Anaesthesia and intensive care
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The intravenous administration of Hartmann's solution at a rate sufficient to maintain the hourly urine volume between 0.5 and 1.0 ml/kg/hr is recommended during major operations. Intra-operative extracellular volume expansion followed by the administration of sodium containing fluids for 48 hours postoperatively decreases the incidence of haemodynamic instability and acute renal failure and results in normal water and sodium excretion by the kidney throughout the peri-operative period. Abnormal extracellular volume may exist prior to induction of anaesthesia particularly in patients with pre-existing cardiovascular, renal and hepatic disease. ⋯ If the operative blood loss in adults is less than one litre, no blood may be necessary. If the loss is between one and 2 litres packed red cells may be sufficient, whereas with a greater loss, filtered whole blood, coagulation factors and platelet infusions may be required. When possible, transfusions of stored autologous blood is recommended for elective operations.
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During an anaesthetic procedure the anaesthetist's main concern is for the patient and his vigilance ensures that the patient is given the best care possible. When a trainee anaesthetist is administering an anaesthetic a tutor is often present to further improve the trainee's practical knowledge or technique. This report presents the results of an investigation of the typical patterns of trainee anaesthetist's behaviour when a tutor is either present or absent in order to establish whether the teaching which occurs in the operating theatre affects the pattern of activity and vigilance. Results indicate that the patterns of behaviour are unaffected by a tutor's presence, and that teaching anaesthetics in the operating theatre may be a legitimate activity which does not interfere with the trainee's prime function of patient care.
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Rapid tracheal intubation, using the standard Macintosh laryngoscope, can be hindered in obstetrical patients by the handle of the laryngoscope hitting the patient's engorged breasts and the hand of the assistant applying cricoid pressure. To overcome these difficulties a variation of the laryngoscope is described. The right angle of the blade to the handle is opened by a further 20 degrees.
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A new laryngoscope incorporation a mechanism operated from the handle which facilitates endotracheal intubation in situations where an introducing stylet would normally be required.