For the past fifteen months, I have been attached to the Third Australian General Hospital as Anaesthetist, and now record my experiences gleaned from somewhere over a thousand cases of anaesthesia in war surgery. I may conveniently divide up the time in question into three equal periods of four months each. During the transfer of the hospital from England to France, and its subsequent establishment as a base hospital on the lines of communication, no surgery was possible for a period of about three months. During my first four months with this unit we existed as a General Hospital at Brighton in England, where practically all our patients arrived from the Base Hospitals in France. From the end of July to the end of November, 1917, I was attached to a Casualty Clearing Station in Flanders, where I gave anaesthetics for one of our own hospital surgeons, working together as "a team" all through the Flanders offensive. There remains a period of four months during which I have either been giving anaesthetics or instructing others in their use, at our Base. Although it is not my intention to quote figures extensively, it may be of interest to give the number of anaesthetics given by me in those three periods. I find at Brighton I gave just under 300 anaesthetics. At the Casualty Clearing Station (c.c.s.) exactly 660. At the Base Hospital upwards of 150, so that my experience of war anaesthesia is derived from a variety of operations in 1100 cases. In considering the experience gained by those anaesthetics, I think my object will be best attained by considering.- 1. The type of Patient. 2. The type of Anaesthetic given. 3. The type of wound and operation for which the anaesthetic was required.

We recognise consciousness in ourselves and in those around us. Consciousness is the essence of our existence, who and what we are, but we are willing and able to let go of it daily during sleep, which we welcome and associate with rest, recovery and well being, knowing that consciousness will return reliably, when we are ready. Yet we cannot define this thing or process which makes us "us". We do not understand how it is constructed from the activity in our brains, how it is deconstructed by sleep, drugs or disease, or how it can be reconstructed by waking or recovery. Our ignorance renders us reliant on inadequate means of measuring consciousness, dependent on movement for its detection. Propofol is an intravenous anaesthetic drug with the capacity to safely, rapidly and reliably produce sedation and anaesthesia, providing an ideal model of unconsciousness for study. Functional magnetic resonance imaging (fMRI) provides a non-invasive means of measuring activity within the brain. EEG is a convenient broad measure of neuronal activity. This thesis exploits the advantages of each of these techniques, fMRI and EEG, first separately and then together, to link highly informative, spatially specific fMRI observations to convenient, reproducible electrophysiological surface measurements. A safe and reliable model of unconsciousness suitable for fMRI interrogation is first developed and explored. Changes in the spatial extent and interregional correlation of neuronal activity when subjects become unresponsive show that the functional connectivity of the striatum is specifically impaired as perception fails. Disruption of the brain’s internal temporal frame of reference impairs the synthesis of perceptions from their fragments. The second experimental chapter specifically examines the behaviour of sleep oscillations during ultraslow increases and decreases in the depth of sedation with propofol. Functional activity shows that the brain is intensely active despite loss of consciousness and reveals measurable transitions in neuronal activity. Combined simultaneous EEG/FMRI then shows that these transitions reflect stepwise changes in the processing of experience and a shift from externally modulated thalamocortical signaling to an internal dialogue.

M.Med.(Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2011 / BACKGROUND Multiple studies have been conducted comparing the efficacy and duration of analgesia obtained from spinal anaesthesia containing local anaesthetics as well as opioids. The literature available has not considered the individual‟s HIV status as a variable. Postoperative analgesic duration and requirements in this group of patients may differ due to the occurrence of acute and chronic pain syndromes, pain arising from the disease itself, side effects of treatment for HIV infection, or opportunistic infections. Response to opioid analgesia may be altered due to previous opioid exposure, potential increase in nociception, drug interactions and emotional status. OBJECTIVES The primary objective of this study was to determine the time to post-operative analgesic request in HIV-positive and negative individuals having caesarean sections under spinal anaesthesia containing bupivacaine or bupivacaine and fentanyl. The secondary objectives of this study were to determine if factors such as height, ethnicity, level of education, CD4 count, and antiretroviral therapy impacted on the duration of analgesia obtained.

M.Med.(Anaesthesia), Faculty of Health Sciences, University of the Witwatersrand, 2008 / BACKGROUND HIV infection is common in South Africa. The disease often remains clinically latent, despite the patient having severe immune compromise. Clinical preoperative assessment may result in patients with this severe systemic disease going unnoticed. OBJECTIVES The primary objective was to determine the relationship between the preoperative physical status of HIV-positive patients presenting for anaesthesia and the CD4- count. The secondary objectives were to determine the prevalence of HIV infection in this group of patients, to determine the prevalence of HIV infection in selected subgroups, to ascertain what proportion of patients presenting for anaesthesia know their HIV status, and to ascertain what proportion of HIVpositive patients are receiving highly active antiretroviral therapy (HAART). METHOD A sample of 350 adult patients presenting for anaesthesia at Chris Hani Baragwanath Hospital was selected. Patients were interviewed preoperatively and were examined, and in doing so their ASA physical status grading was determined. Blood was sampled, and in those who were confirmed HIV-positive, vi a CD4-count was checked. Further data were collected: age, gender, the type, nature, urgency and time of day of surgery, the patient’s knowledge of their HIV status, and whether the patient was receiving HAART or not. RESULTS HIV-positive patients were more likely to be classified as ASA 1 or 2 than ASA 3 or 4 (OR 2.1). HIV-positive patients with CD4-counts above 200 cells.mm-3 were also more likely to be ASA 1 or 2 than ASA 3 or 4 (OR 3.88). However, within the group of HIV-positive patients with CD4-counts below 200 cells.mm-3, significantly more patients were classified as ASA 1 or 2 than ASA 3 or 4 (p<0.0001). Three patients with CD4-counts below 50 cells.mm-3 were classified as ASA 1 or 2. The overall prevalence of HIV infection was 29.4%. Within the various subgroups, the groups with higher disease prevalence rates were females, patients presenting for obstetric surgery, and the younger age groups. The highest prevalence of HIV infection was found in patients aged 30-39 years (43.0%), and the lowest prevalence was found in patients aged 60 years or older (7.7%). CONCLUSIONS Routine clinical preoperative assessment in patients from a population with a high HIV prevalence rate may result in asymptomatic, severe immune compromise secondary to HIV infection being missed in a significant number of patients. Further study into the perioperative outcomes of these patients is warranted.

