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4.  Policy for controlling pain after surgery: effect of sequential changes in management. 
BMJ : British Medical Journal  1992;305(6863):1187-1193.
OBJECTIVE--To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital. DESIGN--A study in seven stages: (1) an audit of current hospital practice succeeded by the sequential introduction to the general surgical wards of (2) pain assessment charts; (3) an algorithm to allow more frequent use of intramuscular analgesia; (4) increased use of local anaesthetic techniques of wound infiltration and nerve blocks; (5) an information sheet for patients about postoperative pain; (6) the introduction of patient controlled analgesia; (7) a repeat audit of hospital practice. Data were collected on each patient 24 hours after operation. SETTING--University Hospital of Wales, which has both district general and tertiary referral functions. PATIENTS--2035 patients over nine months from all surgical specialties (excluding cardiac) at the hospital. General surgical operations were studied in detail and separated into major, intermediate, and minor for data collection. MAIN OUTCOME MEASURES--A change in the median visual analogue pain scores 24 hours after surgery for pain during relaxation, pain on movement, and pain on deep inspiration at each stage of the study. RESULTS--There was a reduction in median visual analogue scores during the study. The median (95% confidence interval) scores for pain during relaxation decreased from 45 (34 to 53) in stage 1 to 16 (10 to 20) in stage 7 for major surgical procedures. Pain on movement decreased from 78 (66 to 80) to 46 (38 to 48), and pain on deep inspiration decreased from 64 (48 to 78) to 36 (31 to 38). The reductions in median scores for intermediate and minor operative procedures showed similar patterns. CONCLUSIONS--The introduction of an acute pain service to the general surgical wards led to considerable improvement in the level of postoperative pain as assessed by visual analogue scores. Simple techniques of regular pain assessment and the more frequent use of intramuscular analgesia as a result of using an algorithm were particularly effective.
PMCID: PMC1883782  PMID: 1467721
5.  Anaesthetic awareness. 
BMJ : British Medical Journal  1990;300(6729):938.
PMCID: PMC1662642  PMID: 2337720
9.  Degree and Duration of Reversal by Naloxone of Effects of Morphine in Conscious Subjects 
British Medical Journal  1974;2(5919):589-591.
The effects of intravenous naloxone on several of the actions of intravenous morphine (mean dose 30 mg/70 kg) were studied in six volunteer subjects. Naloxone produced a well defined reversal of the respiratory depression, analgesia, and miotic and subjective effects of the morphine. The agonist action of morphine outlasted the antagonist action of a single dose of naloxone. The effect of repeated doses of naloxone was also short-lived, but continuous infusions were effective in maintaining reversal.
PMCID: PMC1610781  PMID: 4833964
10.  College of anaethetists. 
British Medical Journal  1972;3(5824):468-469.
PMCID: PMC1785981  PMID: 5069227
11.  Pain relief for crushed chests. 
British Medical Journal  1968;2(5608):828.
PMCID: PMC1991617  PMID: 4872851
12.  Recovery from anaesthesia. 
BMJ : British Medical Journal  1994;308(6932):804.
PMCID: PMC2540027  PMID: 8167484
13.  Reporting to NCEPOD. 
BMJ : British Medical Journal  1992;305(6847):252.
PMCID: PMC1882709  PMID: 1392839
14.  Heat Losses from a Breathing System with a Heated-water Humidifier 
British Medical Journal  1971;4(5788):653-656.
Air was “breathed” in the laboratory through a heated-water humidifier and a breathing tube. Several different humidifiers and tubes were used. The temperature rise of the air on passing through the humidifier and the temperature drop on passing through the tube were measured. Both were dependent on ventilation. Insulating the tube and humidifier together with the insertion of baffles in the latter reduced the rise and fall and their dependence on ventilation. With suitable design the dependence on ventilation and the need to use high water temperatures could be greatly reduced. In addition, a thermostat with a reduced dead zone is needed.
PMCID: PMC1799869  PMID: 5289685
15.  Anaemia and Surgery 
British Medical Journal  1970;3(5714):71-73.
In 1,584 patients who had received an anaesthetic the association was examined between circulating haemoglobin level and the postoperative course (length of hospital stay, the occurrence of a complication, and death). In men a significant association (P<0·05) was found for each index, but in women this was present only for death.
It is suggested that the hypothesis which best explains the associations, and is consistent with further analyses of the data, is that the preoperative haemoglobin level reflects the severity of the underlying condition which has necessitated surgery. A randomized clinical trial would test the alternative hypothesis that anaemia constitutes an additional risk in surgical procedures.
PMCID: PMC1701029  PMID: 5428779
16.  The Anaesthetist and Intensive Care 
British Medical Journal  1969;2(5658):683-684.
Intensive care and its development is part of an evolutionary process in the general organization of hospital medical practice. No new disease process is involved, and this alone should be sufficient to support our view that intensive care does not call for the creation of a new specialty. The experience, skill, and knowledge of anaesthetists qualify them to fill vital roles in intensive care, but it is of paramount importance that in doing so they should neither neglect nor abdicate from their own special field of medical work from which their unique expertise derives.
PMCID: PMC1983656  PMID: 5783127

Results 1-16 (16)