Education and training for intensive therapy in the United Kingdom.
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Biomedical subjects
Publications and source records attributed to S M Willatts.
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An etomidate infusion was used to anaesthetise twelve patients for spinal surgery; six (group I) with 67% nitrous oxide and six (group II) with oxygen enriched air. Anaesthesia was induced with infused etomidate at a rate of 100 micrograms/kg/minute for 10 minutes and maintained at a rate of 10 micrograms/kg/minute. Recovery was assessed as the time to opening eyes on command (t1) and the time to giving correct date of birth (t2). In group I, mean value for t1 was 37.9 minutes and t2 59.1 minutes which is significantly longer than in group II where mean value for t1 was 9.0 minutes and t2 15.1 minutes. Blood was taken for estimation of etomidate levels. In group I the maintenance level was 501 ng/ml and the plasma clearance 20.9 ml/kg/minute. In group II the maintenance level was 367 ng/ml and plasma clearance 27.3 ml/kg/minute. Etomidate infusion appears to be a suitable alternative for neuroanaesthesia when nitrous oxide is contra-indicated.
It is very rare for disturbances of water balance to occur as isolated phenomena. More commonly, mixed electrolyte abnormalities present. However, to permit the logical application of therapy an understanding of basic water balance in health and disease is essential.
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A questionnaire was sent to senior registrars in General Medicine and Anaesthesia enquiring into the amount of training they received in Intensive Therapy and their attitudes to this in the light of their expectations for a consultant post. The results suggest that training is inadequate and that trainees are dissatisfied with the current situation.
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A case of pregnancy complicated by malignant hyperthermia susceptibility is reported. Serum CPK and electrolyte concentrations were measured during pregnancy and labour. Labour and delivery were managed successfully under epidural analgesia using plain bupivacaine 0.5%.
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