The effect of grade of anaesthetist on outcome after day surgery.

We conducted a retrospective survey to investigate if the grade of anaesthetist was a significant factor in determining outcome after day surgery in a district general hospital. All day surgery procedures performed between 1996 and 2006 were included except those under surgically administered local anaesthetic. The outcome measures assessed were unplanned admissions and symptoms reported after discharge. The overall admission rate was 2.6%, the admission rate for anaesthetic-related reasons was 1.5%, and 49% of patients reported some symptoms after discharge. Over the period studied the admission rate fell from 4.2% to 2.0%, admissions for anaesthetic-related reasons fell from 3.0% to 0.7% and reported symptoms fell from 67% to 37%. Consultants anaesthetists were associated with the lowest unplanned admission rate (consultants 2.3%, staff grade and associate specialists 3.1%, and trainees 3.3%), the lowest admission rate for anaesthetic reasons (consultants 1.2%, staff and associate specialists 2.0%, and trainees 1.8%), lower than expected specialty-weighted admissions and the lowest number of reported symptoms (consultants 47.3%, staff grade and associate specialists 52.6%, trainees 49.0%) (p < 0.001). We conclude that there was an improvement in outcome over the period of study and that the grade of anaesthetist is associated with outcome after day surgery.

LBNP and push-pull effect.

The high level of the long lasting acceleration with both an extensive gradient of the acceleration onset and vector alterations belong to the flight specificity in a cockpit of agile aircraft with high manoeuvring capabilities. In these cases the so-called push-pull (PP) effect has its particular significance. This means the tolerance decrease to the plus gravitational acceleration turns up after an exposure to the microgravity on the acceleration level between zero and +0.8 Gz or after previous action of negative acceleration values. The resulting activation of the sympathicus during plus gravitational acceleration process is up to several seconds behind time and pilot's performance is reduced. At the same time both an impairment of the threshold of the vision failure and G-LOC occur. The gravitational acceleration fatigue effect escalates, too.

A comparison of cyclizine and granisetron alone and in combination for the prevention of postoperative nausea and vomiting.

We conducted a randomised double-blinded study of 960 women undergoing day-case surgery to determine whether combination anti-emetic therapy of granisetron and cyclizine was more effective at decreasing the incidence of postoperative nausea and vomiting than these agents used alone. The women were randomly allocated to three groups to receive intravenous granisetron 1 mg, cyclizine 50 mg or both before induction of general anaesthesia. The incidence of postoperative nausea and vomiting was 77/322 (24%) in the granisetron group, 73/316 (23%) in the cyclizine group and 53/322 (17%) in those women given both drugs (p = 0.04). There was no difference in the requirement for rescue anti-emetic drugs. There were no differences in the anaesthetic techniques used in the three groups. We conclude that the risk of postoperative nausea and vomiting is less with cyclizine and granisetron given together than with either given alone.

Testing method of plus and minus Gz tolerance at Czech Air Force pilots.

Pilots' physiological measurement in conditions of alternating plus and minus Gz (gravitational acceleration) has been done during real flights. The comparison of physiological responses during flights at the safe altitude of 7000 ft and low level flights at the altitude of 900 ft over ground bears on the evaluation of changes of the continuous blood pressure and the heart rate. High level of pilots' plus-minus Gz tolerance is essential requirement to cope with low level flights in agile aircraft. It was proved that the sinusoidal profile during real flights is possible to use for pilots' tolerance to plus and minus Gz load evaluation. A system for the physiological signal acquisition in a cockpit of combat aircraft was developed for this purpose.

Physiological response of pilots to the LBNP-, flight-, and centrifuge load.

The possibility of the LBNP method's utilization at persons with low resistance of the cardiovascular system to the orthostatic load is a matter one of the research projects of IAM. We concentrated in previous stages our effort on an evaluation of basic physiological responses of the organism to this type of a load and on determination of reliable markers of the precollapse state. After analysis of results of examinations of 64 probands' set we defined qualifying criteria to the prediction for selection of individuals with the insufficient orthostatic resistance. Verification of experimental results by the comparison with well-established examination methods, during a real flight load and at the examination in a human centrifuge, is a goal of the following research activity. In current period of the task's solution the physiological response to an LBNP load has been compared with the physiological response to the load during real flight in an aircraft.

Physiological response of pilots to the load of lower body negative pressure.

The Czech Air-Force prepares an introduction of a new generation of aircraft with high maneuvering possibilities. The possibility of making full use of the aircraft flight properties assumes sufficient pilot's +Gz tolerance and also its improvement during the new flight training system. The optimal method to achieve this purpose is the human centrifuge utilization. For the Czech Republic, the building or the renting of a human centrifuge for the pilot's selection is unfortunately very expensive. In our institute we are interested in the analysis of the possibilities of the lower body negative pressure (LBNP) technique for the basic pilot's selection with low level of +Gz tolerance, using the examination of the orthostatic cardiovascular reactions of the pilot's organism.