Anaesthesia 2014, 69, 1287–1297
demand and supply across the country; drug users may pay for their habit in services rendered; and drug growers and dealers are unlikely to pay for the drugs they themselves use. The last two points may be addressed by asking patients what the cost of the amount they use would be if they had to pay. P. Banugo C. Lanigan University Hospital Lewisham, Lewisham, London, UK Email: [email protected] No external funding and no conflict of interest declared.
References 1. Dixon H. Ketamine death of public schoolgirl an ‘act of stupidity which destroyed family’. The Telegraph. http://www.telegraph.co.uk 12/02/ 2014 (accessed 16/07/2014). 2. Davies G. Boy, 15, dies after ‘drinking beer laced with ketamine at illegal Croydon rave’. Croydon Advertiser. http://www.croydonadvertiser.co.uk 16/06/2014 (accessed 16/07/2014). 3. Prignot J. Quantification and chemical markers of tobacco exposure. European Journal of Respiratory Disease 1987; 70: 1–7. 4. Health Education Authority. ‘Alcohol Know How: which of these is one unit of alcohol?’ (poster). HEA: Middlesex, England, 1987-2000. 5. Rudra A, Bhattacharya A, Chatterjee S, Sengupta S, Das T. Anaesthetic implications of substance abuse in adolescents. Indian Journal of Anaesthesia 2008; 52: 132–9. 6. Roberts T, Thompson J. Illegal substances in anaesthetic and intensive care practices. Continuing Education in Anaesthesia, Critical Care and Pain. Advance Access, August 11, 2012. 7. Flisberg P, Paech MJ, Shah T, Ledowski T, Kurowski I, Parsons R. Induction dose of propofol in patients using cannabis. European Journal of Anaesthesiology 2009; 26: 192–5. 8. Northcote J, Livingston M. Observational verification of ‘last occasion’ drink estimates of young adults. Alcohol and Alcoholism 2011; 46: 709–13. 1296
Correspondence 9. McGregor K, Makkai T. Self-reported drug use: how prevalent is underreporting? Canberra: Australian Institute of Criminology, June 2003. http://www. aic.gov.au/media_library/publications/ tandi2/tandi260.pdf (accessed 16/07/ 2014). doi:10.1111/anae.12863
Sleep deprivation in intensive care units The cohort study performed by Patel et al., describing how a new set of interventions positively affected sleep quality and delirium levels in the intensive care unit (ICU) [1], has shed new light on how poor sleep quality and quantity can be mitigated by simple multidisciplinary interventions. Reducing light and noise levels is easy and quick to achieve, although not always easy to implement in a fast-paced, modern hospital environment. The authors recommended deployment of such interventions in other hospital environments, as well as ICU [1]. As a Registered Nurse case manager in an acute care oncology unit, I see firsthand the negative effects that improper sleep can have on patient outcomes, quality of care and patient satisfaction. In addition to dimming lights and keeping patients’ doors closed as appropriate, other interventions might be used to reduce noise pollution, both in ICU and hospital-wide. For example, the company SONICU [3] produces web-based software that monitors noise levels in work environments, including healthcare [4], and provides its clients with weekly reports that show noise levels in areas where monitors are
installed. These monitors have red, yellow, and green lights that demonstrate levels of sound and can be utilised anywhere [4]. Future studies involving adult patients could be performed to ascertain whether positive behavioral feedback occurs when staff are provided with data about their efforts to reduce noise levels, and whether patient satisfaction with care improves as a result. H. Nunns The University of Texas at Arlington College of Nursing, Arlington, Texas, USA Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia 2014; 69: 540–49. 2. Barr WJ. Noise notes. American Journal of Nursing 1993; 93: 16. 3. Sonicu. www.sonicu.com (accessed 24/ 07/2014). 4. Brown G. NICU noise and the preterm infant. Neonatal Network 2009; 283: 165–73. doi:10.1111/anae.12871
Isoflurane, driving and walking down the street I read with interest the letter from Pollard and Marr with regard to driving after isoflurane general anaesthesia (GA) [1].
