During the last few years there have been many publications devoted to almost all aspects of cross-infection. Only a small proportion of these deal with anasthetic equipment and, in particular, little attention has been paid to masks, connecting pieces, corrugated tubing and the other parts of anzesthetic machines. In many hospitals little or no attempt is made to sterilise such equipment. We therefore decided to investigate the question of whether infection is likely to be spread by equipment of this type and if so, what steps should be taken to prevent this occurring. In this paper we describe our investigations and findings and also consider briefly the sterilisation of other apparatus used in inhalational anaesthesia.
METHODS OF STERILISATION AND DISINFECTIONWhenever possible physical methods of sterilisation should be used rather than chemical methods because chemical methods are much less reliable and often fail to achieve sterility1.2. This does not mean that there is no place for the use of chemical disinfectants and antiseptics; for many purposes other than the sterilisation of instruments and equipment they are invaluable and indeed essential394. There are several reasons for preferring physical methods. Tubercle bacilli and bacterial spores are highly resistant to most chemical agents and Pseudornonas pyocyanea is relatively resistant to the quaternary am-* This article contains the substance of two separate papers read before the
Numerous physical and psychiatric effects can be attributed to the cessation of psychotropic medications, similar to those agents with abuse potential. In addition, drug withdrawal can exacerbate underlying psychiatric conditions and alter disease course and long-term outcomes. This article discusses specific withdrawal syndromes associated with several classes of psychotropic medications to increase prescriber awareness when tapering and discontinuing psychotropic medications, thereby facilitating discussions with patients about the risks of withdrawal.
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Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinyl choline. Anesthesiology 1997; 87: 979-82. 4 Thwaites AJ, Rice CP, Smith I. Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation. Anaesthesia 1999; 54: 376-81. 5 McCourt KC, Salmela L, Mirakhur RK, et al. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia 1998; 53: 867-71. 6 Andrews JL, Kumar N, van den Brom RHG, Olkkola KT, Roest GJ, Wright PMC. A large simple randomized trial of rocuronium versus succinyl choline in rapidsequence induction of anaesthesia along with propofol. Acta Anaesthesiologica Scandinavica 1999; 43: 4-8. A reply Our objection to rocuronium for rapid sequence induction (RSI) is its prolonged duration of paralysis. The papers quoted by Dr Levy have shown that rocuronium provides intubating conditions similar to suxamethonium 1.0 mg.kg À1. The doses compared were 0.6 or 1.0 mg.kg À1 rocuronium and suxamethonium 1.0 mg.kg À1 [1, 2]. The relatively rapid recovery of
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