Anaesthesia and intensive care
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Robotic surgery is gaining widespread popularity due to advantages such as reduced blood loss, reduced postoperative pain, shorter hospital stay and better visualisation of fine structures. Robots are being used in urological, cardiac, thoracic, orthopaedic, gynaecological and general surgery. Robotic surgery received US Food and Drug Administration approval for use in gynaecological surgery in 2005. ⋯ We highlight the complications encountered in these surgeries and methods to prevent these complications. Robotic gynaecological surgery can be safely performed after considering the physiological effects of the steep Trendelenburg position and of pneumoperitoneum. The benefits of the surgical procedure should be weighed against the risks in patients with underlying cardiorespiratory problems.
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Mesmerism had its roots in late 18th century France, but it was not until the 1830s in Britain that it was systematically applied to the problem of pain. The application of mesmerism in the clinical setting was extremely contentious and it was with some relief that doctors turned to the far more consistent results of chemical anaesthesia. However, though mesmerism were superseded by chemical anaesthetic agents in many areas of application, mesmerism continued to have a life during the second half of the 19th century. ⋯ The first of these took place in Hobart in 1890, more than 40 years after many in Britain had declared mesmerism dead. The extractions were performed by respected dentists and, according to witnesses, Waterworth's mesmerism produced the same effects of insensibility to pain as ether and chloroform. With an examination of the continued application of mesmerism after the advent of chemical anaesthesia, this paper will focus on the work of Newham Waterworth in the 1890s and speculate as to why mesmerism might have resurfaced to some appeal in the Australian colonies in this period.
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Anaesth Intensive Care · Jul 2012
The development and preliminary evaluation of a proposed new scoring system for videolaryngoscopy.
Clear documentation of anaesthetic technique, difficulties and complications is an essential part of good anaesthetic practice, particularly in the area of airway management. The current convention of describing intubation using a videolaryngoscope only in terms of a Cormack and Lehane score is at best unhelpful and at worst dangerous. In an attempt to address the inadequacy of a Cormack and Lehane score to describe videoscopic intubation, we propose a three part scoring system: view, ease and device - the 'Fremantle Score'. ⋯ In three of the eight device and manikin combinations studied, the videolaryngoscopic view correlated with the ease of intubation. This highlights the need for an alternative tool to describe intubation with a videolaryngoscope. We consider this development of a specific videoscopic scoring system a first step in better describing intubation by a videolaryngoscope and improving patient care.