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
Historical ArticleThe contribution of newspapers and their advertisements to the history of colonial anaesthesia.
The first news to reach New Zealand about the beneficial effects of inhalation of ether during surgical operations arrived in Wellington on Sunday July 4 1847. This was 283 days after the first successful demonstration in Boston. ⋯ This period of eighty-four days compares unfavourably with those for Sydney and Cape Town. The reasons for this delay are discussed and using information available in the local Sydney and Wellington newspapers, the delay is shown to have been due to the unavailability of supplies of the necessary chemical reagents.
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Anaesth Intensive Care · Jun 2006
Positive end-expiratory pressure ventilation increases extravascular lung water due to a decrease in lung lymph flow.
Positive end-expiratory pressure (PEEP) is used to improve gas exchange, increase functional residual capacity, recruit air spaces, and decrease pulmonary shunt in patients suffering from respiratory failure. The effect of PEEP on extravascular lung water (EVLW), however, is still not fully understood. This study was designed as a prospective laboratory experiment to evaluate the effects of PEEP on EVLW and pulmonary lymph flow (QL) under physiologic conditions. ⋯ The increase in PEEP resulted in a decrease in QL (7 +/- 1 vs 5 +/- 1 ml/h) and an increase in EVLW (498 +/- 40 vs 630 +/- 58 ml; P<0.05 each) without affecting cardiac output. As PEEP was decreased back to baseline, QL increased significantly (5 +/- 1 vs 10 +/- 2 ml/h), whereas EVLW returned back to baseline. This study suggests that institution of PEEP produces a reversible increase in EVLW that is linked to a decrease in QL.