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Sleep in the Surgical Intensive Care Unit: Continuous Polygraphic Recording of Sleep in Nine Patients Receiving Postoperative Care
850
MISCELLANEOUS
activity may aid in monitoring the disease course and treatment response. J. M. K. 4 tables, 30 references
of stages 3 and 4, and rapid eye movement sleep. The cause of this sleep disturbance is unknown. G. F. S. 2 figures, 3 tables, 17 references Putting the Art Back in Medicine
MISCELLANEOUS Sleep in the Surgical Intensive Care Unit: Continuous Polygraphic Recording of Sleep in Nine Patients Receiving Postoperative Care
J.
AURELL AND D. ELMQUIST, Departments of Anaesthesia and Intensive Care, City Hospital, Helsinborg, and Department of Clinical Neurophysiology, University Hospital, Lund, Sweden
Brit. Med. J., 290: 1029-1032 (Apr. 6) 1985 Nine patients receiving intensive care following a major operation were studied extensively for sleep disturbances in the first few postoperative days. An electroencephalogram with intradermal electrodes, 3-channel electrocardiogram, 2-channel electro-oculogram and a submental electromyogram were performed simultaneously and continuously throughout the study. Pain control was believed to be maximal and environmental disturbance was reduced to a minimum for all patients. The mean cumulative sleep time during the first 2 postoperative days was 3 hours 42 minutes, giving an average of 1 hour 51 minutes of sleep a night. Most of the sleep time was spent in stage 2 sleep. Stages 3 and 4 accounted for less than 5 per cent of the total sleep time (normally 21 per cent of the sleeping time is stage 3 or 4). Rapid eye movement sleep also was greatly suppressed. Sleep time, as estimated by the nurses, was· consistently overestimated compared to the sleep monitors. The authors' findings are similar to previous reports, that is following a major operation there is severe or complete suppression
D.
COLBURN,
Washington, D. C.
Canad. Med. Ass. J., 132: 1081-1082 (May 1) 1985 Recently, Robertson Davies, Canada's leading man ofletters, delivered a poignant and thought-provoking address to a medical audience at Johns Hopkins Medical Center. The 71-yearold actor, dramatist, critic, teacher and author of 32 books delivered several powerful caveats to the medical community in attendance. He stated "It is easy-it is tempting-to choose the god of science. It is a powerful god, indeed, but it is something of a trickster." The implication was that modern medicine is becoming progressively more dehumanized, emphasizing cold scientific knowledge and enamored of the "pursuit of the newest, latest". Physicians should strive for true wisdom rather than mere scientific knowledge. The latter represents the mass of scientific facts that doctors acquire and integrate during the course of their education and practice. Wisdom, on the other hand, represents the "the inner humanistic voice that binds healer and patient". Davies offered several suggestions that might help toward accomplishing this end. First, physicians should strive to be well rounded individuals and "inoculate themselves against stupidity by massive daily injections of music, art, and literature". Second, the medical community should follow the direction of Dr. William Osler who "took neither himself nor his vast medical knowledge with total unremitting solemnity". Third, and perhaps most difficult, the physician must be completely honest with his patients. J. M. K. 1 figure
MISCELLANEOUS
activity may aid in monitoring the disease course and treatment response. J. M. K. 4 tables, 30 references
of stages 3 and 4, and rapid eye movement sleep. The cause of this sleep disturbance is unknown. G. F. S. 2 figures, 3 tables, 17 references Putting the Art Back in Medicine
MISCELLANEOUS Sleep in the Surgical Intensive Care Unit: Continuous Polygraphic Recording of Sleep in Nine Patients Receiving Postoperative Care
J.
AURELL AND D. ELMQUIST, Departments of Anaesthesia and Intensive Care, City Hospital, Helsinborg, and Department of Clinical Neurophysiology, University Hospital, Lund, Sweden
Brit. Med. J., 290: 1029-1032 (Apr. 6) 1985 Nine patients receiving intensive care following a major operation were studied extensively for sleep disturbances in the first few postoperative days. An electroencephalogram with intradermal electrodes, 3-channel electrocardiogram, 2-channel electro-oculogram and a submental electromyogram were performed simultaneously and continuously throughout the study. Pain control was believed to be maximal and environmental disturbance was reduced to a minimum for all patients. The mean cumulative sleep time during the first 2 postoperative days was 3 hours 42 minutes, giving an average of 1 hour 51 minutes of sleep a night. Most of the sleep time was spent in stage 2 sleep. Stages 3 and 4 accounted for less than 5 per cent of the total sleep time (normally 21 per cent of the sleeping time is stage 3 or 4). Rapid eye movement sleep also was greatly suppressed. Sleep time, as estimated by the nurses, was· consistently overestimated compared to the sleep monitors. The authors' findings are similar to previous reports, that is following a major operation there is severe or complete suppression
D.
COLBURN,
Washington, D. C.
Canad. Med. Ass. J., 132: 1081-1082 (May 1) 1985 Recently, Robertson Davies, Canada's leading man ofletters, delivered a poignant and thought-provoking address to a medical audience at Johns Hopkins Medical Center. The 71-yearold actor, dramatist, critic, teacher and author of 32 books delivered several powerful caveats to the medical community in attendance. He stated "It is easy-it is tempting-to choose the god of science. It is a powerful god, indeed, but it is something of a trickster." The implication was that modern medicine is becoming progressively more dehumanized, emphasizing cold scientific knowledge and enamored of the "pursuit of the newest, latest". Physicians should strive for true wisdom rather than mere scientific knowledge. The latter represents the mass of scientific facts that doctors acquire and integrate during the course of their education and practice. Wisdom, on the other hand, represents the "the inner humanistic voice that binds healer and patient". Davies offered several suggestions that might help toward accomplishing this end. First, physicians should strive to be well rounded individuals and "inoculate themselves against stupidity by massive daily injections of music, art, and literature". Second, the medical community should follow the direction of Dr. William Osler who "took neither himself nor his vast medical knowledge with total unremitting solemnity". Third, and perhaps most difficult, the physician must be completely honest with his patients. J. M. K. 1 figure