For patients undergoing craniotomy, it is desirable to have stable and easily controllable hemodynamics during intense surgical stimulation. However, rapid postoperative recovery is essential to assess neurologic function. Remifentanil, an ultra-short-acting mu-opioid receptor agonist, may be the ideal agent to confer the above characteristics. In this prospective randomized study, we compared the hemodynamic stability, recovery characteristics, and the dose of propofol required for maintaining anesthesia supplemented with an infusion of remifentanil, alfentanil, or fentanyl in 34 patients scheduled for supratentorial craniotomy. With routine monitors in place, anesthesia was induced with propofol (2-3 mg/kg), atracurium (0.5 mg/kg), and either remifentanil (1 microg/kg), alfentanil (10 microg/kg), or fentanyl (2 micro/kg). The lungs were ventilated with O2/air to mild hypocapnia. Anesthesia was maintained with infusions of propofol (50-100 microg/kg/min) and either remifentanil (0.2 microg/kg/min), alfentanil (20 microg/kg/h), or fentanyl (2 microg/kg/h). There were no significant differences among the groups in the dose of propofol maintenance required, heart rate, or mean arterial pressure. However, the time to eye opening (minutes) was significantly shorter in the remifentanil compared to the alfentanil group (6+/-3; 21+/-14; P = 0.0027) but not the fentanyl group (15+/-9). We conclude that remifentanil is an appropriate opioid to use in combination with propofol during anesthesia for supratentorial craniotomy.

A telephone survey of 20 English intensive care units (ICUs) confirmed that visual estimation of patient weight is often performed. Four experienced intensive care staff (three doctors and one nurse) estimated the weight and measured the height of 30 volunteers and the estimates were compared with accurate reference measurements. The estimates were shown to be significantly inaccurate for individual observers. We consider the degree of inaccuracy to be of clinical importance. However, pooling the individual estimates of weight as mean values improved accuracy. Recommendations are made concerning the performance of height and weight determination.

Summary Re‐admissions have been cited as a measure of critical care quality and outreach teams have recently been introduced to improve critical care delivery. The aim of this study was to examine whether the number, causes and sequence of re‐admissions to critical care altered as a result of the introduction of an outreach team. Re‐admissions between April 2000 and November 2001 were examined. The reasons for re‐admission were classified as (i) same pathology or disease process; (ii) new, but related, pathology; (iii) new and unrelated pathology; (iv) exacerbation of other comorbidities. During the two‐year period, a total of 2546 patients were admitted to critical care of which 100 were re‐admitted (49 before outreach and 51 after outreach). The reasons for re‐admission did not vary before or after the introduction of the outreach team (same pathology 15 vs. 15; new, but related, pathology 17 vs. 23; new, but unrelated, 14 vs. 9; exacerbation of comorbidity 3 vs. 4, respectively, Chi‐squared = 2.07, df = 3, p = 0.56). There was also no difference between the duration of stay on the general ward in between the critical care unit admissions before (median 2.93 [interquartile range 1.32–6.05] days) or after (median 2.25 [interquartile range 1.06–6.32] days) the introduction of an outreach team. As we could not detect any change in patterns of re‐admissions as a result of the introduction of an outreach team, we would suggest that although outreach is an important development for critical care, its performance should be measured by other parameters.

A telephone survey of 20 English intensive care units (ICUs) con®rmed that visual estimation of patient weight is often performed. Four experienced intensive care staff (three doctors and one nurse) estimated the weight and measured the height of 30 volunteers and the estimates were compared with accurate reference measurements. The estimates were shown to be signi®cantly inaccurate for individual observers. We consider the degree of inaccuracy to be of clinical importance. However, pooling the individual estimates of weight as mean values improved accuracy. Recommendations are made concerning the performance of height and weight determination.