Anaesthesia
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Enough evidence now exists to suggest that windowless environments in hospitals increase the risk to the patient for a number of reasons. These include a direct influence on his own physiological and psychological state, a lowering of the standard of care by an effect on hospital staff, and increased vulnerability to physical hazards. The psychological ill effects of the intensive therapy unit (ITU) environment on its occupants are well recognised. The aggravation of these effects by the construction of any further windowless units can no longer be regarded as acceptable.
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Case Reports
Treatment of a flail injury of the chest. A case report with consideration of the evolution of therapy.
A patient with flail-chest injury, and associated abdominal and musculo-skeletal trauma, required several modes of mechanical ventilation in the Surgical Intensive Care Unit Ventilator modalities included mechanical ventilation with positive end-expiratory pressure (PEEP) and intermittent mandatory ventilation (IMV) with continuous positive airway pressure (CPAP) during 12 days of intensive respiratory care. This treatment has resulted from an evolution of ideas about pathophysiology and treatment of the flail-chest injury. Future developments portend a shorter duration of ventilatory support; alternatively, a radically new mode of therapy may simplify the care of the flail-chest injured patient.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anaesthesia and blood loss in total hip replacement.
Twenty-seven consecutive patients scheduled for total hip replacement were randomly divided into three groups. The first group had their operations under epidural analgesia, the second whilst breathing halothane spontaneously and patients in the third group were anaesthetised using a modified neuroleptoanaesthetic (NLA) technique. Blood lost during the operation was measured by a colorimetric technique. ⋯ There was no significant difference in the amounts of blood collected by closed suction drainage in any of the three groups and the mean values for total overall blood loss incurred by procedure were 734-1 +/- 40-7 ml (s.e.m.) for the epidural group, 986-3 +/- 94-9 ml (s.e.m.) for the halothane group and 1168-4 +/- 126 ml (s.e.m.) for the NLA group. In this series only 3 of 10 patients (30%) who had their operation under epidural anaesthesia required transfusion with whole blood, compared with 7 of 9 (78%) in the halothane group, and 7 of 8 (87-5%) in the neuroleptoanalgesia group. From this series it is evident that the need for transfusion of whole blood in total hip replacement can be significantly reduced by the use of epidural analgesia.