Annals of the Royal College of Surgeons of England
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The Eisenmenger syndrome is a form of cyanotic congenital heart disease not usually amenable to corrective surgery. It is, however, compatible with leading an active life in early adulthood and due to advances in medical therapy it is not uncommon for patients with this syndrome to live to 30 years or more. Occasionally, therefore, anaesthetists and surgeons will be required to care for these patients when they present for incidental surgery. This article reviews the appropriate measures for the safe operative and perioperative care of patients, based on an understanding of the pathophysiological changes which occur in the Eisenmenger syndrome.
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Following the introduction of muscle relaxants into anaesthesia there became recognised a state in which patients may be aware of their surroundings but unable to communicate their plight. This state of awareness is more likely to occur during light inhalational or total intravenous anaesthesia. Detection of awareness is difficult and several methods have been described. ⋯ Awareness can occur without patient recall and may be due to equipment failure or anaesthetic failure. The former is avoidable and the latter ought to be. Recommendations have been made regarding the use of premedicant drugs and volatile anaesthetic agents to reduce the incidence of awareness.
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Ann R Coll Surg Engl · Jan 1979
ReviewBlast injury with particular reference to recent terrorist bombing incidents.
The aetiology of primary blast lung is discussed with reference to the biodynamics of blast injury, and the clinical and pathological features of the condition are described. An analysis of casualties from bomb blast incidents occurring in Northern Ireland leads to the following conclusions concerning the injuries found in persons exposed to explosions: (1) there is a predominance of head and neck trauma, including fractures, lacerations, burns, and eye and ear injuries; (2) fractures and traumatic amputations are common and often multiple; (3) penetrating trunk wounds carry a grave prognosis; and (4) primary blast lung is rare. A comparison of four bombing incidents in England in 1973 and 1974 shows how the type and severity of injury are related to the place in which the explosion occurs. The administrative and clinical aspects of the management of casualties resulting from terrorist bombing activities are discussed.