Anaesthesia and intensive care
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Anaesth Intensive Care · Apr 1998
ReviewIntrathecal pethidine: pharmacology and clinical applications.
Pethidine is the only member of the opioid family that has clinically important local anaesthetic activity in the dose range normally used for analgesia. Pethidine is unique as the only opioid in current use that is effective as the sole agent for spinal anaesthesia. ⋯ Articles reviewed include those identified by a Medline search using keywords "intrathecal" or "spinal anaesthesia/ anesthesia" and "pethidine" or "meperidine". Reference lists from identified papers were scrutinized to identify further relevant articles.
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A prospective survey of one thousand and sixty-two patients receiving epidural analgesia in surgical wards was undertaken over a two-year period. The duration of infusion ranged from one to fourteen days, with a mode of three days. There were 1131 episodes where a local anaesthetic and opioid mixture was used and 160 where opioids were used alone. ⋯ Epidural analgesia can be used safely in surgical wards provided that regular review of the patients is undertaken. It must be anticipated however, that up to 20% of patients will not receive adequate analgesia for the first 48 hours postoperatively. The failure rate could be halved if accidental dislodgement of epidural catheters could be eliminated.
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Anaesth Intensive Care · Apr 1998
Comparative StudyAnaesthesia circuits, humidity output, and mucociliary structure and function.
We compared the effects of humidity delivered by the circle system at low fresh gas flows (FGF) with a conventional two-limb and coaxial circuit on the structure and function of the tracheobronchial epithelium in dogs. Animals were anaesthetized and mechanically ventilated using an anaesthesia ventilator to maintain normocarbia. Group I (control) animals received a FGF equal to the required minute ventilation mimicking an open circuit technique. ⋯ Alterations in tracheobronchial structure and function result from exposure to dry gases and are amplified by the duration of exposure. Our findings suggest a minimum of 12 to 15 mg H2O/l is necessary to prevent these alterations. In this study, the combination of low FGF and a coaxial anaesthesia circuit reached this minimum threshold more quickly than a conventional two-limb circuit.
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Anaesth Intensive Care · Apr 1998
Case ReportsRemifentanil and propofol total intravenous anaesthesia for thymectomy in myasthenia gravis.
We report a case of trans-sternal thymectomy for myasthenia gravis using a non relaxant, total intravenous technique with propofol and remifentanil. This afforded excellent control of heart rate and pressor responses during surgery while allowing early return of spontaneous ventilation and extubation within nine minutes of termination of anaesthesia. Advantages and disadvantages of this approach versus relaxant and volatile techniques are discussed with particular reference to preservation of neuromuscular function.
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Anaesth Intensive Care · Apr 1998
Postoperative nausea and vomiting: development of a management protocol.
Postoperative nausea and vomiting (PONV) is still an important and common problem. Despite the introduction of new antiemetic drugs, the management of PONV remains difficult. ⋯ Implementation of this management protocol has been well-accepted by staff, appears to have reduced delay in patient treatment and improved patient care, and has significantly reduced staff workload. It is planned to use continuous quality improvement techniques to further refine the algorithm and continue assessment of its efficacy and of patient satisfaction.