Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1994
Specialist training and examinations in anaesthesia and intensive care in Australia and New Zealand.
The Australian and New Zealand College of Anaesthetists approves specialist training positions and requires specified periods of training in anaesthesia and intensive care. A common Primary examination in basic sciences is used by both specialties. ⋯ The syllabus for the Final examination is based on two College documents entitled Objectives of Training, one for anaesthesia and one for intensive care. Other requirements and anticipated future changes to the present training, examination and recertification systems include examination review, in-training assessment, a formal project, a new pain management qualification and a maintenance of standards (recertification) programme.
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Ann Acad Med Singap · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialSubcutaneous infusion of ketamine and morphine for relief of postoperative pain: a double-blind comparative study.
Low dose ketamine by subcutaneous infusion (0.1 mg.kg-1.h-1) was compared in a double-blind fashion with a similar infusion of morphine (0.03 mg.kg-1.h-1) for postoperative analgesia in 60 ASA-I adults after major abdominal surgery. Pain was assessed using visual analogue scales and sedation was graded on a four-point rank drowsiness score. Cardiovascular and respiratory parameters were also recorded. ⋯ Both tidal and minute volume parameters improved better with ketamine (P < 0.001); patients were more awake and alert as evidenced by the drowsiness score (P < 0.001). Nine out of 30 patients who received morphine required catheterisation for urinary retention (P < 0.05). The study revealed higher analgesic efficacy of a low dose subcutaneous infusion of ketamine with lesser sedation and fewer side effects.
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Ann Acad Med Singap · Jul 1994
Randomized Controlled Trial Clinical TrialPlacebo effect of eutectic mixture of lidocaine and prilocaine (EMLA) cream in reducing venepuncture pain in children.
A randomized double-blind study was made of 60 children aged 5 to 11 years to assess the efficacy of a eutectic mixture of local anaesthetics (EMLA), lidocaine and prilocaine, and placebo cream in reducing venepuncture pain. The 5% EMLA or placebo cream, approximately 2 grams (2 ml), was applied to the anticipated venepuncture site and covered with an occlusive dressing for a least 60 minutes. The venepuncture of 20-gauge butterfly needle was done after wiping the skin dry and observing for any local reactions. ⋯ The results showed that there were no statistical differences in the subject characteristics and pain scores, between the EMLA and the placebo group. Most children in both groups experienced no pain to mild pain from venepuncture. The possible causes were discussed and it was concluded that the placebo effect of having cream and good doctor-children rapport reduced fear and anxiety, resulting in the reduction of venepuncture pain in children.
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The anaesthesia specialty has focused on the safety of the patient and examination of untoward outcomes. Serious injuries are now rare in medically advanced countries. Still, anaesthesia deaths and complications are important because the anaesthetic itself has no intended therapeutic effect. ⋯ Many efforts are believed to have contributed to improvements in the safety of anaesthesia: improved training of anaesthesia clinicians, new pharmaceuticals, new technologies for monitoring (especially pulse oximetry and capnography), standards for monitoring and other aspects of anaesthesia care, safety enhancements in anaesthesia equipment and the implementation of quality assurance and risk management programmes. The creation of the Anesthesia Patient Safety Foundation in the United States and a similar organization in Australia have helped to bring about awareness of safety issues and to support study of patient safety. Ultimately, the motto of the Anesthesia Patient Safety Foundation should be the goal of all anaesthesia professionals: "That no patient shall be harmed by anaesthesia".
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Desflurane is a new fluorinated ether with rapid onset of and recovery from anaesthesia. Recovery characteristics are comparable with or faster than after propofol infusion or isoflurane anaesthesia. The minimum alveolar concentration (MAC) varies with age from 9.4% (infants) to 6% (adults), and is reduced by opioids and sedative premedication. ⋯ Desflurane is a respiratory depressant, and enhances the action of neuromuscular blocking agents. Cerebrovascular autoregulation appears to be preserved, but intracranial pressure may still rise during desflurane anaesthesia. Delivery of vapour is using a new electrically heated vaporizer, the Tec 6, with internal monitoring circuitry and new safety features.