Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Biography Historical Article
Harold Griffith Memorial Lecture. The Griffith legacy.
1992 was the anniversary of Crawford Long's use of ether in 1842, and Griffith and Johnson's introduction of Intocostrin into anaesthetic practice in 1942. Harold Randall Griffith was born in Montreal in 1894 and died in 1985. He interrupted his medical studies to serve in the first world war and was awarded the Military Medal for gallantry at the battle of Vimy Ridge. ⋯ He was one of those responsible for inaugurating the World Federation of Societies of Anaesthesiology and was President of the First World Congress of Anaesthesiology in 1955. It is remarkable that the introduction of curare into anaesthetic practice was delayed until 1942, since curare had been used in anaesthesia some 30 years previously. However, it was probably Griffith's confidence in his own clinical abilities which enabled him to seize the opportunity when it was offered.
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The aim of this study was to devise and validate a technique to deliver constant air-oxygen mixtures from a standard anaesthetic machine using only oxygen as the compressed gas source. The common gas outlet was modified to allow measured quantities of ambient air to be insufflated via a three-way attachment into a closed circle absorber system with a double-circuit collapsible bellows ventilator. During positive pressure ventilation, leakages of between 50-150 ml.min-1 occur from the circuit and nomograms of the minimal air and oxygen flow rates needed to maintain constant oxygen concentrations in the presence of the leaks were then mathematically derived. ⋯ Next, the technique was studied on 18 patients who underwent isoflurane or propofol anaesthesia (duration 40-210 min) for various surgical procedures. Pooled mean values (SD) obtained were 29.3% (1.86), 40.95% (1.65) and 50.06% (1.41) respectively for predicted oxygen concentrations of 30, 40 and 50% respectively. We conclude that this technique can be used to deliver constant air-oxygen mixtures accurately during inhalational or total intravenous anaesthesia when N2O is contraindicated but a source of compressed air is not readily available.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of epidural tramadol and epidural morphine for postoperative analgesia.
The present study compared epidural tramadol with epidural morphine for postoperative analgesia in 20 patients undergoing major abdominal surgery. Intraoperatively, the patients were anaesthetized by a balanced technique of general anaesthesia combined with lumbar epidural lidocaine. In ten of the patients 100 mg tramadol diluted in 10 ml normal saline was also injected epidurally, while 4 mg epidural morphine was used in the other ten patients. ⋯ This was not associated with any increase in PaCO2 or a decrease of respiratory rate, suggesting that hypoxaemia rather than hypercarbia or decreased respiratory rate may be an earlier indicator of respiratory rate, suggesting that hypoxaemia rather than hypercarbia or decreased respiratory rate may be an earlier indicator of respiratory depression in patients breathing room air without oxygen supplementation. The absence of clinically relevant respiratory depression following epidural tramadol compared with epidural morphine may be attributed to the different mechanisms of their analgesic action. The results suggest that epidural tramadol can be used to provide prolonged postoperative analgesia without serious side effects.
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Randomized Controlled Trial Clinical Trial
Perioperative gastric aspiration increases postoperative nausea and vomiting in outpatients.
The efficacy of aspiration of gastric contents to reduce postoperative nausea and vomiting was investigated in a controlled randomized, double-blind study of 265 outpatients. Patients in the treated group had their stomachs aspirated with an orogastric tube. In the control group no tube was inserted. ⋯ It was also comparable in the recovery room and the day surgery unit. However, treated patients had a higher incidence of both nausea (26.5% vs 12.0%, P < 0.005) and vomiting (16.7% vs 6.8%, P < 0.02) after their discharge from the day surgery unit. We conclude that aspiration of gastric contents with an orogastric tube does not decrease postoperative nausea and vomiting in outpatients and may increase it after discharge of the patient.