Anaesthesia
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Historical Article
Then and now. Anaesthesia thirty years ago (1947) Volume 2.
The year 1947 was a year of consolidation for the specialty of anaesthesia in Britain. The medical profession in the United Kingdom was poised between the old order of the voluntary hospitals and the new order of the National Health Service. ⋯ Volume 2 of Anaesthesia reflects this change. It reviews the past, both political and scientific and looks forward to the future with anticipation tinged with some apprehension.
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Acid aspiration in an important cause of anaesthetic mortality. 430 patients referred for gastric analysis were reviewed. According to observations made at endoscopy, patients were divided into 4 groups--no abnormality, oesophagitis/gastritis, gastric ulcers and duodenal ulcers. The volume of gastric juice varied from 0 to 400 ml, and the pH from 0-8 to 8. ⋯ This last figure is significantly greater than the group with no detectable abnormality. These results indicated that the stomach of a fasting patient often contains sufficient volume of acid gastric juice to place the subject at risk from acid aspiration during anaesthesia. Antacid therapy in all these patients seems imperative and consideration should also be given to preoperative gastric aspiration before induction of general anaesthesia.
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Enough evidence now exists to suggest that windowless environments in hospitals increase the risk to the patient for a number of reasons. These include a direct influence on his own physiological and psychological state, a lowering of the standard of care by an effect on hospital staff, and increased vulnerability to physical hazards. The psychological ill effects of the intensive therapy unit (ITU) environment on its occupants are well recognised. The aggravation of these effects by the construction of any further windowless units can no longer be regarded as acceptable.