Anaesthesia
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The World Federation of Societies of Anaesthesiologists (WFSA) was formed in 1955 and is currently composed of 120 national societies. The aims of WFSA are to improve the standards of anaesthesia worldwide, with a particular emphasis in developing countries. This article details the structure of the WFSA, the various activities carried out by the different committees, and our achievements in education and training.
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Review Meta Analysis
Remifentanil for general anaesthesia: a systematic review.
We performed a quantitative systematic review of randomised, controlled trials that compared remifentanil to short-acting opioids (fentanyl, alfentanil, or sufentanil) for general anaesthesia. Eighty-five trials were identified and these included a total of 13 057 patients. ⋯ Remifentanil had no overall impact on postoperative nausea (1.03, 0.97-1.09) or vomiting (1.06, 0.96-1.17), but was associated with twice as much shivering (2.15, 1.73-2.69). Remifentanil does not seem to offer any advantage for lengthy, major interventions, but may be useful for selected patients, e.g. when postoperative respiratory depression is a concern.
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Good quality educational material for anaesthesia providers in the developing world is limited in both quantity and availability. Traditionally, textbooks have been the main source of information but these are frequently expensive, easily damaged and rapidly become outdated. Many first world texts concentrate on the use of expensive drugs for an increasingly complex range of patients and procedures, making them less suitable for practitioners in resource-poor locations. Improved access to broadband internet connections will increasingly be a major portal for the delivery of up to date educational material.
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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.