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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Anaesth Intensive Care · Jun 2006
Historical ArticleSome observations on early military anaesthesia.
Although anaesthesia was discovered in 1846, pain relief had been used for many years previously. Opium, mandragora, and Indian hemp amongst others have been used since the earliest times as alluded to by many of the classical writers. The use of refrigeration anaesthesia is known to have been recommended a millennium ago although it never had much usage. ⋯ However, it was not until the Crimean War that anaesthesia began to play an important part in battle surgery with many anaesthetics being given with varying results. The War of the Rebellion was the next war in which anaesthesia was important and the first one in which proper statistics were kept allowing useful analysis. Anaesthesia had irrevocably found its place in battlefield surgery.
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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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Anaesth Intensive Care · Jun 2006
Biography Historical ArticleBrian Dwyer and the St. Vincent's Pain Clinic 1962 to 1989.
Brian Dwyer was the Director of the Department of Anaesthetics at St. Vincent's Hospital in Sydney from 1955 to 1985. He developed a major interest in the management of intractable pain and was most impressed by the multidisciplinary pain clinic which was commissioned at the University of Washington in Seattle by John Bonica in 1960. ⋯ As a result of his work, Brian Dwyer received international recognition as a pioneer in the field of chronic pain management and the St. Vincent's Pain Clinic served as a model for the establishment of similar units, both in Australia and overseas. Brian Dwyer was the first chairman of the Clinic and remained in that position until his retirement in 1989.