Anaesthesia and intensive care
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Anaesth Intensive Care · May 1992
A survey of Fellows of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons endorsed in intensive care by examination in the first 10 years of final examinations in intensive care.
Fifty-nine of the 70 Fellows of the Faculty of Anaesthetists who had passed the Final Examination in Intensive Care including that of October 1989, responded to a questionnaire on the pattern of their intensive care and anaesthetic practice and their perception of the training and examination. Responses came predominantly from Fellows who had passed the examination more than two years previously. Forty-eight (81%) were practising intensive care at least 50% of the time and 51% had become Director or Deputy Director of an Intensive Care Unit. ⋯ Only eight had sought intensive care as their first vocational qualification. Training and examination were generally regarded favourably except for training in research methods and experience in internal medicine. The results suggest that the intensive care specialist is not likely to leave such practice in the long term, but there has been a reluctance to abandon altogether training and some subsequent practice in anaesthetics.
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Intradermal testing and RIA testing for specific IgE antibodies to neuromuscular blocking drugs (NMBDs) were performed in patients referred to an Anaesthetic Allergy Clinic. Six patients were initially investigated four to 29 years after clinical anaphylaxis during anaesthesia and two of these patients and sixteen others were investigated by intradermal testing on two occasions at least four years apart. Seven patients had RIA tests for NMBD-specific IgE antibodies on two occasions at the time of skin testing. ⋯ In one patient all tests became negative and in another the skin test became negative but the positive RIA persisted. Evidence of antibodies to NMBDs persisted in 21 of 22 patients who had had anaphylactic reactions to these drugs during anaesthesia. In the absence of evidence of allergy diminishing with time in the majority of patients it would seem wise to avoid drugs responsible for reactions for the rest of the patient's life.
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Anaesth Intensive Care · May 1992
The effects of oxytocin on the pulmonary and systemic circulation in pregnant ewes.
The haemodynamic effects of oxytocin on the pulmonary and systemic circulation were studied in six awake, pregnant (greater than 140 days gestation) ewes. Bolus doses of oxytocin 0.2 units/kg and then 0.8 units/kg were administered. A dose of 0.2 units/kg resulted in small but significant increases in mean pulmonary artery pressure (14%, P less than 0.05) and pulmonary vascular resistance (24%, P less than 0.05. ⋯ Acute pulmonary hypertension was then induced with glass bead microemboli (150-200 microns), with an increase in pulmonary artery pressure of 26 mmHg and pulmonary vascular resistance of 448 dyn. s. cm-5. Boluses of oxytocin 0.2 and 0.8 units/kg were then administered. There were no significant changes, except for a 30% increase in systemic vascular resistance at one minute after oxytocin, 0.8 units/kg (P less than 0.05).