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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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.
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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
Specialist anaesthetic training and certification process in England.
Specialist accreditation in anaesthesia in the United Kingdom currently requires a minimum of six years recognised training after full medical registration. In future, the training programme will become more structured, with more emphasis on regular in-training assessment, and attempts are being made to reduce the overall training period. ⋯ It is one of the first postgraduate bodies to introduce the Objective Structured Clinical Examination (OSCE) into its examination structure. A more formal programme of Continuing Medical Education is also being considered.