Anaesthesia and intensive care
-
Anaesth Intensive Care · Jul 2011
Historical ArticleChloroform for the King? Joseph Clover, Henry Thompson and the King of the Belgians.
In May 1863 the British surgeon, Henry Thompson, departed for Belgium to attend Leopold, King of the Belgians. The King was in agony: he had suffered with bladder stones for months and multiple procedures, without anaesthesia, had failed to relieve his symptoms. Henry Thompson was therefore consulted about the possibility of operating under the influence of chloroform. ⋯ History records that the successful operation was performed under chloroform anaesthesia administered by Joseph Clover. But a letter from Henry Thompson, discovered in Clover's personal papers, raises a number of questions about this operation. This was the procedure that made Henry Thompson rich and famous, but was it actually performed under anaesthesia? And if not, why not?
-
Anaesth Intensive Care · Jul 2011
Case ReportsCalcitonin for acute neuropathic pain associated with spinal cord injury.
Neuropathic pain associated with spinal cord injury is caused by complex neural mechanisms and is often refractory to standard therapy. Salmon calcitonin was an effective treatment for neuropathic symptoms in this case series of three patients with recent spinal cord injury. ⋯ Calcitonin is thought to exert its effect by modulation of the serotonergic system and is generally well tolerated and convenient to administer. This underutilised drug may be a very useful adjuvant for neuropathic pain associated with spinal cord injury.
-
Anaesth Intensive Care · Jul 2011
Clinical prediction of weaning and extubation in Australian and New Zealand intensive care units.
Our objective was to describe, in Australian and New Zealand adult intensive care units, the relative frequency in which various clinical criteria were used to predict weaning and extubation, and the weaning methods employed. Participant intensivists at 55 intensive care units completed a self-administered questionnaire, using visual analogue scales (0 = not at all predictive, 10 = perfectly predictive, not used = null score) to record the perceived utility of 30 potential predictors. Survey response rate was 71% (164/230). ⋯ Most popular clinical criteria were those perceived to have high predictive accuracy, both for weaning (respiratory rate 96%, pressure support setting 94% and Glasgow coma score 91%) and extubation readiness (respiratory rate 98%, effective cough 94% and Glasgow Coma Score 92%). Weaning mostly employed pressure support ventilation (55%), with less use of synchronised intermittent mandatory ventilation (32%) and spontaneous breathing trials (13%). Classic ventilatory performance predictors including respiratory rate and effective cough were reported to be of greater clinical utility than other more recently proposed measures.
-
Anaesth Intensive Care · Jul 2011
Biography Historical ArticleGolden Rules of Anaesthesia: the smallest book on anaesthesia?
Golden Rules of Anaesthesia, a waistcoat pocket-sized book by Robert James Probyn-Williams was published in three editions between 1904 and 1908. It may be the smallest English-language book on anaesthesia.
-
Anaesth Intensive Care · Jul 2011
Changing patterns in endotracheal intubation for anaesthesia trainees: a retrospective analysis of 80,000 cases over 10 years.
Several overseas studies have suggested that opportunities for anaesthesia trainees to learn and practise endotracheal intubation have decreased over time. We analysed the operating theatre data collection system at a large Australian metropolitan teaching hospital from 1998 to 2008 to determine if numbers for trainees' caseloads in general, and endotracheal intubation in particular had changed. The total caseload per trainee of approximately 800 cases per year was stable throughout the study period. ⋯ The mean number of endotracheal intubations per trainee per year fell by 10% and of supraglottic devices by 16%, neither of which was statistically significant. Endotracheal intubation for caesarean sections did however fall significantly from an average of nine to an average of six cases per trainee per year. Our findings contrast with other reports of much larger decreases in the number of endotracheal intubations performed by trainees over the last decade, but suggest that our local practice is similar to the international experience of decreasing opportunities for endotracheal intubation in obstetric anaesthesia.