Ivermectin is cheap and effective in the treatment of paediatric scabies. Ivermectin has minimal observed toxicity and has the additional beneficial effects of antiparasitic action in onchocerciasis, filariasis and strongyloidiasis. Ivermectin is better than benzyl benzoate for the treatment of paediatric scabies in developing countries.

SummaryWe developed a screening questionnaire to be used by nurses to decide which patients should see an anaesthetist for further evaluation before the day of surgery. Our objective was to measure the accuracy of responses to the questionnaire. Agreement between questionnaire responses and the anaesthetist's assessment was assessed. For questions with a prevalence of 5 to 95%, the Kappa coefficient was used; percentage agreement was used for all other questions. Criterion validity was excellent ⁄ good for all questions with a prevalence between 5 and 95%, except for the question 'Do you have kidney disease?' For questions with prevalence < 5%, all demonstrated adequate criterion validity except the questions 'Has anyone in your family had a problem following an anaesthetic?' and 'If you have been put to sleep for an operation were there any anaesthetic problems?' Therefore, it is reasonable for nurses to use this questionnaire to determine which patients an anaesthetist should see before the day of surgery.Keywords Anaesthesia; pre-operative, assessment, questionnaire. Recent advances in anaesthetic and surgical practice have facilitated the growth of 'fast track' surgery [1, 2]. Careful outpatient assessment is fundamental to the success of this type of surgery and the Association of Anaesthetists of Great Britain and Ireland now recommends assessment at a pre-operative assessment (POA) clinic [3].The provision of a pre-operative screening and assessment service at POA clinics supplies background information about patient's general medical status and fitness for anaesthesia. POA clinics improve patient care by allowing careful pre-operative evaluation and optimisation of coexisting disease [4], reduce costs [5, 6], improve efficiency [7], and lower surgical cancellation rates [8, 9].In POA clinics, nurses increasingly carry out preoperative screening [10]. Although they are not qualified to decide if a patient is fit for anaesthesia, they play a valuable role in identifying patients who are at risk and require further evaluation and optimisation before the day of surgery [11]. Nurses screen patients for risk factors for fitness for anaesthesia and surgery using questionnaires [12]. These can be self-administered by the patient [9], or used during structured interviews [13], or computer programs [14]. Although many locally developed questionnaires exist, few have been formally assessed.We have developed a multi-tiered screening questionnaire to be used by nurses to decide which patients should be seen at a POA clinic by an anaesthetist for further evaluation and optimisation. Using Delphi consensus methods, we have already evaluated content validity for each question [15] to ensure that the questions are relevant to concept being measured.Our objective was to perform item analysis of the screening questionnaire and measure criterion validity [16], that is, is it a true measure of what it is designed to measure?By testing individual questions beyond basic content validity, we were able to put them together in a...

Ketamine remains one of the most commonly used anaesthetic agents around the world. Despite it being the anaesthetic agent of choice in many developing nations, there is a paucity of literature describing ketamine in the developing world. In what we believe is the first randomized controlled trial to be performed in Vanuatu (formerly the New Hebrides) we compared the use of ketamine 0.9 mg/kg and diazepam 0.07 mg/kg with ketamine 0.3 mg/kg and 2% lignocaine infiltration in 50 Melanesian women undergoing post partum tubal ligation. All women received 0.5 mg/kg intramuscular pethidine.Visual analog pain scores and verbal numeric satisfaction scores were similar between the groups. However the time to obeyed command was significantly faster in the 0.3 mg/kg ketamine group (7.0±4.9 vs 13.0±9.2 min). The incidence of dreaming was similar and the content rated as pleasant by both groups. In institutions where postanaesthesia care resources are limited, 0.3 mg/kg ketamine with local anaesthesia provides for earlier self-care of patients after tubal ligation, without compromise of analgesia, emergence or satisfaction. The implications of these findings extend to other procedures that require short general anaesthesia, which can be adequately performed with low-dose ketamine and local anaesthesia. The latter technique allows more rapid awakening.

'Ketofol', the single-syringe combination of ketamine and propofol (50 mg of ketamine and 90 mg of propofol in a 10 ml syringe) is becoming increasingly popular for short procedures, progressively replacing the more traditional use of ketamine and diazepam in some settings. This audit examined the haemodynamic, emergence and other characteristics of ketofol administration in 42, otherwise fit, women undergoing bilateral post-partum tubal ligation at Vila Central Hospital in Vanuatu. The combination of ketamine and propofol had no clinically important adverse haemodynamic effects. Wake-up from ketofol was favourable, with low rates of nausea and minimal emergence delirium. However, 43% of patients required airway support. For short procedures such as post-partum tubal ligation in fit patients, ketofol appears to have minimal adverse haemodynamic effects and favourable emergence characteristics.