Anaesthesia and intensive care
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Anaesth Intensive Care · Oct 1999
Randomized Controlled Trial Clinical TrialThe effect of single dose intravenous dexamethasone in tonsillectomy in children.
A prospective, randomized, double-blinded, placebo-controlled clinical trial was conducted in 41 patients evaluating the effect of a single preoperative dose of intravenous dexamethasone on postoperative vomiting and pain in children undergoing elective tonsillectomy. Dexamethasone was found to significantly reduce the incidence of vomiting in the first 24 hours postoperatively (P = 0.02), the time to first intake of solids (P = 0.001), the need to administer a rescue antiemetic (P = 0.005) and intravenous fluid therapy requirements (P = 0.006) in the postoperative period. No significant difference was found between the dexamethasone and placebo groups in the time to first intake of fluids, pain scores or analgesic requirement postoperatively. These results indicate that dexamethasone substantially reduces morbidity after tonsillectomy in children.
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Anaesth Intensive Care · Oct 1999
Case ReportsRemifentanil in emergency caesarean section in pre-eclampsia complicated by thrombocytopenia and abnormal liver function.
We describe the use of remifentanil in a woman with severe pre-eclampsia who presented for emergency caesarean section. Remifentanil was effective in obtunding the hypertensive response to laryngoscopy and intubation. ⋯ With its short duration of action, the use of this new opioid has several potential advantages in the above setting. Further studies are required to explore the use of remifentanil as an adjunct to obstetric general anaesthesia.
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Anaesth Intensive Care · Oct 1999
Biography Historical ArticleRupert Walter Hornabrook--Australia's first full-time anaesthetist.
Rupert Walter Hornabrook, born in 1871, was the first physician in Australia to devote his medical practice solely to anaesthesia. He was appointed to the Royal Melbourne Hospital in 1909, after an adventurous earlier career which ranged from service in plague hospitals in India to the Boer War in South Africa. Hornabrook was a colourful character whose work in anaesthesia included popularizing the use of the ethyl chloride-ether sequence in the early 1900s, when chloroform and closed inhalers were the norm. He was also a vigorous campaigner for the recognition of anaesthesia as a branch of medicine in its own right.
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Anaesth Intensive Care · Oct 1999
Reduction of preoperative investigations with the introduction of an anaesthetist-led preoperative assessment clinic.
Preoperative investigations, when used to screen for disease not clinically evident, have been shown to be unnecessary. The aim of this study was to rationalize the ordering of preoperative investigations by introducing guidelines and screening all investigations ordered at a new Day of Surgery Admissions clinic. Two hundred and one elective general and ear, nose and throat (ENT) patients attending this clinic at Sir Charles Gairdner Hospital from July to September 1997 were induced in a prospective study group. ⋯ There were significant reductions in most types of investigations (electrocardiogram, chest X-ray, liver function tests, urea and electrolytes, full blood examination, coagulation profile) ordered with the Day of Surgery Admissions clinic intervention. This resulted in an estimated reduction of preoperative investigation costs by 38%. It was concluded that the clinic intervention was associated with a reduction in indiscriminate preoperative investigation ordering patterns.
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Anaesth Intensive Care · Oct 1999
Case ReportsCombined spinal-epidural analgesia in the management of labouring parturients with mitral stenosis.
We report the use of combined spinal-epidural analgesia during labour in three parturients with moderately severe mitral stenosis. In each case, rapid analgesia was achieved using intrathecal fentanyl 25 micrograms without major haemodynamic changes. ⋯ Supplementary analgesia in the latter stages of labour was provided using slow epidural boluses of fentanyl, with or without a low concentration of bupivacaine, which was sufficient to allow controlled instrumental deliveries. We conclude that combined spinal-epidural analgesia is a useful technique for providing analgesia and maintaining haemodynamic stability in parturients with mitral stenosis.