Anaesthesia
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A questionnaire circulated to members of the Intensive Care Society in England and Wales brought 101 replies, representing 74 hospitals, including 16 teaching hospitals. Anaesthesia is the dominant specialty in this field and the majority of general units included in this survey are staffed and directed by consultants from this specialty, though their involvement in such work varies widely. Only about half the units are largely supervised by consultants with a heavy commitment to it. ⋯ Despite this agreement on special training, only a small minority of members believe intensive care work should largely be restricted to separate career specialists, "intensivists'. However most recognise the need for each unit to have a largely full-time manager and coordinator, whose personal qualities are more important than his original specialty. Most units have one kind of problem or another, the most common being a shortage of money and nurses.
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Letter Case Reports
The use of the fibre-optic bronchoscope for the passage of a double lumen tube.
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Randomized Controlled Trial Clinical Trial
Halothane uptake and nitrous oxide concentration. Arterial halothane levels during Caesarean section.
The effect on halothane uptake of changing the nitrous oxide concentration during the first few minutes of a general anaesthetic for Caesarean section was investigated. In 10 mothers anaesthesia was maintained with halothane 0.4%, nitrous oxide 33% and oxygen 66%. In 10 others the sole difference in anaesthetic technique was that the ratio of nitrous oxide to oxygen was reversed for the first 3 minutes only. ⋯ Cord blood concentrations between the two groups were comparable. The difference in halothane levels is a demonstration of the influence of the concentration effect of nitrous oxide on the uptake of halothane, the second gas effect. The relevance of anaesthetic uptake to obstetric anaesthesia and awareness is discussed.
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Morphine (2--6 mg) injected into the epidural space was ineffective in relieving the pain of labour in eight patients. Morphine (2 mg) injected into the epidural space of 60 patients whilst they were undergoing Caesarean section was associated only modestly, if at all, with a diminished incidence of postoperative pain and discomfort, when compared with the epidural injection of saline in 60 patients matched for type of operation and type of anaesthesia. A relatively high incidence of postoperative vomiting was noted among the patients who received morphine.
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A patient with the Treacher-Collins syndrome is described, in whom intubation of the trachea was achieved using ketamine as the sole anaesthetic agent. Intubation was aided by blind location of the glottis with a gum-elastic stylet.