Total intravenous anaesthesia for day-care surgery using diclofenac for analgesia - abstract

The trend in modern surgery is to do more and more cases as "Day Care". This approach saves money by promoting the efficient use of available bed space and the time of hospital-based health professionals. The main objective of the anaesthetic technique is to produce conditions satisfactory to surgeon and patient, using agents that allow for the safe and rapid discharge of the patient from the hospital. Inhalation techniques with halothane and by using narcotics for post-operative analgesia are the standard techniques used in the Queen Elizabeth Hospital in Barbados. However, studies have shown that the combination of various narcotics such as Fentanyl and Alfentanyl for analgesia in total intravenous anaesthesia techniques, using continuous intravenous Propofol, will produce satisfactory anaesthesia for many types of surgical procedures with short recovery periods. Substitution of analgesics in the non-steroidal anti-flammatory drug group (NSAIDs), in combination with Propofol, offers the opportunity for avoiding the side-effects of narcotics. Accordingly, the effectiveness of total intravenous anaesthesia, using Propofol with the NSAID Diclofenac for analgesia in patients undergoing laparoscopic gynaecological surgery as day-care patients was compared with the standard inhalation anaesthetic technique, using a narcotic (Fetanyl) analgesia. The thirty-eight female patients studied were induced with Propofol (2.5 mg/kg-1) for muscle relaxation. Nineteen received Fentanyl (1-1.5 ægm kg-1) i.v. immediately prior to induction and anaesthesia was continued, using 50 percent nitrous oxide (2-1 min-1) in oxygen and Halothane (1-1.5 percent). The other nineteen received Diclofenac (75 mg i.m.) one hour before surgery and anaesthesia was continued with an infusion of Propofol, using an Ohmeda 9000 syringe pump at 12 mg. kg-1.h-1. Conditions for surgery were satisfactory in both groups and there was no signidicant difference in the degree of post-operative analgesia or the time to awaken under anaesthesia and all patients said they would be happy to have the anaesthetic technique used again. However, the total intravenous technique is expensive and therefore its use is recommended only when inhalation methods or the use of narcotics in undesirable (AU)

Inspiratory valve malfunction in a circle system: pitfalls in capnography

Capnography is a useful technique in monitoring the integrity of anaesthetic equipment such as the malfunctioning of unidirectional valves in circle system. However, the lack of a precise mechanism in existing capnographs to identify the start of inspiration and the beginning of expiration in the capnograms, makes the analysis of the carbon dioxide waveforms during inspiration difficult and thus results in inaccurate assessement of rebreathing. We report a case where, during the malfunction of the inspiratory unidirectional valve in the circle system, the capnograph failed to detect the presence of substantial rebreathing. Critical analysis of the capnogram recorded during the malfunction revealed that there was substantial rebreathing which was underestimated by the capnograph as it reports only the lowest CO2 concentration rebreathed during inspiration in such abnormal situations.(AU)

Anaesthesia without nitrous oxide

Nitrous oxide has a long history of successful use in inhalational anaesthesia. Nevertheless questions are being raised over possible deleterious effects which may complicate its routine use. As more potent volatile agents have become available, compressed air/oxygen mixtures are gradually replacing nitrous oxide as a carrier gas in inhalational anaesthesia. We recommend that compressed air be installed on all anaesthetic machines and that in future, machines be designed so as to make it impossible to administer both nitrous oxide and air simultaneously. (Summary)

The supply of oxygen to the Queen Elizabeth Hospital - abstract

The Queen Elizabeth Hospital gets its oxygen supplies as compressed gas in cylinders from the sole producer in Barbados. Expenditure on oxygen will have risen to B$500,000 per annum in 1988. The rising use and cost of oxygen, stimulated the Queen Elizabeth Hospital Administration to consider generation of its oxygen. A cost analysis revealed that by doing this, it may be possible to save B$250,000 in expenditure on oxygen annually. An oxygen concentrator was installed at the Hospital and put into use in November, 1988 (AU)

Propofol: a new intravenous anaesthetic

Propofol, a new intravenous anaesthetic induction agent, was evaluated on female patients undergoing short surgical procedures. The incidence of pain on injection, apnoea following injection, and the fall of systolic and diastolic blood pressure levels, was similar to that previously reported. There was no significant fall in pulse rate. The quality of anaesthesia during induction was good in all patients who reported they would be happy to receive the drug again (AU)

Should air-oxygen nitrous oxide-oxygen in general anaesthesia?

The use of compressed air-oxygen mixtures to replace nitrous oxide-oxygen in general anaesthesia was investigated in 378 patients. There were neither prolongations of recovery time nor instances of awareness under anaesthesia. The cost of general anaesthesia using compressed air-oxygen was about half that for nitrous oxide-oxygen mixtures.(AU)

Can compressed air/oxygen replace nitrous oxide/oxygen in general anaesthesia? a preliminary survey - abstract

The use of compressed air/oxygen mixtures to replace nitrous oxide/oxygen in general anaesthesia is investigated in 378 patients. There was no prolongation of recovery time nor instances of awareness under anaesthesia. The cost of general anaesthesia, using compressed air/oxygen mixtures was BDS$10.05 per patient while the cost of using nitrous oxide/oxygen mixtures was BD$20.11 per patient (AU)