Anaesthesia and intensive care
-
Anaesth Intensive Care · Jul 2009
Comparative StudyPreventing pain on injection of propofol: a comparison between peripheral ketamine pre-treatment and ketamine added to propofol.
The purpose of this study was to examine possible peripheral mechanisms for the reduction of propofol injection pain by the addition of ketamine. We hypothesised that pH changes associated with the addition of ketamine to propofol decrease propofol-induced pain on injection. We compared the efficacy of intravenous ketamine pretreatment under tourniquet with ketamine added to the propofol. ⋯ Forty-eight patients (51%) in Group P complained of pain on injection compared with 28 patients (30%) in Group M (P = 0.005). The pH of the 1% propofol-ketamine mixture was 5.84 while 1% propofol had a pH of 7.86. Our results support pH changes as a more important cause for the decrease in propofol injection pain with the addition of ketamine to propofol than a peripheral effect of ketamine.
-
Anaesth Intensive Care · Jul 2009
Randomized Controlled TrialSubarachnoid morphine, bupivacaine and fentanyl as part of combined spinal-epidural analgesia for low anterior resection. A prospective, randomised, double-blind clinical trial.
This study was designed to compare the efficacy of subarachnoid morphine alone or in combination with bupivacaine and fentanyl for combined spinal-epidural analgesia in colorectal surgery. This is a prospective, randomised, double-blind clinical trial. Sixty patients undergoing low anterior resection were assigned to one of three groups: subarachnoid morphine, bupivacaine and fentanyl, subarachnoid morphine and bupivacaine or subarachnoid morphine only. ⋯ There were no significant adverse effects. All patients ambulated the morning after surgery. The addition of bupivacaine and fentanyl to subarachnoid morphine did not confer any advantage on postoperative visual analogue scale scores and tramadol use, but lowered the need for additional intraoperative intravenous fentanyl and epidural bupivacaine and prolonged the time to first analgesia request.
-
Anaesth Intensive Care · Jul 2009
ReviewEvidence-based evolution of the high stakes postgraduate intensive care examination in Australia and New Zealand.
The fellowship examination for intensive care medicine in Australia and New Zealand, first held in 1979, has undergone four major periods of development and change since inception. These periods are characterised as: 1. 1979 to 1996--initiation and establishment of the exam as a relevant and comprehensive assessment process for a new specialty. 2. 1997 to 2001--revision to increase breadth of coverage, increase reliability for a growing number of candidates and ensure that each candidate received the same exam: Expansion: to incorporate assessment of CanMEDS skills (including communication, procedures and professional qualities). Lengthening: to increase the number of exposures, to ensure reliability. ⋯ The exam has been regarded as a 'tough but fair' assessment in its 30 years of existence and the committee overseeing its development has aimed to continually review the process to maintain those qualities as well as reliability, validity and feasibility. The increasing number of candidates has allowed accumulation of usable statistics but has tested the feasibility of running such a labour intensive exam. To date, there have been 800 presentations to the exam with 498 successful candidates.
-
Anaesth Intensive Care · Jul 2009
Biography Historical ArticleWilliam TG Morton's early ether inhalers: a tale of three inhalers and their inscriptions.
Three ether inhalers with inscriptions stating that they had been used in early ether anaesthesia were found. All three inhalers were initially linked to WTG Morton. ⋯ The third inhaler was found to have been incorrectly attributed to Morton. It was first used by John Foster Brewster Flagg, a dentist in Philadelphia.
-
In June 1842 the wife of Lewis W Gilles, a banker in Launceston, wrote to Mrs Pugh, inviting her and her husband, Mr William Russ Pugh, to an entertainment and ball. The Pughs neither responded to the invitation, nor attended the ball. Mrs Gilles mentioned the discourtesy of their non-attendance to a friend, who the following morning brought the complaint to the attention of Dr Pugh. ⋯ A Supreme Court defamation and libel case followed with Gilles as plaintiff and Pugh as defendant. Gilles won the case but received only token damages. And the missing letter? Too late, Mrs Pugh's maid found it tucked between the pages of a periodical on the dresser