No description available.

Diss. (sammanfattning). Uppsala : Sveriges lantbruksuniv. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Sveriges lantbruksuniv., 2004. / Härtill 6 uppsatser.

Made available in DSpace on 2014-06-11T19:31:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-03-09Bitstream added on 2014-06-13T19:01:29Z : No. of bitstreams: 1 conceicao_edv_dr_jabo.pdf: 517707 bytes, checksum: 5bc1ab6d19256b698bccf00abaf5611c (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Avaliaram-se os efeitos da infusão contínua de propofol em associação ao fentanil ou sufentanil sobre a hemodinâmica, eletrocardiografia e índice biespectral em cadelas submetidas à ovariosalpingo-histerectomia. Para tal, foram utilizadas 20 cadelas hígidas, induzidas à anestesia geral com 10 mg/kg de propofol. Após a intubação com sonda orotraqueal de Magill, receberam suporte ventilatório com oxigênio a 100% e fluxo de 15 mUkg/min em circuito fechado, ciciado no modo pressão controlada, mantendo-se a ventilação a pressão positiva intermitente. A manutenção anestésica foi realizada com a administração de O,4mglkglmin de propofol e foram distribuídos em dois grupos de 10 animais que receberam 5J,lglkg de fentanil (GPF) ou 1J,lg/kg de sufentanil (GPS) por via intravenosa, seguida de infusão contínua... / Possible effects of the continuous infusion of propofol associated with fentanyl or sufentanil on haemodynamic, blood gas analysis, electrocardiography and bispectral index in female dogs, submitted to the surgical procedure of ovariosalpingohysterectomy, were evaluated. Twenty healthy female dogs were used and general anesthesia was induced with 10mglkg of propofol. They received ventilatory support with 100% oxygen and a 15 mUkg/min flow in a cIosed circuit, cycled with controlled pressure. Ali animais were submitted to total intravenous anesthesia with propotol (O.4mg/kglmin) and distributed in two groups of ten animais each one. They received 5J.1glkg of fentanyl (GPF) or 1J.1g1kg of sufentanil... (Complete abstract click electronic access below)

Många patienter upplever oro inför anestesi och kirurgiska ingrepp. Detta har negativa effekter även på den postoperativa vården. Dagligen träffar anestesisjuksköterskor patienter inför anestesi och gör preoperativa bedömningar. Då forskning tydligt visar på hög grad av oro hos patienter känns det viktigt att granska och belysa detta. Syftet var att granska och sammanfatta forskningsresultat som belyser patienters oro inför anestesi. Detta examensarbete är en integrativ litteraturstudie. Forskning visar att olika interventioner har effekt på patienters oro, både farmakologiska och icke-farmakologiska. Att patienten får tydlig information kring ingrepp och anestesi samt träffar anestesisjuksköterska i god tid innan ingreppet har positiv påverkan på patienters oro. Andra interventioner såsom musikterapi, akupressur och reflexologi har också positiv påverkan på oro.

Knowledge of the absorption of inhalation anaesthetic agents is essential if one is to safely administer them. Despite many years of research in linear science, no model has been described that can reliably predict inhalation agent uptake. To date no published investigation has looked for non¬linearity in the absorption process. The aim if this research project was to determine if the absorption of anaesthetic agents is non-linear, using isoflurane and enflurane as examples. To detect non-linearity, four conditions must be met: <ul> <li>Sensitivity to initial conditions, </li> <li>Fractal Dimension of the attract or, </li> <li>Invariant probability distribution of the attractor, and</li> <li>Detection of an underlying dynamical process. <br></li></ul> Ten measured time series for both isoflurane and enflurane absorption were measured. These were then compared with ten noise signals, with similar standard deviations, means and number of points in the series. Calculated Lyapunov exponents tested sensitivity to initial conditions. The dimension of the attractor was calculated using the following statistics, each giving an approximation of the fractal dimension. Approximate entropy, information entropy, correlation dimension and fractal dimension (box counting method). The Invariant probability distribution of the attractor was tested for using non-linear forecasting. Detection of an underlying dynamical process was determined by the method of surrogate data. Each of the four conditions required have been met with statistical significance ( p< 0.05) and acceptable statistical power (>0.8). It is therefore concluded that the absorption of both isoflurane and enflurane are non-linear processes. The implications and implementations in anaesthesia practice are discussed. / Thesis (PhD (Anaesthesiology))--University of Pretoria, 2005. / Anaesthesiology / unrestricted