© 2014 The Association of Anaesthetists of Great Britain and Ireland
demand and supply across the country; drug users may pay for their habit in services rendered; and drug growers and dealers are unlikely to pay for the drugs they themselves use. The last two points may be addressed by asking patients what the cost of the amount they use would be if they had to pay. P. Banugo C. Lanigan University Hospital Lewisham, Lewisham, London, UK Email: [email protected] No external funding and no conflict of interest declared.
References 1. Dixon H. Ketamine death of public schoolgirl an ‘act of stupidity which destroyed family’. The Telegraph. http://www.telegraph.co.uk 12/02/ 2014 (accessed 16/07/2014). 2. Davies G. Boy, 15, dies after ‘drinking beer laced with ketamine at illegal Croydon rave’. Croydon Advertiser. http://www.croydonadvertiser.co.uk 16/06/2014 (accessed 16/07/2014). 3. Prignot J. Quantification and chemical markers of tobacco exposure. European Journal of Respiratory Disease 1987; 70: 1–7. 4. Health Education Authority. ‘Alcohol Know How: which of these is one unit of alcohol?’ (poster). HEA: Middlesex, England, 1987-2000. 5. Rudra A, Bhattacharya A, Chatterjee S, Sengupta S, Das T. Anaesthetic implications of substance abuse in adolescents. Indian Journal of Anaesthesia 2008; 52: 132–9. 6. Roberts T, Thompson J. Illegal substances in anaesthetic and intensive care practices. Continuing Education in Anaesthesia, Critical Care and Pain. Advance Access, August 11, 2012. 7. Flisberg P, Paech MJ, Shah T, Ledowski T, Kurowski I, Parsons R. Induction dose of propofol in patients using cannabis. European Journal of Anaesthesiology 2009; 26: 192–5. 8. Northcote J, Livingston M. Observational verification of ‘last occasion’ drink estimates of young adults. Alcohol and Alcoholism 2011; 46: 709–13. 1296
Correspondence 9. McGregor K, Makkai T. Self-reported drug use: how prevalent is underreporting? Canberra: Australian Institute of Criminology, June 2003. http://www. aic.gov.au/media_library/publications/ tandi2/tandi260.pdf (accessed 16/07/ 2014). doi:10.1111/anae.12863
Sleep deprivation in intensive care units The cohort study performed by Patel et al., describing how a new set of interventions positively affected sleep quality and delirium levels in the intensive care unit (ICU) [1], has shed new light on how poor sleep quality and quantity can be mitigated by simple multidisciplinary interventions. Reducing light and noise levels is easy and quick to achieve, although not always easy to implement in a fast-paced, modern hospital environment. The authors recommended deployment of such interventions in other hospital environments, as well as ICU [1]. As a Registered Nurse case manager in an acute care oncology unit, I see firsthand the negative effects that improper sleep can have on patient outcomes, quality of care and patient satisfaction. In addition to dimming lights and keeping patients’ doors closed as appropriate, other interventions might be used to reduce noise pollution, both in ICU and hospital-wide. For example, the company SONICU [3] produces web-based software that monitors noise levels in work environments, including healthcare [4], and provides its clients with weekly reports that show noise levels in areas where monitors are
installed. These monitors have red, yellow, and green lights that demonstrate levels of sound and can be utilised anywhere [4]. Future studies involving adult patients could be performed to ascertain whether positive behavioral feedback occurs when staff are provided with data about their efforts to reduce noise levels, and whether patient satisfaction with care improves as a result. H. Nunns The University of Texas at Arlington College of Nursing, Arlington, Texas, USA Email: [email protected] No external funding and no competing interests declared. Previously posted on the Anaesthesia correspondence website: www.anaesthesia correspondence.com.
References 1. Patel J, Baldwin J, Bunting P, Laha S. The effect of a multicomponent multidisciplinary bundle of interventions on sleep and delirium in medical and surgical intensive care patients. Anaesthesia 2014; 69: 540–49. 2. Barr WJ. Noise notes. American Journal of Nursing 1993; 93: 16. 3. Sonicu. www.sonicu.com (accessed 24/ 07/2014). 4. Brown G. NICU noise and the preterm infant. Neonatal Network 2009; 283: 165–73. doi:10.1111/anae.12871
Isoflurane, driving and walking down the street I read with interest the letter from Pollard and Marr with regard to driving after isoflurane general anaesthesia (GA) [1].
© 2014 The Association of Anaesthetists of Great Britain and Ireland
