Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2009
Randomized Controlled TrialThe effects of dexmedetomidine and fentanyl on emergence characteristics after adenoidectomy in children.
This randomised controlled study evaluated the effects of fentanyl and dexmedetomidine on emergence characteristics of children having adenoidectomy and anaesthetised with sevoflurane. Ninety children, two to seven years of age and ASA physical status I, were studied. Children were randomly assigned to one of three groups of 30 children, with the study intervention injection given intravenously after intubation. ⋯ Fentanyl 2.5 microg x kg(-1) and dexmedetomidine 0.5 microg x kg(-1) had similar haemodynamic effects and emergence characteristics. Fentanyl has been safely used in children for many years. Further studies of dexmedetomidine safety and its interaction with other anaesthetic agents are required before recommending its routine use during general anaesthesia in children.
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Anaesth Intensive Care · Jul 2009
Randomized Controlled TrialDifferential increases in blood flow velocity in the middle cerebral artery after tourniquet deflation during sevoflurane, isoflurane or propofol anaesthesia.
The purpose of this study was to examine the comparative effects of sevoflurane, isoflurane or propofol on cerebral blood flow velocity after tourniquet deflation during orthopaedic surgery. Thirty patients undergoing elective orthopaedic surgery were randomly divided into sevoflurane, isoflurane and propofol groups. Anaesthesia was maintained with sevoflurane, isoflurane or propofol infusion in 33% oxygen and 67% nitrous oxide, in whatever concentrations were necessary to keep bispectral index values between 45 and 50. ⋯ Arterial blood pressure, heart rate, velocity in the middle cerebral artery and arterial blood gas analysis were measured every minute for 10 minutes after release of the tourniquet in all three groups. Velocity in the middle cerebral artery in the three groups increased for five minutes after tourniquet deflation. Because of the different cerebrovascular effects of the three agents, the degree of increase in flow velocity in the isoflurane group was greater than in the other two groups, the change in flow velocity in the propofol group being the lowest (at three minutes after deflation 40 +/- 7%, 32 +/- 6% and 28 +/- 10% in the isoflurane, sevoflurane and propofol groups respectively, P < 0.05).
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Anaesth Intensive Care · Jul 2009
ReviewEvidence-based evolution of the high stakes postgraduate intensive care examination in Australia and New Zealand.
The fellowship examination for intensive care medicine in Australia and New Zealand, first held in 1979, has undergone four major periods of development and change since inception. These periods are characterised as: 1. 1979 to 1996--initiation and establishment of the exam as a relevant and comprehensive assessment process for a new specialty. 2. 1997 to 2001--revision to increase breadth of coverage, increase reliability for a growing number of candidates and ensure that each candidate received the same exam: Expansion: to incorporate assessment of CanMEDS skills (including communication, procedures and professional qualities). Lengthening: to increase the number of exposures, to ensure reliability. ⋯ The exam has been regarded as a 'tough but fair' assessment in its 30 years of existence and the committee overseeing its development has aimed to continually review the process to maintain those qualities as well as reliability, validity and feasibility. The increasing number of candidates has allowed accumulation of usable statistics but has tested the feasibility of running such a labour intensive exam. To date, there have been 800 presentations to the exam with 498 successful candidates.
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Anaesth Intensive Care · Jul 2009
Randomized Controlled TrialEffect of remifentanil on tracheal intubation conditions and haemodynamics in children anaesthetised with sevoflurane and nitrous oxide.
This study examined the effect of remifentanil added to inhalation agents on intubating conditions in children (aged one to seven years). As is our routine, all patients were premedicated with 0.004 mg/kg glycopyrrolate intramuscularly 30 minutes before anaesthesia to prevent bradycardia and salivary secretion, and received intravenous 1 mg/kg ketamine prior to transfer into the operating room to facilitate separation of the child from the parents. Laryngoscopy was attempted after ventilation with 8% sevoflurane in 50% nitrous oxide and 50% oxygen for two minutes, and intravenous administration of either a placebo bolus of saline (Group S) or one of two doses of remifentanil, 1 microg/kg (Group R1) or 2 microg/kg (Group R2) given over 30 seconds, commenced at the beginning of the sevoflurane administration. ⋯ Mean blood pressure was lower in Group R1 and R2 compared with Group S (P < 0.005). Our routine use of ketamine and glycopyrrolate may have influenced the relative lack of significant hypotension and bradycardia. Sevoflurane, nitrous oxide and remifentanil provided acceptable conditions for tracheal intubation in children and could be an acceptable alternative to intravenous induction and neuromuscular blocking agents.
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Anaesth Intensive Care · Jul 2009
Biography Historical ArticleWilliam TG Morton's early ether inhalers: a tale of three inhalers and their inscriptions.
Three ether inhalers with inscriptions stating that they had been used in early ether anaesthesia were found. All three inhalers were initially linked to WTG Morton. ⋯ The third inhaler was found to have been incorrectly attributed to Morton. It was first used by John Foster Brewster Flagg, a dentist in Philadelphia.