Assuntos
Analgesia/história , Dor Pós-Operatória/história , Transtornos Respiratórios/história , Analgesia/efeitos adversos , Analgesia Epidural/história , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/história , Bupivacaína/efeitos adversos , Bupivacaína/história , História do Século XX , Humanos , Morfina/efeitos adversos , Morfina/história , Dor Pós-Operatória/tratamento farmacológico , Transtornos Respiratórios/etiologiaRESUMO
From its introduction in 1847, chloroform proved to be a potent anaesthetic agent and over the next 50 yr its use became widespread. However, in 1912 the Committee on Anaesthesia of the American Medical Association stated that they were concerned with the occurrence of delayed chloroform poisoning in a number of cases. This conclusion was based on case reports and experimental animal data. However, subsequent studies and reported series of chloroform anaesthesia in humans have suggested a lower incidence of clinically significant liver injury. In this article we have investigated this discrepancy by analysing the published clinical data relating chloroform anaesthesia to liver damage.
Assuntos
Anestésicos Inalatórios/história , Clorofórmio/história , Hepatopatias/história , Anestesia por Inalação/história , Anestésicos Inalatórios/intoxicação , Doença Hepática Induzida por Substâncias e Drogas , Clorofórmio/intoxicação , Ensaios Clínicos Controlados como Assunto/história , História do Século XIX , História do Século XX , Humanos , Prontuários Médicos , Fatores de TempoAssuntos
Anestesia Geral/efeitos adversos , Doenças do Sistema Nervoso Central/diagnóstico , Antagonistas Colinérgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Doenças do Sistema Nervoso Central/induzido quimicamente , Inibidores da Colinesterase/uso terapêutico , Diagnóstico Diferencial , Humanos , Fisostigmina/uso terapêutico , SíndromeRESUMO
Patients undergoing anaesthesia in which halothane, enflurane or isoflurane were used, were surveyed with reference to 16 unwanted effects selected by the nominal group method. A simple record card was completed at the time of anaesthetic administration. The overall incidence of complications was 13.9%. One complication was reported in 10.8% of the cases, and more than one in 3.1%. Complications were more frequent in the obese, the elderly and those patients receiving isoflurane, but in view of the small overall use of this agent, the anaesthetists involved may still have been on a learning curve.
Assuntos
Anestesia por Inalação/efeitos adversos , Complicações Intraoperatórias/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Anestesiologia , Criança , Estudos Transversais , Enflurano/efeitos adversos , Halotano/efeitos adversos , Humanos , Isoflurano/efeitos adversos , Auditoria Médica , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
We have investigated the possible toxicity of nitrous oxide on vitamin B12 and its sequelae upon folic acid metabolism using the urine formiminoglutamic acid excretion test, an index of the functional state of folate metabolism. Ten control subjects not exposed to nitrous oxide and five patients receiving limb surgery under local anaesthesia excreted normal amounts of formiminoglutamic acid in urine for 6 days. Fifty patients received nitrous oxide anaesthesia for similar surgery and, of these, 22 had a dose-dependent increase in excretion on the first 2 days after operation. There were large individual variations. Exposure to 70% nitrous oxide appeared to cause abnormal metabolism of folate when exposure was greater than 90 min. Ten anaesthetists demonstrated normal excretion of formiminoglutamic acid; their exposure to nitrous oxide was typical of that in other studies of theatre environmental pollution.
Assuntos
Anestesia por Inalação , Deficiência de Ácido Fólico/induzido quimicamente , Óxido Nitroso/efeitos adversos , Exposição Ocupacional , Procedimentos Cirúrgicos Operatórios , Adulto , Teste de FIGLU , Humanos , Pessoa de Meia-IdadeRESUMO
I.m. ketorolac trometamol 30 mg was compared with morphine sulphate 10 mg after cholecystectomy in a double-blind, multiple dose, randomized study of 100 patients. Assessments of pain were made immediately after operation (day 1), and the next morning (day 2). Pain intensity (verbal response score and visual analogue scale) was recorded before injection and then over a 6-h period. Pain relief was assessed also. The effect of ketorolac on operative blood loss and platelet function was examined. Time to commencing oral intake and the duration of administration of i.v. fluids were recorded. Adverse events were noted. Ketorolac produced significantly less analgesia than morphine on day 1, but on day 2 the two drugs produced a similar effect. Blood loss was not increased by ketorolac, although platelet function was impaired. Repeated i.m. administration of ketorolac did not produce any serious adverse effects.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Tolmetino/análogos & derivados , Trometamina/uso terapêutico , Tempo de Sangramento , Perda Sanguínea Cirúrgica , Colecistectomia , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Humanos , Injeções Intramusculares , Cetorolaco de Trometamina , Masculino , Pessoa de Meia-Idade , Morfina/farmacologia , Medição da Dor , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária , Fatores de Tempo , Tolmetino/efeitos adversos , Tolmetino/farmacologia , Tolmetino/uso terapêutico , Trometamina/efeitos adversos , Trometamina/farmacologiaRESUMO
All 484 candidates for the 1988 Fellowship in Anaesthesia (Part Three) were surveyed to investigate any differences between successful and unsuccessful candidates in study techniques, work and domestic factors, and examination history that might lead to better guidance to those preparing for the examination and an improvement in the current success rate of less than 30%. Candidates' views were sought also on the examination process. The response rate was 67%. Forty-two percent of respondents passed the examination. Forty-seven percent of successful and 55% of unsuccessful candidates considered their clinical workload was excessive. Successful candidates reported better departmental support, more systematic and adequate preparation, and a better knowledge of the scope of the examination. Unsuccessful candidates were more likely to have had a personal or family crisis or change in job which impeded their preparation for the examination. Almost 50% of all respondents were unhappy with the method of announcing results.
Assuntos
Logro , Anestesiologia/educação , Educação de Pós-Graduação em Medicina , Avaliação Educacional , Adulto , Atitude do Pessoal de Saúde , Inglaterra , Feminino , Humanos , Masculino , Sociedades Médicas , TrabalhoRESUMO
In an open sequential pharmacodynamic study in 40 patients, the rate of onset of neuromuscular blockade using tubocurarine or vecuronium was measured. Comparison was made between groups of 10 patients who received thiopentone followed by either blocker and a "reverse" sequence where the blocker was injected before thiopentone. There was a small difference between groups, amounting to a few seconds in rate of onset of block, but this was not suggestive of a systematic effect of the drug sequence.