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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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 development of new preoperative fasting guidelines in paediatrics was reviewed in the light of present knowledge and some recent investigations. Although the proportion of healthy children with the potential risk of aspiration pneumonitis is relatively high (60-75%), the incidence of aspiration is low--1 to 8.6 in 10,000. In healthy children, there is no increase in the risk of aspiration by allowing them to drink clear fluids up to 2-3 hours before anaesthesia when compared with the conventional fasting regimen. ⋯ It is useful to have simple and explicit preoperative fasting instructions for parents to follow, especially in the day case setting. It is essential to note that the laryngeal mask airway (LMA) does not protect the patient's airway against the risk of regurgitation and aspiration of gastric contents in the same way as an endotracheal tube. Hence, constant vigilance is required when LMA is used 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".