Anaesthesia and intensive care
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Anaesth Intensive Care · Jun 2006
Historical ArticleThe introduction of halothane into clinical practice: the Oxford experience.
This paper reviews the clinical situation in anaesthesia before the introduction of halothane into clinical practice in 1956, emphasising the limitations of agents available at the time. The background to the development of halogenated hydrocarbon compounds as anaesthesia agents is presented, including the involvement of Imperial Chemical Industries in England. The Nuffield Department of Anaesthetics was involved in the clinical trials and the designing and execution of these. The results of their work and the problems encountered are presented.
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We aimed to assess elective day surgery patients' understanding of the reason for pre-operative fasting. One hundred adult patients presenting to the peri-operative unit for day procedures requiring general anaesthesia were surveyed before discharge. All day-stay, adult patients able to complete a questionnaire in English were included. ⋯ Two per cent (95%CI [0.2,7]) of patients reported actual non-compliance, and 4% (95%CI [1,10]) stated they would consider misrepresenting their fasting status if it was inconvenient for them to have their surgery postponed. The results of this study suggest a need to better inform day surgery patients about the reason for pre-operative fasting. A better understanding of the need for pre-operative fasting may lead to improved compliance and patient safety.
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Anaesth Intensive Care · Jun 2006
Data linkage enables evaluation of long-term survival after intensive care.
Outcomes of intensive care are important to the patient and for assessment of benefit. Short-term outcomes after critical illness are well described, but less is known about long-term outcomes. This study describes the use of data linkage, combining intensive care unit (ICU) clinical data with administrative morbidity and mortality data, to assess long-term outcomes after treatment in ICU. ⋯ Age, type of admission, severity of illness (measured by Acute Physiologic and Chronic Health Evaluation (APACHE) II and the presence of organ failure), ICU length of stay, comorbidity (Chronic Health Evaluation and Charlson comorbidity index) and ICU admission diagnosis, were all associated with survival at 1, 3, 5, 10, and 15 year follow-up (P<0.001 at all time points). Linkage of clinical and administrative data provides a feasible method for ascertaining long-term survival after critical illness. Age, admission severity of illness, diagnosis and comorbidity influenced long-term unadjusted survival.
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By exposing the mu-receptor (MOP-R) to more than one exogenous ligand, the administration during general anaesthesia of more than one opioid with principal action on the receptor may confound and lead to complications or unexpected outcomes. The giving of such a 'mixed message' can result in respiratory depression, excess sedation and delayed recovery to an unusual degree. We present a case of apparent extreme opioid sensitivity and discuss a possible mechanism. Such occurrences may be more common than previously realised.