Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2015
Historical ArticlePioneers of laryngoscopy: indirect, direct and video laryngoscopy.
Airway management is one of the core skills of the anaesthetist and various techniques of airway management have developed over many years. Initially, the only view of the glottis that could be obtained was an indirect view (indirect laryngoscopy). ⋯ Currently, in the early 21st century, there has been a return to indirect laryngoscopy via videolaryngoscopy using a videolaryngoscope. The aim of this paper is to give a historical overview of the development of both direct and indirect laryngoscopy.
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Anaesth Intensive Care · Jul 2015
Biography Historical ArticleBecoming a physician anaesthetist-difficulties encountered for half a century.
William T. G. Morton was not the first to use ether or nitrous oxide as an anaesthetic. ⋯ Some were prolific writers and helped spread the use of anaesthesia. However, attracting physicians to this new discipline proved difficult and there were segments of the medical establishment and society who were unwilling to accept this most significant advancement. In this article, we examine the reasons why many physicians and patients resisted the use of anaesthesia.
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Anaesth Intensive Care · Jul 2015
Sevoflurane for analgesia-testing a modified vaporiser for delivery.
The Diamedica Sevoflurane Inhaler (Diamedica UK Ltd, Bratton Fleming, UK) (DSI) is a breathing system which includes a modification of an existing vaporiser (Diamedica Draw-over Vaporiser, Diamedica UK Ltd, Bratton Fleming, UK), to enable the delivery of 0.8% sevoflurane. Previous studies have suggested that self-administered sevoflurane at sub-anaesthetic concentration can provide useful pain relief during the first stage of labour and that it may be more effective than Entonox. Further research and potential clinical use have been impeded by the lack of a practical delivery system. ⋯ The results from testing this revised version are also described. Mean sevoflurane output from the DSI-2 was found to be within a clinically acceptable range at the minute volumes tested (0.78% to 0.88%) and ambient temperatures tested (0.69% to 0.9%). Based upon these results, the authors propose to undertake further studies of sevoflurane analgesia using the DSI-2.
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Anaesth Intensive Care · Jul 2015
Historical ArticlePioneering early Intensive Care Medicine by the 'Scandinavian Method' of treatment for severe acute barbiturate poisoning.
Between the 1920s and the mid-1950s, barbiturates were the sedative-hypnotic agents most used in clinical practice. Their ready availability and narrow therapeutic margin accounted for disturbingly high rates of acute poisoning, whether suicidal or accidental. Until the late 1940s, medical treatment was relatively ineffective, with mortality subsequently high - not only from the effects of coma, respiratory depression and cardiovascular shock with renal impairment, but also from complications of the heavy use in the 1930s and 1940s of analeptic stimulating agents. ⋯ Clemmesen's Intoxication Unit opened at the Bispebjerg Hospital, Copenhagen, on 1 October 1949. ICU pioneer Bjørn Ibsen suggested it was the initial ICU, while noting that it supplied Intensive Therapy for one type of disorder only (as had HCA Lassen's Blegdam Hospital unit for Denmark's 1952 to 1953 polio epidemic). Treatment for barbiturate poisoning during the 1950s in some other Scandinavian hospitals will also be considered briefly.
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The Heister mouth gag is attributed to Lorenz Heister, an eighteenth century German surgeon. There is no evidence that Heister designed the mouth gag, the earliest known illustration of which is in the 1719 edition of Heister's Chirurgie. In the first half of the twentieth century, the Heister gag was widely available for use during anaesthesia. It is now rarely used by anaesthestists, but occasionally used by surgeons during oral surgery.