Anaesthetists expend a great deal of professional care on vocal cords. These delicate structures are positioned at the entry to the trachea and lungs; they vibrate to produce sound during speech and singing.
During spontaneous breathing the cords are open and they close during straining. For some operations, anaesthetists pass a tube through the vocal cords in order to control breathing.
This video shows the cords in action during singing…(produced and directed by Sara Lundberg)
In October 2013, the Australian Society of Anaesthetists hosted their annual National Scientific Conference right here in Canberra. Many of Canberra’s anaesthetists were involved in the organising of what turned out to be an very successful meeting of anaesthetists from all over the world.
Amongst the invited international speakers at the meeting was Professor Mike Grocott (http://www.youtube.com/watch?v=rciZliQWvWs) who has recently published a review “Oxygen therapy in Anaesthesia” in the British Journal of Anaesthesia {BJA 2013;111(6):867-871}. Prof Grocott has published widely on his research interests relating to oxygenation and he is director of the Xtreme Everest programme of hypoxia research (studying the effects and responses to low levels of oxygen at altitude).
Anaesthetists spend most of their clinical lives in anaesthesia serving the goal of delivering adequate amounts of oxygen to tissues and vital organs. We do that by making sure that the heart pumps enough blood with enough oxygen carrying red cells around the body.
The BJA review challenges the view that if some oxygen is good, more must be better. The goal should be to deliver the right amount, to the right patients at the right time.
That thesis makes as much sense from a health economic viewpoint as from a physiological one. We follow the same plan when delivering anaesthesia agents – some patients want “the lot”. What we actually do is titrate the drugs that we use to their effects or other end-points: not too little, not too much…just enough.
Pain relief for the opioid intolerant patient
One of the suggestions regarding the publication of the website was to have a “recent events” section within the website in the format of a blog. Here it is.
My recent reading has been around the subject of analgesia (pain-relief) for the opioid-intolerant patient. That is, how to formulate postoperative analgesia plans for patients who cannot take morphine or morphine-like medications. Usually, the intolerance is linked to nausea and vomiting.
The consensus (the actual evidence is not great) is that a combination of drug and non-drug approaches help. That is the way all pain-relief plans are formulated. As far as medications go: changing routes of administration, changing to controlled release preparations and choosing medications from different classes are all reasonable approaches.
It is probably unrealistic to promise an specific outcome in terms of pain relief after an operation or procedure. The only guarantees should be that the basis of recommendations will be good evidence (where that exists) and safe practice. The other aims should be to continue to be available to offer options that are reasonable and to see issues through as they arise.