Anaesthesia and intensive care
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Anaesth Intensive Care · Feb 1986
ReviewExtracorporeal CO2 Removal in severe adult respiratory distress syndrome.
Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function. There are several possible mechanisms by which the technique may facilitate lung repair, including improvement of lung tissue oxygenation, the avoidance of high airway pressures and regional alkalosis in the lung, a reduction in oxygen toxicity, and the frequency observed reduction in pulmonary artery pressure. The apparent effectiveness of the technique and other associated evidence have implications which should lead us to reconsider some aspects of our conventional management of patients with severe ARDS.
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Anaesth Intensive Care · Feb 1986
Randomized Controlled Trial Clinical TrialReduction of heat loss during transurethral resection of the prostate.
A prospective trial was performed on 100 patients to determine whether using a reflective blanket (Space Blanket) and heated glycine 1.5% bladder irrigation solution would decrease the fall in body temperature associated with transurethral resection of the prostate under spinal anaesthesia. Patients who received a combination of reflective blanket and heated glycine 1.5% solution had their fall in body temperature significantly reduced when compared with those patients managed without a reflective blanket and/or heated 1.5% glycine. There was a marked decrease in the number of patients shivering and no increase in blood loss was seen when heated bladder irrigation solution was used.
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The Combibag self-inflating resuscitator incorporates an adult and a paediatric segment as well as a two-stage pressure-limiting safety valve. The resuscitator is not without problems. ⋯ Problems can also occur with the valve either sticking or being blown forward off its seating, thereby making the resuscitator inoperable and dangerous. The use of a two-stage pressure-limiting safety valve should prevent unnecessary barotrauma but could well lead to unrecognised venting with inadequate ventilation when used by inexperienced personnel.
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This paper was commissioned to cover the beginnings of anaesthesia: the transition from surgical operations with pain to those without. It reviews some previous pre-anaesthetic histories (Part I): it focuses upon attitudes to pain; and it seeks evidence from the one hundred years before the discovery of anaesthesia. Finally (Part II) it outlines the introduction of nitrous oxide and of ether anaesthesia.