Anaesthesia
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An anaesthetic charity 'Mothers of Africa' has been established as a link between the academic departments of anaesthesia in Togo and Benin and the University Hospital of Wales. Visits by UK consultant anaesthetists have identified a number of clinical areas where collaborative working in both classroom and theatre has the potential to improve outcomes in maternal mortality and morbidity.
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Randomized Controlled Trial
M-Entropy guidance vs standard practice during propofol-remifentanil anaesthesia: a randomised controlled trial.
Seventy-two patients undergoing routine surgical procedures under propofol-remifentanil anaesthesia were randomly assigned to receive either standard clinical practice (n = 35) or standard practice plus monitoring of depth of anaesthesia with M-Entropy (n = 37). Patients in the standard practice group received more propofol than the entropy group (mean (SD) 95 (14) vs 81 (22) microg.kg(-1).min(-1), respectively; p < 0.01), and less remifentanil (0.39 (0.08) vs 0.46 (0.08) microg.kg(-1).min(-1), respectively; p < 0.001). ⋯ Both regimens resulted in fast recovery with no clinical advantage for either one. There were no significant differences in haemodynamic parameters, postoperative nausea and vomiting or satisfaction with the procedure.
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The Primary Trauma Care programme is a course designed to train anaesthetists, surgeons and others in the systematic review and management of severe trauma victims at the District Hospital. Over the last 10 years, many individuals have been involved in training, empowering and supporting doctors and nurses in a number of countries. ⋯ The Primary Trauma Care Foundation continues to support these regional offices in their need for qualified instructors, fund-raising, and for updating educational material. With anaesthetic support, the Primary Trauma Care Foundation will continue to empower anaesthetists worldwide as they work with their surgical colleagues to treat severely injured patients in areas where, previously, due to inadequate resources and training, comprehensive treatment was not available.
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Ketamine is a very versatile inexpensive drug and plays an invaluable role in the developing world. In regions where access and funding for a wider range of drugs is problematic, its broad range of clinical applications is ideal. Its good safety profile and ease of storage makes it ideal for use in areas where refrigerators, complex monitoring, electricity and oxygen may all be in short supply or unreliable. Ketamine is also finding increasing use in both the acute and chronic pain settings and research is still ongoing into a potential neuroprotective effect for ketamine in brain injury.