Anaesthesia
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In 1994, 66% of all surgery in the USA was performed as ambulatory surgery. Day surgery is also expanding to other countries worldwide. To provide safe anaesthesia and good outcomes for longer and more extensive operations performed in ambulatory facilities, patients must be carefully evaluated before surgery, their home readiness must be assessed, and they must fully understand all relevant information. ⋯ If a patient does not have an escort home, the surgical procedure should be cancelled or the patient admitted to the hospital. As the number of patients and complexity of scheduled surgical procedures increases, the outcome of day surgery will increasingly depend on the anaesthetist's skills. The recently introduced short-acting drugs may further improve the outcome after day surgery by facilitating rapid recovery and an early return to normal daily activities.
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Although many anaesthesia machines are equipped with circle rebreathing systems, inhalational anaesthesia remains frequently performed using relatively high fresh-gas flows. The major advantages of rebreathing techniques can be achieved only if the fresh-gas flow is reduced to 1 l.min-1 or less. Although there are potential risks associated with low-flow anaesthesia, modern anaesthesia machines meet all the technical requirements for the safe use of low-flow techniques if they are used in conjunction with equipment for monitoring inhaled and exhaled gas concentrations; these monitors are already increasingly available and, in the near future, are likely to become an obligatory safety standard in many countries. For both economic and ecological reasons, the use of new inhalational anaesthetics, with low tissue solubility and low anaesthetic potency, can be justified only if the efficiency of administration is optimised by using low-flow anaesthetic techniques.
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The skin-epidural distance was measured in 274 children to assess the usefulness of 1 mm.kg-1 as a guideline. Children aged between 2 days and 16 years, weighing between 2 and 43 kg were investigated. Lumbar epidurals were performed under general anaesthesia using a midline approach in the L3-4 interspace with the patient in the lateral position. ⋯ Poor correlation was noted below 6 months (n = 22) and over 10 years (n = 19). No dural puncture or bloody tap occurred. One mm.kg-1 body weight was shown to be a useful guideline for children between 6 months and 10 years of age.
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The Ohmeda Universal PAC drawover apparatus, a modification of an earlier series of vapour-specific vaporizers, was assessed with regard to its output under varying gas flows and temperatures and its clinical usage with isoflurane and enflurane. The device tended to over-deliver vapour, particularly at low flows and at high temperatures. ⋯ The device was not assessed with ether or halothane. The robust construction, relatively large capacity and thermocompensation make it suitable for field or military anaesthesia.