Anaesthesia
-
The Human Rights Act 1998 was incorporated into UK statutory law on October 2, 2000. The 18 Articles of the Act are likely to have a significant impact on the practice of medicine in the UK, particularly in reference to consent, disclosure of medical information and patient access to healthcare. This article examines the implications of the new legislation for anaesthetic and intensive care practice.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of anaesthetic techniques for shock wave lithotripsy: the use of a remifentanil infusion alone compared to intermittent fentanyl boluses combined with a low dose propofol infusion.
This study examined the intra-operative and postoperative characteristics of a remifentanil infusion alone, or intermittent fentanyl bolus admistration combined with a propofol infusion, for the anaesthetic management of patients undergoing shock wave lithotripsy. One of the key parameters investigated was the time to discharge. Fifty patients scheduled for extracorporeal shock wavelithotripsy (ESWL) were randomly allocated to receive either a continuous infusion of 0.2-0.4 micro g.kg-1.min-1 of remifentanil (Group 1) or a bolus of 3 micro g.kg-1 fentanyl followed by a continuous infusion of propofol at a rate of 2 mg.kg-1.h-1 with additional boluses of 0.05 mg fentanyl administered as required (Group 2). ⋯ However, patients in the remifentanil Group 1 showed a higher incidence of nausea (52% vs. 0%, p < 0.01) and retching (36% vs. 0%, p < 0.01) 120 min following ESWL compared to Group 2. This resulted in prolonged discharge times (p < 0.01) in this group. We found that remifentanil used as the sole agent failed to demonstrate any advantage over the combination of fentanyl/propofol with regard to rapid recovery and discharge following anaesthesia for extracorporal shock wave lithotripsy.
-
A postal survey was sent to all anaesthetic departments in the UK to identify current practice and gain insight into anaesthetists' attitudes regarding the use of anaesthetic rooms for induction of general anaesthesia. Replies were received from 247 (88%) departments. Of these, 10 (4%) departments routinely anaesthetise all patients in theatre. ⋯ Only 9.7% of all respondents believed that clinical governance would necessitate a change to anaesthetizing all patients in theatre compared to 25% who believed that the increasing costs of monitoring equipment would lead to a change. Overall 79% of respondents prefer to use the anaesthetic room, 16% prefer in-theatre induction and 5% expressed no preference. However, of those who routinely anaesthetise in theatre, 70% thought it to be preferable.