In a prospective study, 40

A randomized, single-blind trial of two spinal anesthetic solutions for outpatient laparoscopy was conducted to compare intraoperative conditions and postoperative recovery. Thirty women (ASA physical status I and II) were assigned to one of two groups. Group I patients received a small-dose hypobaric solution of 1% lidocaine 25 mg made up to 3 mL by the addition of fentanyl 25 micrograms. Group II patients received a conventional-dose hyperbaric solution of 5% lidocaine 75 mg (in 7.5% dextrose) made up to 3 mL by the addition of 1.5 mL 10% dextrose. All patients received 500 mL of crystalloid preloading. Spinal anesthesia was performed at L2-3 or L3-4 with a 27-gauge Quincke point needle. Surgery commenced when the level of sensory anesthesia reached T-6. Intraoperative hypotension requiring treatment with ephedrine occurred in 54% of Group II patients but not in any Group I patients. Median (range) time for full motor recovery was 50 (0-95) min in Group I patients compared to 90 (50-120) min in Group II patients (P = 0.0005). Sensory recovery also occurred faster in Group I patients (100 +/- 22 min) compared with Group II patients (140 +/- 27 min, P = 0.0001). Postoperative headache occurred in 38% of all patients and 70% of these were postural in nature. Oral analgesia was the only treatment required. Spinal anesthesia did not result in a significant incidence of postoperative backache. On follow-up, 96% said they found spinal needle insertion acceptable, 93% found surgery comfortable, and 90% said they would request spinal anesthesia for laparoscopy in future. Overall, this study found spinal anesthesia for outpatient laparoscopy to have high patient acceptance and a comparable complication rate to other studies. The small-dose hypobaric lidocaine-fentanyl technique has advantages over conventional-dose hyperbaric lidocaine of no hypotension and faster recovery.

Purpose: To compare the analgesic effects of preoperative oral clonidine with intraoperative intravenous fentanyl in children undergoing tonsillectomy or adenotonsillectomy. Methods: This randomized, controlled, double-blind study of 36 ASA I-II children, age 7-12 yr undergoing adenotonsillectomy was conducted at a tertiary care paediatric teaching hospital. Either 4 lug'kg q clonidine p0 was given 60-90 rain preoperatively or 3/~g-kg -s fentanyl iv was given intraoperatively. Postoperatively visual analog pain scores (VAS) were recorded at rest and on swallowing every I 0 rain for the first 30 rain and then every I 5 min for two hours. Morphine 0.05 mg'kg -I iv was given for VAS _>5. If >3 doses were required, 1.5 mg.kg -I codeine p0 and 20 mg'kg q acetaminophen p0 were given. Sedation and anxiety scores were recorded preoperatively. Haemodynamic changes, blood loss, recovery scores, and the incidence of vomiting, hypotension, and airway obstruction were recorded. Results: Children who received donidine had a higher incidence of preoperative sedation (63%) than those receiving fentanyl (6%). Preinduction mean arterial pressure was lower in the clonidine group but required no intervention. VAS scores were similar throughout the observation period. There was no difference either in the number of morphine or codeine rescue doses administered or in the incidence of side effects. Conclusion: Oral clonidine is an effective analgesic and sedative for children undergoing tonsillectomy or adenotonsillectomy. Objectif : Comparer les effets analg&iques de l'administration orale de clonidine prEop&atoire et de fentanyl intraveineux perop&atoire chez des enfants devant subir une amygdalectomie ou une adEno-amygdalectomie. M~thode : Cette Etude randomisEe, contr61Ee et ~ double insu a porte sur 36 enfants ASA MI, ~gEs de 7 ~ 12 arts, devant subir une adEno-amygdalectomie dans un h6pital universitaire de soins pEdiatriques tertiaires. On a administrE 4 ug-kg "i de clonidine po 60-90 min avant l'intervention ou 3 ugkg ~ de fentanyl iv au cours de l'intervention. Les niveaux de douleur ont EtE enregistr& apt& rop&ation, ~ raide de l'EcheIle visuelle analogue (EVA), au repos et lors de la dEglutition ~ toutes les I 0 rain pendant les 30 premieres min et ~ toutes les 15 min pendant les deux heures suivantes. On a administrE 0,0S mg'kg -I de morphine iv pour des scores ~S ~ I'EVA. Si plus de 3 doses &aient n&essaires, on a donne aussi 1,5 mg-kg I de codeine po et 20 mg'kg i d'acEtaminophEne po. Avant l'intervention, on a enregistrE les niveaux de sedation et d'anxiEtE. Les changements hEmodynamiques, les pertes sanguines, les niveaux de rEcupEration et l'incidence de vomissements, d'hypotension et d'obstruction du conduit a&ien ont EtE not&. R~u]tats : Les enfants qui ont re~u de la clonidine ont pr&entE une plus grande incidence de sedation prEop&a-toire (63 %) que ceux qui ont re~u du fentanyl (6 %). Avant l'induction de l'anesth&ie, la tension art&ielle moyenne &ait plus basse dans le groupe qui avait regu de la clonidine, mais...