Ann Acad Med Singap
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The anaesthetic machine used by most anaesthetists today closely resembles the anaesthetic machine of the late 1940s, with the addition of a multitude of devices and monitors necessary for the complexity of modern anaesthesia. Although modern anaesthesia boasts of a high level of safety, the ad hoc development of the anaesthetic machine has done little to enhance this safety record. Future improvements in patient safety will at least partially depend on improved ergonomics and human factor engineering in the design and arrangement of the anaesthetic workplace. Some innovative designs are now being seen both commercially and experimentally in which all monitoring is integrated and servo feedback control loops are used to deliver anaesthetic agents to the patient.
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Magnetic resonance imaging (MRI) has become an increasingly popular non-invasive radiological diagnostic procedure, with several distinct advantages over computerised tomography (CT). The images are produced using a strong (1.5-Tesla) magnetic field and radiofrequency (RF) pulses. Due to the effects of the strong magnetic field, certain groups of patients with implanted ferromagnetic objects and women in their first trimester of pregnancy are precluded from undergoing MRI. ⋯ The problems related to anaesthesia in MRI include the constant presence of a strong magnetic field, the RF pulses and their effect on the anaesthesia machine, monitoring devices, magnetically coded material, and loose ferromagnetic objects. In this article, the current availability of MRI-compatible anaesthesia machine, various monitoring devices, and safe conduct of anaesthesia during MRI for patients of all ages are discussed. In addition, the implications of the strong magnetic field on patient resuscitation inside the MRI suite and the recommended procedure for a successful outcome are outlined.
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The mechanism of anaesthesia is still a black box, although many investigators have been concerned about this theme since the 19th century. It is too complex to clarify the mode of anaesthetic action, as a variety of compounds have been adopted as anaesthetics. Hill coefficients calculated from the righting reflex dose-response curve in enflurane, isoflurane sevoflurane and halothane anaesthesia in a certain strain of mice were from 14 to 56. ⋯ It is suspected from Overton's experiment that the action site is not in the core of lipid bilayer but on the surface of membrane. It was demonstrated by 2 methodologies. Two-dimensional nuclear Overhauser effect spectrum in H1-NMR spectra of dipalmitoyl phosphatidylcholine (DPPC) vesicle membrane in the presence of methoxyflurane revealed from the existence of the cross-peak between the methoxy-proton and the choline methyl-proton that methoxyflurane molecule interacted only to the polar head of lipid membrane at lower temperatures.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ann Acad Med Singap · Jul 1994
Education of specialists in anaesthesia and intensive care in Europe--A Swedish perspective.
Sweden as well as most other countries in western Europe are parts of a common labour market where free movement of the labour force is encouraged. As in all recognised specialties of medicine, most national Anaesthesia societies or colleges have joined the Specialist Committee of the Union Européenne des Médicins Spécialistes (UEMS) as well as the European Board of Anaesthesiology in a joint European effort intended to promote the highest possible standard in the practice of Anaesthesia and Intensive Care throughout the European Union and the European Economic Space. ⋯ The European Academy of Anaesthesiology is working together with these organisations and is offering the specialist organisations or colleges in Europe to take part in their specialist examination, hospital recognition programme and in-training examinations. Our country, among others, has adopted the European Diploma of Anaesthesiology and Intensive Care as the national examination for future specialists in our discipline.
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Ann Acad Med Singap · Jul 1994
Septic shock in a surgical intensive care--validation of multiorgan and APACHE II scores in predicting outcome.
We analysed retrospectively the records of 353 admissions to the National University Hospital's Surgical Intensive Care Unit over a one-year period and found 25 patients with septicaemic shock requiring vasoactive therapy. The mortality rate was 68%. ⋯ Only the APACHE II was a significant predictor of outcome, the rest having poor predictive ability. We conclude that the present scoring systems are too inaccurate for us to base important clinical decisions on.