Pilot study on midazolam as an induction agent for minor surgical procedures

Midazolam, a water-soluble benzodiazepine, was used to induce anaesthesia in 32 patients for minor surgical procedures. Patients showed cardiovascular stability, smooth induction and good recovery at a dose of 0.15 mg/kg. This dose was unaffected by premedication, and as such this drug is recommended as a satisfactory induction agent for short surgical procedures (AU)

The role of paramedical personnel in the anaesthetic services of Jamaica - abstract

The position relating to anaesthetic personnel in Jamaica in order to decide logically on the need and advisability of using paramedical personnel in this specialty. The figures quoted are taken from the Jamaican Anaesthetic Survey carried out from March 16 to September 14, 1970, in which records of the details of anaesthetics administered in all hospitals were collected and analysed. Of 16,000 anaesthetics given in the island in the survey period, over, 700 were given by untrained staff. Out of nineteen rural hospitals, eight had no trained anaesthetic staff for the major part of the survery period. Untrained staff administered 25 percent of the anaesthetics in the rural hospitals, and all these hospitals, except two, rely to some degree on untrained staff for emergency surgery. 40 percent of anaesthetics in emergency situation is given by untrained staff. Figures from the survey suggest a higher mortality rate for the untrained personnel group. It was estimated that there were 4.3 preventable deaths per 1,000 anaesthetics given by nurses who were specially trained as opposed to 1.1 for trained nurses and 1.8 when the anaesthetics were administered by doctors. Recruitment of doctors into anaesthesia is unsatisfactory. In 1966 the figure for full-time Anaesthetic Specialists per 100,000 populatioin in the United Kingdom was 4.7. In 1970 in Jamaica the figure was 1.3. Between 1960 and 1970, 47 junior anaesthetists were trained at the University of the West Indies. Of these, eleven (11) were still in Jamaica 1970, but only one is working in the rural hospital. Only seventeen (17) graduates of the University of the West Indies have received local training in anaesthesia in the same period, and only four (4) of these are working in Jamaica. As a possible solution to this problem it is proposed that six nurses will be required to be trained each year for the next 5 years. Various factors were considered in arriving at this figure. It was estimated for example that the number of anaesthetics giving per arriving at this figure. It was estimated for example that the number of anaesthetics given per year by an anaesthetic nurse in the present hospital system is 400 to 500. Also, the presently low operation rate in this country is expected to increase over the next ten years, i.e. Operation Rate, U.K. (1966) = 3770 ops. per 100,000 Pop. Operation Rate Jamaica (1970) = 1950 ops. per 100,000 Pop. The rate of population increase (2.4 percent) and possible loss of at least 50 percent of those trained were also considered. Certain necessities for optimum functioning of anaesthetic nurses are discussed, as are real and imaginary, diffuculties connected with their employment. It is concluded that paramedical anaesthetic personnel are required in Jamaica. The registered nurse best suits the role of the future trainee. The nurse anaesthetists should be invited and encouraged to take an integrated place in the medical anaethetic hierarchy, but a career structure with satisfactory salary and status, and opportunities for promotion is essential. An independent nurse anaesthetist structure is undesirable (AU)

Surgery: post-anaesthetic excitement following intravenous administration of barbiturates

Post-anaesthetic excitement may occur in neurotic or alcoholic subjects even after heavy doses of barbiturate have been given. It may be prevented or modified by the pre-anaesthetic administration of morphia or allied drug. When present, it may be lessened or abolished by morphia (in alcoholics) or possibly by alcohol. (AU)