Service evaluation of laceration risk using trainer adrenaline auto-injectors

ObjectiveAnaphylaxis is a severe, potentially fatal allergic reaction best treated with intramuscular epinephrine via epinephrine auto-injectors (AAIs). Our published concerns over laceration injuries to young children associated with AAIs led to this service evaluation of the two administration methods: swing and jab (S&J) and place and press (P&P), to determine potential laceration risk.DesignA trainer EpiPen was used with facepaint placed in the needle indentation which would record the length of movement of the AAI. The two different methods ‘administered’ were alternated. Children were asked to move their leg to simulate a withdrawal reaction. Age, whether they moved, and length of paint mark were recorded.SettingOutpatients waiting area in Noah’s Ark Children’s Hospital, Cardiff.ParticipantsChildren aged 5–11 with no prior knowledge of AAI use.InterventionNo intervention was implemented.Results135 children (mean age 8 years; range 5–11 years) were asked to participate; measurements were taken from 100 children. 50 children moved for one or both methods. For those that moved, S&J mean paint length=8.3 mm (SD 17.4, 95% CI 3.4 to 13.3), P&P mean=3.5 mm (SD 11.0, 95% CI 0.4 to 6.6). Mean difference between methods was 4.8 mm (SD 10.1, 95% CI 1.9 to 7.7). Slightly more children moved for S&J (44) compared with 38 for P&P.ConclusionsS&J produces more movement and longer paint marks than P&P. The risk of laceration when administering an EpiPen to young children may be lower by using the more controlled P&P. We feel it is advisable to teach P&P instead in children below 11 years of age.

Comparison of pre-emptive butorphanol or metamizole with ketamine +medetomidine and s-ketamine + medetomidine anaesthesia in improving intraoperative analgesia in mice

In accordance with the ‘refinement’ component of the 3Rs, the primary aim of this study was to investigate and compare ketamine + medetomidine (KM) and s-ketamine + medetomidine (SKM) anaesthetic protocols in C57BL/6J mice (both sexes). We sought to determine whether s-ketamine could provide adequate surgical tolerance at a 50% dose relative to that of ketamine racemate and whether antagonism of medetomidine could be initiated 15 min earlier. The second aim was to investigate the potential improvement in analgesia for both anaesthetic protocols by adding butorphanol or metamizole. Analgesia was tested via the pedal withdrawal reaction (PWR) to a painful stimulus. During anaesthesia, respiratory frequency, pulse oximetry, body temperature and PWR were monitored. Among the 16 mice in each group, the PWR was lost in all the KM + metamizole (35:56 ± 6:07 min), KM + butorphanol (43:45 ± 2:14 min) and SKM + butorphanol (24:03 ± 5:50 min) mice, 15 of the non-premedicated KM (37:00 ± 8:11 min) mice, and 9 of the pure SKM (20:00 ± 4:19 min) mice; the latter group increased to 11 mice (17:16 ± 5:10 min) with premedication of metamizole. In contrast to the racemic combination, s-ketamine at the dose used here did not lead to sufficient loss of the PWR. However, earlier partial antagonism of SKM resulted in a slightly shorter and qualitatively better recovery than later partial antagonism of SKM. The addition of metamizole or butorphanol to KM or SKM anaesthesia positively influences the analgesic quality. However, when butorphanol is added, controlled ventilation may be necessary, especially for male mice.