The art of providing anaesthesia in Greek mythology.

We endeavored to thoroughly review Greek mythology and collect tales dealing with anaesthesia and myochalasis (paralysis). Among the evaluated sources were the poems of Hesiod, the epics of Homer, the tragedies of the great Athenian poets (namely Aeschylus, Sophocles and Euripides) as well as the contributions of several Latin writers, including Ovid. We found several examples of achieving hypnosis, analgesia and amnesia through the administration of drugs (inhaled or not) and music. Adverse events of drugs used for this purpose, such as post-anaesthetic emergence delirium, hallucinations, respiratory arrest and penis erection, were described in the presented myths. We noted that providing sleep was considered a divine privilege, although several mortals (mainly women) exhibited such powers as well. The concepts of sleep and death were closely associated in ancient classical thought. This review may stimulate anaesthetists' fantasy and may help them realise the nobility of their medical specialty.

Attributable mortality of ventilator-associated pneumonia: a meta-analysis.

OBJECTIVE: To investigate whether ventilator-associated pneumonia (VAP) is a true cause of mortality in the intensive care unit setting. METHODS: We performed a meta-analysis of available data without time restrictions. A conservative random effects model was employed to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Of 968 retrieved reports, 44 studies fulfilled our inclusion criteria. Presence, as opposed to absence, of VAP was associated with higher mortality in the ICU setting (OR 1.96, 95%CI 1.26-3.04). This result persisted when matched case-control studies (OR 1.73, 95%CI 1.23-2.45) or studies in which VAP was microbiologically confirmed in all patients (OR 2.20, 95%CI 1.01-4.81) were evaluated separately. VAP continued to be associated with higher mortality when the impact of immune suppression was controlled. VAP was not associated with higher mortality in the subgroup analysis of studies including patients who received appropriate initial antimicrobial treatment (OR 1.64, 95%CI 0.68-3.96). CONCLUSION: Presence, compared to absence, of VAP seems to be associated with higher mortality in critically ill patients. Appropriateness of initial antimicrobial treatment in such patients may moderate this association.