Anaesthesia
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The Triservice anaesthetic apparatus is a draw-over using ambient air as the primary carrier gas. Its modules are a self-inflating bag, a vaporiser, a supplementary oxygen regulator and a ventilator; each is described. The outputs of halothane and trichloroethylene were measured with changes of temperature, continuous and intermittent gas flows and with alteration in barometric pressure. ⋯ The resistance to airflow of the apparatus was also measured and the effect of extreme cold observed. The merits, limitations and the way in which the equipment may be used are discussed. A carrying case with equipment for 10 anaesthetics is illustrated.
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The effectiveness of methadone given postoperatively by the lumbar epidural route to patients following upper abdominal or thoracic surgery was assessed. Intermittent injections of methadone diluted in large volumes of normal saline were given during the first 48 hours after surgery. Pain relief was assessed by both the patient and an observer using a visual linear analogue scoring system. Methadone 4-5 mg in 18-20 ml normal provided good postoperative pain relief for 6-8 hours.
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Comparative Study
Postoperative analgesia in major orthopaedic surgery. Epidural and intrathecal opiates.
Sixty-two patients were given morphine 2 mg and 69 patients were given diamorphine 0.5 mg by either the epidural or intrathecal route. All had undergone either total hip replacement or spinal disc surgery. ⋯ Headache, pruritus, urinary retention and nausea and vomiting were recorded, the incidence of the latter being unacceptably high, particularly when the drugs were administered by the intrathecal route: one patient required resuscitation. It is suggested that previously reported respiratory depression using these techniques is associated with the administration of other analgesics contemporaneously; that dosage should be limited to one-fifth of the estimation intramuscular dose; and that patients should be observed in a recovery ward for 24 hours.
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Reports of anaesthetic misadventures were regularly collected in the Anaesthetic Department of a district general hospital, to identify recurring problems. Eighty-one misadventures, none of which had serious outcome, were reported during a 6-month period, in which 8312 anaesthetics were administered. Human error was more frequently responsible than equipment failure, and failure to perform a normal check was the factor most frequently associated. Local hazard warnings were circulated when necessary to members of the Department, and the reports formed the basis of departmental discussion and teaching.