Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1994
Specialist training and certification process for anaesthesiologist in Japan.
Anaesthesiology is the first medical specialty in Japan to be legislated for training and certification by the Ministry of Health and Welfare. The Japanese Society of Anaesthesiologists (JSA) is the regulating body since 1960. Consultants or independent specialists in anaesthesiology are known as Diplomates of the Board of JSA. ⋯ This national examination system has a written, oral, on-site evaluation and demonstration of research by credit accumulation. Presently, 34% of post-anaesthesia trainees are Diplomates and this is an increasing trend. Recertification is mandatory with continued medical education as the Diplomate status is valid for 5 years only.
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Animal anaesthesia is a wide and varied subject considering the great number of available animal models, each having its characteristic tolerance and reaction to anaesthesia and its behavioural peculiarity. It is more often than not that experimental researchers tend to give scant attention to animal anaesthesia in the preparation of a research protocol as a result of which their research findings can become difficult or impossible to interpret. This article outlines the fundamental anaesthetic requirements and techniques in various animals and the practices adopted by the Department of Experimental Surgery, Singapore General Hospital. Consideration in the choice of anaesthetic drugs in various animal models and experimental situations, and problems of animal handling before and after anaesthesia are highlighted.
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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.