Anaesthesia and intensive care
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Anaesth Intensive Care · Jul 2012
The effect of hair colour on anaesthetic requirements and recovery time after surgery.
Patients with red hair are much more likely to have a variant of the melanocortin-1 receptor gene and this may affect sensitivity to general anaesthetics and pain response. We did a prospective, matched cohort study of 468 healthy adult patients undergoing general anaesthesia for elective surgery. All patients received an inhalational general anaesthetic. ⋯ There was no significant difference in recovery times, pain scores or quality of recovery scores in those with red hair. After adjusting for age, sex, American Society of Anesthesiologists physical status and duration of surgery, the recovery ratio for time to eye-opening in redheads was comparable to those with black or brown hair, 0.82 (0.57-1.19), P=0.30. We found no evidence that patient hair colour affects anaesthetic requirements or recovery characteristics in a broad range of surgical procedures.
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Anaesth Intensive Care · Jul 2012
Gabapentin in the treatment of post-dural puncture headache: a case series.
Gabapentin has been reported to be useful in the management of epilepsy, neuropathic pain and post-dural puncture headache. Seventeen obstetric cases are presented in which gabapentin was used either as a primary therapy for the management of severe headache following a diagnosed dural puncture or as an analgesic adjunct in patients with dural puncture headache unresponsive to epidural blood patch. ⋯ In nine patients we observed an excellent result with reduction of headache severity within 24 hours. Gabapentin appears potentially beneficial in the management of patients with post-dural puncture headaches.
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On 16 February 1845 the Reverend W. H. Browne, rector of St John's Church in Launceston, Van Diemen's Land, wrote in his journal, "My dear Wife died very suddenly almost immediately after and in consequence of taking a preparation of Hyd. ⋯ Acid prepared & supplied by Dr Pugh". This journal entry raises a number of questions. Was Dr Pugh treating a condition which he thought merited that treatment or was it a ghastly mistake? Was Caroline Browne suffering from pulmonary tuberculosis? Was hydrocyanic acid an accepted treatment at that time? Did Mrs Browne take the wrong dose? Was an incorrect concentration of the drug prepared by Dr Pugh? Did he use the wrong pharmacopoeia in preparing the hydrocyanic acid? Why was there no inquest? Only some of these questions can be answered.
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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.