Anaesthesia
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Morphine (2--6 mg) injected into the epidural space was ineffective in relieving the pain of labour in eight patients. Morphine (2 mg) injected into the epidural space of 60 patients whilst they were undergoing Caesarean section was associated only modestly, if at all, with a diminished incidence of postoperative pain and discomfort, when compared with the epidural injection of saline in 60 patients matched for type of operation and type of anaesthesia. A relatively high incidence of postoperative vomiting was noted among the patients who received morphine.
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Unusual case of brachial plexus palsy developed in a patient following general anaesthesia in the sitting position. Congenital skeletal anomalies together with severe bony degenerative changes surrounding the nerve roots probably precipitated the palsy.
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A questionnaire circulated to members of the Intensive Care Society in England and Wales brought 101 replies, representing 74 hospitals, including 16 teaching hospitals. Anaesthesia is the dominant specialty in this field and the majority of general units included in this survey are staffed and directed by consultants from this specialty, though their involvement in such work varies widely. Only about half the units are largely supervised by consultants with a heavy commitment to it. ⋯ Despite this agreement on special training, only a small minority of members believe intensive care work should largely be restricted to separate career specialists, "intensivists'. However most recognise the need for each unit to have a largely full-time manager and coordinator, whose personal qualities are more important than his original specialty. Most units have one kind of problem or another, the most common being a shortage of money and nurses.
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Case histories of three patients with intractable pain, all of whom responded to epidural morphine, are presented. Drug tolerance appeared to develop in two patients who survived longer than 10 days. Nevertheless this method of pain relief may be a useful adjunct to terminal care and in certain circumstances may allow for easier management in the patient's own home.