This article on the assessment and management of ventricular arrhythmias is the third in a series exploring cardiac monitoring in the perioperative care setting. Ventricular arrhythmias, which arise within the ventricular myocardium, can be potentially lifethreatening. Many of the causes of these arrhythmias can be found in the peri-operative setting and thus it is essential that practitioners are able to differentiate the rhythms and respond appropriately.

The number of devices available to monitor the haemodynamic status of patients is increasing. Practitioners need to be aware of the non-invasive and invasive methods available in order to care for their patients safely and effectively. This article reviews a number of noninvasive measurements of haemodynamic function, in addition to invasive methods such as arterial blood pressure, central venous pressure and pulmonary artery pressure monitoring. It is argued that using these methods in combination provides a comprehensive haemodynamic assessment.

Recruitment and retention within specialist areas of nursing has been consistently difficult to achieve. This research explores the value of providing education and how this may enhance the ability to recruit and retain staff within the perioperative environment. This an area where nurses are perceived as not essential to the provision of quality care due to the technical nature of the nurses′ role detracting from the patient centred care delivered.

A multiple strategy approach was used with data collected via two questionnaires from ten Trusts within the South East of England. Findings demonstrated that while the provision of education may enhance the recruitment and retention of staff, prior to this occurring operating theatres needed to address the issues of motivation and morale within their departments. Many staff were found to be demotivated their views and opinions supporting the work of Herzberg (1959) on job satisfaction. Conclusions were that only once ‘satisfiers’ were increased and ‘dissatisfiers’ addressed could the provision of education supported by an educationalist benefit recruitment and retention of staff.

The Association of Anaesthetists approached BARNA for comment on this paper prior to its publication. This work will review the content of the document published in September 2002. The Association has published two similar documents prior to this in 1985 and 1993. They recognise that the post anaesthetic care of a patient has evolved rapidly since the last document was published. The current document is a response to the rapidly changing nature of anaesthesia and surgery and the direct impact that has on the post anaesthetic care unit, the patients and the staff who work within the unit. A summary of the key recommendations can be seen below and these will be expanded upon and discussed.

With regard to the problematic use of opioid analgesic drugs, attention is focused not only on those who began using opioids for recreational purposes, but also on those who may become iatrogenically addicted to opioids administered for pain control. It has been suggested that narcotics opioids cause psychological and physical dependence after relatively small therapeutic doses, for a relatively short period of administration Glatt 1974 and that physical dependence may even start to manifest after a single therapeutic dose Qones 1980. Despite these claims, some patients report that they are able to benefit from relatively long-term opioid analgesia without experiencing the effects of problematic drug use that are associated with recreational drug users (Cowan et al 2001, 2002). This issue has obvious implications for anaesthetic and recovery room practitioners who routinely administer opioids to patients in their care. In view of this, the following case study report may be of interest to such practitioners.