Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2005
ReviewAcute pain management pharmacology for the patient with concurrent renal or hepatic disease.
The clinical utility of most analgesic drugs is altered in the presence of patients with impaired renal or hepatic function not simply because of altered clearance of the parent drug, but also through production and accumulation of toxic or therapeutically active metabolites. Some analgesic agents may also aggravate pre-existing renal and hepatic disease. A search was performed, taking in published articles and pharmaceutical data to determine available evidence for managing acute pain effectively and safely in these two patient groups. ⋯ The agent least subject to alteration in this context is remifentanil; however the drugs' potency has other inherent dangers. Other agents must only be used with caution and close patient monitoring. Amitriptyline, carbamazepine and valproate should be avoided as the risk of fulminant hepatic failure is higher in this population, and methadone is contraindicated in the presence of severe liver disease.
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Anaesth Intensive Care · Jun 2005
Biography Historical ArticleNorman R. James F.F.A.R.A.C.S., a pioneer of high quality anaesthesia in Australia.
Dr Norman R. James was a multi-talented, highly accomplished clinician, teacher and innovator broadly recognized on three continents. In the United Kingdom, he served in London's Emergency Medical Service during World War II and was dubbed "England's foremost exponent of regional anaesthesia". ⋯ T. "Pepper" Jenkins, the charismatic founder of anesthesiology at the University of Texas Southwestern Medical School, recruited him to Dallas in 1960, where he taught the art and science of anesthesiology at Parkland Memorial Hospital until his retirement in 1974. He died in 1987 and is buried in Winnsboro, Texas. A brief story of his life and career follows.
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Anaesth Intensive Care · Jun 2005
Biography Historical ArticleVivian Richard Ebsary, A.M. biomedical engineer, inventor, philanthropist.
Vivian Ebsary was an inventor, designer and manufacturer of varied pieces of medical equipment, particularly those involving pumps. These included hypothermia machines and the heart-lung cardiopulmonary bypass machines used in Australian and New Zealand hospitals from the mid 1950s until well into the 1970s. Ebsary also designed and manufactured anaesthetic machines, a hyperbaric unit, scoliosis implant equipment, a chairlift and many other devices for use in the general community. This paper presents an overview of his life's involvement with medicine and medical technology in Australia.
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Anaesth Intensive Care · Jun 2005
ReviewAnaesthesia for neurosurgery in the sitting position: a practical approach.
Neurosurgery in the sitting position offers advantages for certain operations. However, the approach is associated with potential complications, in particular venous air embolism. As the venous pressure at wound level is usually negative, air can be entrained. ⋯ Other particular concerns to the anaesthetist are airway management, avoidance of pressure injuries, and the risk of pneumocephalus, oral trauma, and quadriplegia. Newer anaesthetic agents have made the choice of anaesthetic technique easier. An appreciation of the implications of neurosurgery in the sitting position can make the procedure safer
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Anaesth Intensive Care · Jun 2005
Comparative StudyEffect of newer anaesthetics on duration of stay in postanaesthesia care unit in patients undergoing major abdominal surgery.
Newer anaesthetic agents, such as remifentanil and sevoflurane, are more expensive than conventional anaesthetics, such as isoflurane and fentanyl. However, newer anaesthetics might outweigh their higher acquisition costs by reducing length of stay in the postanaesthesia care unit and thereby reducing personnel costs. We retrospectively investigated the influence of newer anaesthetics on time to eligibility for discharge from the postanaesthesia care unit in consecutive patients undergoing major abdominal surgery. ⋯ In the sevoflurane/fentanyl group, time to eligibility for discharge from the unit showed a tendency to be increased (P = 0.08), however these patients were significantly older compared to the other groups. Sevoflurane and remifentanil did not appear to reduce time to eligibility to discharge from the postanaesthesia care unit in our patients undergoing major abdominal surgery compared to isoflurane and fentanyl. This study highlighted the necessity for carefully planned transition from remifentanil to other longer-acting analgesia in our patients.