Ether in the developing world: rethinking an abandoned agent.

BACKGROUND: The first true demonstration of ether as an inhalation anesthetic was on October 16, 1846 by William T.G. Morton, a Boston dentist. Ether has been replaced completely by newer inhalation agents and open drop delivery systems have been exchanged for complicated vaporizers and monitoring systems. Anesthesia in the developing world, however, where lack of financial stability has halted the development of the field, still closely resembles primitive anesthetics. DISCUSSION: In areas where resources are scarce, patients are often not given supplemental intraoperative analgesia. While halothane provides little analgesia, ether provides excellent intra-operative pain control that can extend for several hours into the postoperative period. An important barrier to the widespread use of ether is availability. With decreasing demand, production of the inexpensive inhalation agent has fallen. Ether is inexpensive to manufacture, and encouraging increased production at a local level would help developing nations to cut costs and become more self-sufficient.

[Impact of the decrease of nitrous oxide use on the consumption of halogenated agents]. / Impact de la diminution d'utilisation du protoxyde d'azote sur la consommation d'agents halogénés.

OBJECTIVE: Nitrous oxide (N2O) toxicity and its impact on pollution lead to restrict its use. A decrease of N2O consumption should increase the hypnotic inhaled consumption. This monocentric study estimated consumptions and costs of halogenated agents (HA) and N2O over 5 years when the N2O consumption was reduced. STUDY DESIGN: Retrospective from a computerized database. PATIENTS: Between 2006 and 2010, 34,097 procedures were studied after two meetings exposing the risks of the N2O. METHODS: At the end of anesthesia, consumptions of hypnotic agents (millilitres transmitted by the injectors and the blender) were archived in the database. The annual consumption of agents was obtained by adding the individual consumptions, then divided by the annual number of cases. The costs were given by the hospital pharmacy from invoices. RESULTS: N2O consumption per anesthesia constantly decreased during the study, from 75.1L by act to 22.7L. The sum of the annual consumptions of N2O and air did not change suggesting that total fresh gas flow remained stable. Between 2006 and 2010, the sevoflurane consumption by act increased by 25%, from 16.5 to 20.6mL, and desflurane consumption by 37%, from 46.1 to 63.1mL by patient. The costs of the administration of hypnotic agents remained stable. CONCLUSION: N2O consumption decrease had an impact on the consumption of HA. The cost reduction of the N2O was counterbalanced by the increase of halogenated vapor cost. The profit of the ecological impact of the reduction in N2O use could be quantified.

[Using nitrous oxide and oxygen with children during painful procedures]. / L'utilisation du méopa chez l'enfant lors d'un geste douloureux.

Introduced 20 years ago, the use of an equimolar mixture of oxygen and nitrous oxide with children as an analgesia during painful treatment is an effective and widespread practice. It represents a major advance in the quality of care. Its use must however be supervised and carried out by trained professionals.

Equipment and environmental issues for nonoperating room anesthesia.

PURPOSE OF REVIEW: The demand for anesthesia care outside the operating room continues to grow, driven by trends in advanced diagnostic techniques and the financial advantages of providing care out of the hospital setting. This review examines recent literature identifying new equipment and environmental issues that impact on nonoperating-room anesthesia care. RECENT FINDINGS: This review addresses the safety implications of the new high-field-strength (3 Tesla) magnetic resonance imaging scanners and also the differences in anesthesia delivery system design that influence the duration of function when only gas cylinders are available. SUMMARY: Practitioners who render anesthesia care outside of the operating room need to be cognizant of changing equipment design, which raises new challenges for rendering safe care.

[Total intravenous anaesthesia without medical gases during economic blockade of the country]. / Totalna intravenska anestezija bez medicinskih plinova u uvjetima ekonomske blokade zemlje.

In June and July 1992, when the corridor--through which we received the necessary medical supply--was closed, 61 patients (mostly wounded persons, 62%) underwent an urgent surgery. Because of the lack of oxygen and nitric oxydul, the patients were administered the intravenous total anaesthesia without medical gases. The control group was composed of 30 patients operated on in June and July 1991. The patients received Mydasolam (0.3 mg/kg) for general anaesthesia. Anaesthesia was maintained with Phentanil (15 mg/kg) and Alcurone (0.3 mg/kg). The control group was subjected to standard balanced anaesthesia (Thiopenton + nitric oxydul/oxygen + Halotin + Pancuron). The results of the two groups were compared. The observed, analysed and compared parameters were: the introduction period to anaesthesia, systolic blood pressure, diastolic blood pressure and time elapsed from the end of surgery to extubation. The introduction to anaesthesia was markedly unfavourable (p), the systolic and diastolic blood pressures, measured in five-minute intervals during anaesthesia, were significantly lower (p). The difference was especially great in the period from the end of surgery to the time of extubation: 73 +/- 12 minutes in the studied group, and 7 +/- 5 minutes in the control group. The method of total intravenous anaesthesia without medical gases satisfied our needs and expectations during the shortage of medical supplies. However, the standard balanced anaesthesia is a better method because it provokes a faster introduction to general anaesthesia, haemodynamic effects are less compromized, revival from anaesthesia is faster, the use of anaesthetics and equipment and engagement of the personnel are not great.