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PubMedDate not supplied

Local anaesthesia in the operating theatre.

Cocaine was the first drug to be used as a local anaesthetic. It was introduced into medicine in 1884 by Koller. Other drugs soon followed, for example, ethyl chloride spray, tropocaine, eugenol (oil of cloves) and Nupercaine. A wide range of uses for local anaesthetics soon developed and the term 'regional anaesthesia' was first used by Cushing in 1901 to describe pain relief by nerve blockade. Local anaesthetic drugs are water soluble salts of lipid soluble alkaloids. Each molecule is composed of an aromatic portion, intermediate chain and an amide portion. The portions are joined by either amide or ester linkages. Ester-linked drugs are hydrolysed in the plasma by plasma cholinesterase and their half-life varies from one to eight minutes. Amide-linked drugs are degraded by oxidative dealkylation in the liver. The half-life of these drugs varies from 1.5 to more than three hours. The addition of a vasoconstrictor, such as adrenaline, will prolong the duration of action of both the amide- and ester-linked drugs. Degradation of the amide-linked drugs depends on factors such as hepatic blood flow and liver conditions, such as cirrhosis, and congestive cardiac failure. Anaphylactic reactions are more common with ester-linked drugs than amide-linked drugs. The drugs are usually available for injection as hydrochlorides in a salt solution with small amounts of fungicides or preservatives added to give stability.

Anesthetics, Local↗
PubMedDate not supplied

The computer-oriented paperless operating room.

1. As the need for faster data entry and extrapolation increased at Hinsdale Hospital, several problems were identified with the paper system: It was slow, cumbersome, and inaccurate. This was particularly evident in patient scheduling, patient billing, and inventory control. Hinsdale decided to work toward total computerization of patient charting, billing, scheduling, and supply management. 2. After months of research, countless site visits, and interviews with software representatives, Hinsdale selected a Minneapolis-based software company. The software package that was implemented was composed of five modules: Surgery Scheduling, Personnel, Supply, Dynamic (Broadcast), and InterOperative (Patient Charting). 3. Computerization demands both time and patience by all involved--in both the decision process and the physical installation. There is no blueprint available to make this process an easy one. However, there are resources and consultants that can and should be used.

Computers↗
PubMedDate not supplied

Postoperative pneumonia.

1. Postoperative nosocomial (hospital-associated) pneumonia is among the most serious complications of surgery. The mortality from these pneumonias is 30%, even with treatment with appropriate antibiotics. 2. The incidence of pneumonia in patients on ventilators averages 14 times that of patients not receiving mechanical ventilator support. These pneumonias are a major factor in the deaths of patients using ventilators. The design and necessary functions of ventilators contribute to bacterial colonization of the machinery, airway, and lungs. Burn patients also represent a particularly vulnerable group in relation to nosocomial pneumonia. 3. Health care workers can introduce organisms from the environment or the patient in the next bed by neglecting handwashing between patients. Some health care professionals think it is not necessary to change the gloves that protect them from bloodborne pathogens when moving between patients. Such erroneous beliefs add significantly to the patient's bacterial colonization, often with treatment-resistant organisms.

Aged↗
PubMedDate not supplied

A tuberculosis outbreak from a patient's draining lesion: how did it happen?

1. Mycobacterium tuberculosis can be transmitted from a pulmonary source when droplet nuclei in the 1 to 5 micron range are generated by coughing, singing, or even talking. 2. It is possible for large numbers of droplet nuclei containing M tuberculosis bacteria to be generated during the surgical drainage, débridement, and syringe irrigation of abscesses caused by M tuberculosis. These procedures can produce such a high concentration of droplet nuclei that the ventilation system cannot remove them fast enough to protect the surgical staff from infection. 3. The unrecognized case of tuberculosis is much more likely to be the source of transmission of M tuberculosis than is the individual who has a diagnosis of TB or "rule-out TB." This is because once a diagnosis is known or suspected, interventions are initiated that make the patient less infectious.

Abscess↗
PubMed1996

The operating room of the future.

As more and more care moves to the home setting, the ability to undergo a surgical procedure from the comfort of your own home may not be that far away. As for the operating room itself, patient care will be radically different than it has been in the past. Radiologists, assisted by computers and robots, may be performing procedures on patients "anesthetized" by acupuncture, therapeutic touch and aromatherapy in a totally bloodless environment.

Forecasting↗