Anaesthesia and intensive care
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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.
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Anaesth Intensive Care · Jul 2009
Comparative StudyPreventing pain on injection of propofol: a comparison between peripheral ketamine pre-treatment and ketamine added to propofol.
The purpose of this study was to examine possible peripheral mechanisms for the reduction of propofol injection pain by the addition of ketamine. We hypothesised that pH changes associated with the addition of ketamine to propofol decrease propofol-induced pain on injection. We compared the efficacy of intravenous ketamine pretreatment under tourniquet with ketamine added to the propofol. ⋯ Forty-eight patients (51%) in Group P complained of pain on injection compared with 28 patients (30%) in Group M (P = 0.005). The pH of the 1% propofol-ketamine mixture was 5.84 while 1% propofol had a pH of 7.86. Our results support pH changes as a more important cause for the decrease in propofol injection pain with the addition of ketamine to propofol than a peripheral effect of ketamine.
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Our objective was to survey all consultant surgeons, including obstetricians/gynaecologists, in the State of Western Australia to assess their experience with, and readiness to assist anaesthetists with a difficult or failed airway. Survey questionnaires were mailed to all surgeons registered in Western Australia (n = 445). A total of 238 responses (53%) were received, mostly from general surgeons, obstetrician/gynaecologists and orthopaedic surgeons. ⋯ These findings indicate that surgeons in Western Australia perform surgical airways infrequently and only occasionally assist anaesthetists with difficult airway management. However, some surgeons lack confidence and training in surgical airway management. Because anaesthetists cannot always rely on their surgical colleagues to provide a surgical airway during a crisis, we recommend that anaesthetists discuss airway management with their surgical colleagues for all patients with identified difficult airways and that anaesthesia training should include surgical airway management.
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Anaesth Intensive Care · Jul 2009
Historical ArticleSome prehistory of New Zealand intensive care medicine.
In taking 1960 as the foundation year for the practice of intensive care medicine in New Zealand, this paper briefly looks into the previous two centuries for some interventions in life-threatening conditions. With the help of descriptions in early 19th century journals and books by perceptive observers, the author focuses on some beliefs and practices of the Maori people during pre-European and later times, as well as aspects of medical treatment in New Zealand for early settlers and their descendents. ⋯ Drowning is highlighted as a common cause of accidental death, and consideration is given to alcohol as a factor. Following the 1893 foundation of the New Zealand Medical Journal, a limited number of its papers which are historically relevant to today's intensive care are explored: topics include tetanus, laryngeal diphtheria, direct cardiac massage, traumatic shock, thiopentone management for fitting and the ventilatory failure due to poliomyelitis.
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Anaesth Intensive Care · Jul 2009
Application of the transversus abdominis plane block in the intensive care unit.
We present three patients admitted to the intensive care unit following major intra-abdominal surgery who underwent ultrasound guided transversus abdominis plane (TAP) block for postoperative analgesia. In two patients, epidural analgesia was relatively contraindicated. ⋯ We found that the TAP blocks provided satisfactory analgesia and appeared to enhance recovery by reducing morphine requirements and avoiding opioid-related side-effects. We put forward a case for more frequent use of this simple and safe technique in the intensive care setting.