Anaesthesia and intensive care
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The hepatitis C virus (HCV) genome was isolated during the late 1980s using molecular cloning techniques. It is recognized as the cause of most cases of percutaneously transmitted non-A, non-B hepatitis. Prevalence of antibodies to HCV(anti-HCV) in the general Australian population is 0.3%. ⋯ Treatment strategies for HCV, utilizing recombinant interferons, are proving useful in patients with mild to moderate liver disease, but fare less well in patients with cirrhosis. Currently, there is no vaccine for hepatitis C, so pre-exposure prophylaxis is not possible. Equally, no post-exposure intervention, for example with gamma globulin, has been shown to be beneficial, though there may be a role for early interferon therapy.
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Generally the basic sciences of physics, chemistry and mathematics and the applied sciences of anatomy physiology and pharmacology are associated with the history of the development and advancement of anaesthesia. In considering the history of infection control in anaesthesia, the contribution of microbiology must be added to the above. When sifting through old books and journals it is often difficult to understand the stimuli for the leaps of progress; I believe the zeitgeist is often the invisible (to our eyes) all important factor. An attempt to briefly illustrate some of the main events and characters follows.
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Anaesth Intensive Care · Apr 1996
Revision of the anaesthetic aspects of an infection control policy following reporting of hepatitis C nosocomial infection.
Following the report by the N. S. ⋯ Review of the existing policies of other organizations and the published scientific data in this area was the basis of the revision. The final policy as it pertains to anaesthesia requires universal precautions, disposal or decontamination and high level disinfection of instruments and apparatus that come into contact with patients or blood or body substances and protection of the breathing circuit by a filter with disposal or high-level disinfection of all parts of the circuit not so protected for every patient.
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Anaesth Intensive Care · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntubation without muscle relaxant: an alternative technique for rapid tracheal intubation.
The quality of laryngoscopy and tracheal intubation with propofol augmented by alfentanil was investigated as an alternative technique for rapid tracheal intubation. 119 patients aged between 18 and 60 years (ASA 1 and 2) undergoing elective surgery were prospectively studied in a randomized double-blind controlled fashion. Tracheal intubation facilitated by suxamethonium 1.0 mg/kg alfentanil 15 mu g/kg alfentanil 30 mu g/kg or saline control was compared after propofol induction. The quality of laryngoscopy and intubation were graded according to jaw relaxation, ease of insertion of the endotracheal tube and coughing on intubation. ⋯ Alfentanil 15 mu g/kg was not statistically significantly different from saline (P = 0.112). Alfentanil 30 mu g/kg provided similar overall intubating conditions (P = 0.5) to suxamethonium 1.0 mg/kg. Alfentanil in both dosages effectively attenuated the haemodynamic responses to laryngoscopy and tracheal intubation.
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Anaesth Intensive Care · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialA comparison of the efficacy of ketorolac and indomethacin for postoperative analgesia following laparoscopic surgery in day patients.
The analgesia provided in the postoperative period by three regimens commonly used in our private anaesthetic practice were compared in a double-blind study of one hundred and thirty-seven women presenting for day-case laparoscopic procedures. After random allocation into three groups, all patients were similarly anaesthetized and then received both a rectal suppository and an IM injection. Group P received two placebos, Group I had an indomethacin suppository 100 mg and Group K an IM injection of ketorolac 30 mg. ⋯ The parenterally administered ketorolac may be a useful analgesic supplement in these patients. However the trial was aborted following the appearance in the literature of case reports of postoperative renal failure. Further investigation of the efficacy and side-effect profile of reduced doses may be warranted.