Canadian journal of anaesthesia = Journal canadien d'anesthésie
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A literature review was undertaken to document the status of anaesthetic education in both the peer-reviewed anaesthesia and medical education literature. A search was performed using Silver Platter for the period 1983-91, and the most widely circulated medical education and anaesthesia journals in North America were reviewed in detail. Although anaesthetists are involved in many educational activities, the literature is oriented towards postgraduate training. ⋯ A limited number of teaching methods, especially simulators, have been the focus of much interest, while other methods, such as bedside teaching, have received little attention. Programs of recertification or maintenance of competence, which have been announced by certifying bodies, may place new emphasis on the study of the design, effectiveness, and outcome of continuing medical education. In conclusion, the review revealed that there are many opportunities for anaesthetists to conduct educational research into many traditional and new areas of medical education.
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Randomized Controlled Trial Clinical Trial
Maternal inspired oxygen concentration and fetal oxygenation during caesarean section.
This study was designed to determine whether fetal arterial and venous PO2 could be increased by increasing maternal FIO2 in the period between hysterotomy and birth. Two groups of ten patients were studied. All were anaesthetised with the same technique except for the FIO2 after hysterotomy. ⋯ Although the maternal arterial PO2 was higher at birth in the 100% O2 group (177.4 +/- 42.3 mmHg vs 281.0 +/- 94.2 mmHg), there were no differences between the arterial umbilical cord PO2 (19.3 +/- 5.7 mmHg vs 18.5 +/- 7.3 mmHg) and the venous umbilical cord PO2 (31.1 +/- 7.6 mmHg vs 33.0 +/- 10.8 mmHg). Awareness was present in one patient in the 50% O2 group and in four patients in the 100% O2 group but this difference was not statistically significant. It is concluded that a higher inspired maternal oxygen concentration between hysterotomy and birth does not result in any increase in fetal PO2.
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Case Reports
Use of propofol for the prevention of chemotherapy-induced nausea and emesis in oncology patients.
Nausea and vomiting associated with antineoplastic chemotherapy are distressing and may keep patients from complying with chemotherapy protocols. No drug has emerged among many as an effective antiemetic. It has been speculated that propofol may have intrinsic antiemetic properties. ⋯ All three patients were alert, reported low nausea scores by visual analogue scale, and had no episodes of vomiting. When the infusion was discontinued, nausea and vomiting were noted in two patients. Propofol, given in a subanaesthetic infusion, was safe and effective as an antiemetic in these three patients.
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Randomized Controlled Trial Clinical Trial
Ineffectiveness of acupuncture and droperidol in preventing vomiting following strabismus repair in children.
The antiemetic effects and side-effects of P6 acupuncture and droperidol pre-treatment were evaluated in a randomized, patient- and observer-blinded study. Ninety unpremedicated children of ASA physical status I or II undergoing outpatient strabismus repair, and aged over one year, were studied. All patients received intravenous thiopentone 5 mg.kg-1, atropine 0.02 mg.kg-1 and succinylcholine 1.5 mg.kg-1, and the trachea was intubated. ⋯ The incidence of restlessness was significantly greater in children receiving droperidol (63%) or both treatments (67%) than in those receiving acupuncture alone (30%; P = 0.007). P6 acupuncture and droperidol are equally ineffective in preventing vomiting within 48 hours of paediatric strabismus repair. Droperidol is associated with increased incidence of postoperative restlessness.
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The accuracy of bolus injections using different sized syringes was studied. A 1 ml bolus was delivered from a 1 ml, 5 ml, 10 ml, and a 20 ml syringe (n = 205). The 1 ml syringe was the most accurate (P less than 0.001) and the bolus delivered was the least variable (P less than 0.001). ⋯ The 5 ml syringe was the most accurate (P less than 0.05) and the 3 ml and 5 ml syringes delivered a bolus with the least variability (P less than 0.001). A 5 ml bolus was delivered from a 5 ml, 10 ml, and a 20 ml syringe (n = 123); in this case there was no significant difference in the accuracy or variability of bolus among the three syringes. We conclude that for accuracy of small volume boluses (less than 5 ml), small-sized syringes should be used.