Naloxone reversal of meptazinol-induced respiratory depression. An investigation of the effect of naloxone on meptazinol-induced respiratory depression in anaesthetised.
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Biomedical subjects
Publications and source records attributed to M D Vickers.
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The short-term objective of the DHSS of a 1:1 consultant: junior ratio by 1988 is compatible with current trends in consultant expansion and implies no reduction in registrars before then. The target of doubling the number of consultants in 15 years cannot be met in anaesthesia without a fairly sharp, and relatively short-lived increase in senior registrar numbers. This has implications for planning in other specialties, particularly surgery. It seems prudent to assume the target will take longer than 15 years to achieve. Between 1988 and 2004 there would need to be a reduction of between one and two registrar posts per region per annum if the DHSS target of a consultant:junior ratio of 1.8:1 is to be met. Lesser reductions would be necessary if there were to be expansion of Hospital Practitioners in anaesthesia. No change in the number of senior registrar posts need be envisaged. If entry were properly controlled, the current number of registrar posts would be compatible with a viable career structure for British graduates.
A change in the ratio of trainees to consultants is necessary: despite being the agreed policy of the profession and DHSS, existing central planning machinery has failed to bring about its implementation. There is no reason to suppose that central methods can ever achieve the desired ends without intolerable constraints on the liberty of doctors. Freedom for individual groups of consultants to negotiate local changes in manpower coupled with inducements to both them and the authorities would seem to provide a promising approach that has not yet been adequately debated for explored. In the nature of it such an idea is unlikely to be attractive to central bureaucratic organisations, whether governmental or professional.
Meptazinol and pethidine were compared under double-blind conditions in 20 patients, using an on-demand analgesic system to provide pain relief after upper abdominal surgery. The degree of analgesia, subjectively assessed, was good with both meptazinol and pethidine; although meptazinol produced significantly more nausea than did pethidine (P less than 0.01), there was no statistically significant difference in the frequency of other side-effects. Over 24 h average consumption of meptazinol was 2.4 times that of pethidine, suggesting that, when given by i.v. injection, meptazinol is less potent that pethidine.
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In a double-blind study of on-demand intravenous analgesia buprenorphine was found to be about 600 times as potent as pethidine. The incidence of side effects was similar with both drugs. The quality of analgesia, subjectively assessed, was good with both drugs using this method of administration. Provided that its low potential for abuse is substantiated, buprenorphine appears to be a powerful analgesic that may successfully be given intravenously on demand.
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Three comparable groups of surgical patients were given nefopam 0.2 mg kg-1 or 0.4 mg kg-1 or morphine 0.15 mg kg-1 for pain relief after operation. Nefopam 0.4 mg kg-1 was equi-analgesic with morphine 0.15 mg kg-1 and produced no obvious cardiovascular or respiratory side-effects.
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A high degree of safety from fires and explosions exists in operating theatres in the U.K. and this is reflected in the extremely low number of fatal and non-fatal accidents which occur. This has been achieved by safety precautions which in some respects have been over-careful and overexpensive. Antistatic precautions applied to the breathing circuit seem to have been the crucial factor in achieving this level of safety.
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The Cardiff Aldavac system consists of a reservoir, adsorption canister, flow restrictor and the necessary pipe connections. It enables theatre pollution control without structural alteration or special installation. It utilizes the hospital piped medical vacuum system but protects the system from excessive flows or contamination by volatile anaesthetics and still allows the vacuum to be used for other purposes.
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In the general euphoria over the many views in the Merrison Report that the profession welcomed too little attention has been paid to what has been said about specialist registration. The report contains several basic confusions and a serious misunderstanding of the nature of specialist medical training and practice. It makes several cardinal errors in thinking that some notorious problems related to NHS staffing are also related to a lack of an effective specialist register, and it shows how the creation of such a register would largely destroy the authority of the colleges and faculties. Nowhere in the report is there any convincing argument to show that specialist registration would confer advantages sufficient to outweigh the disadvantages. To let specialist registration in the UK slip in on the irrelevant coat tails of EEC requirements would be a grave dereliction of the long-term interests of medical practice and patient care. The General Medical Council is holding a conference in which this topic is to be discussed on 24 February 1976 and it is still not too late for the profession to think again on this topic.