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Anaesthesia

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https://www.readbyqxmd.com/read/28547753/the-cost-effectiveness-of-patient-controlled-analgesia-vs-standard-care-in-patients-presenting-to-the-emergency-department-in-pain-who-are-subsequently-admitted-to-hospital
#1
C Pritchard, J E Smith, S Creanor, R Squire, A Barton, J Benger, L Cocking, P Ewings, M Rockett
The clinical effectiveness of patient-controlled analgesia has been demonstrated in a variety of settings. However, patient-controlled analgesia is rarely utilised in the emergency department. The aim of this study was to compare the cost-effectiveness of patient-controlled analgesia vs. standard care in participants admitted to hospital from the emergency department with pain due to traumatic injury or non-traumatic abdominal pain. Pain scores were measured hourly for 12 h using a visual analogue scale. Cost-effectiveness was measured as the additional cost per hour in moderate to severe pain avoided by using patient-controlled analgesia rather than standard care (the incremental cost-effectiveness ratio)...
May 26, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28543041/the-added-value-of-cardiac-index-and-pulse-pressure-variation-monitoring-to-mean-arterial-pressure-guided-volume-therapy-in-moderate-risk-abdominal-surgery-coguide-a-pragmatic-multicentre-randomised-controlled-trial
#2
J Stens, J-P Hering, C W P van der Hoeven, A Boom, H S Traast, L E Garmers, S A Loer, C Boer
There is disagreement regarding the benefits of goal-directed therapy in moderate-risk abdominal surgery. Therefore, we tested the hypothesis that the addition of non-invasive cardiac index and pulse pressure variation monitoring to mean arterial pressure-based goal-directed therapy would reduce the incidence of postoperative complications in patients having moderate-risk abdominal surgery. In this pragmatic multicentre randomised controlled trial, we randomly allocated 244 patients by envelope drawing in a 1:1 fashion, stratified per centre...
May 25, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542868/initial-placement-and-secondary-displacement-of-a-new-suture-method-catheter-for-sciatic-nerve-block-in-healthy-volunteers-a-randomised-double-blind-pilot-study
#3
T S Lyngeraa, C Rothe, C Steen-Hansen, M H Madsen, C B Christiansen, A M Andreasen, L H Lundstrøm, K H W Lange
We performed a randomised double-blind pilot study in 16 healthy volunteers to investigate the success rate for placing a new suture-method catheter for sciatic nerve block. A catheter was inserted into both legs of volunteers and each was randomly allocated to receive 15 ml lidocaine 2% through the catheter in one leg and 15 ml saline in the other leg. Successful placement of the catheter was defined as a 20% decrease in maximum voluntary isometric contraction for dorsiflexion of the ankle. Secondary outcomes were maximum voluntary isometric contraction for plantar flexion at the ankle, surface electromyography and cold sensation...
May 25, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542836/promoting-the-use-of-peripheral-nerve-catheters-better-catheter-accuracy-or-more-user-friendliness
#4
EDITORIAL
M Fredrickson
No abstract text is available yet for this article.
May 25, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542800/what-should-we-do-when-traditional-research-fails
#5
EDITORIAL
D Murray
No abstract text is available yet for this article.
May 25, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#6
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28542716/improving-needle-tip-identification-during-ultrasound-guided-procedures-in-anaesthetic-practice
#7
REVIEW
H J Scholten, A Pourtaherian, N Mihajlovic, H H M Korsten, R A Bouwman
Ultrasound guidance is becoming standard practice for needle-based interventions in anaesthetic practice, such as vascular access and peripheral nerve blocks. However, difficulties in aligning the needle and the transducer can lead to incorrect identification of the needle tip, possibly damaging structures not visible on the ultrasound screen. Additional techniques specifically developed to aid alignment of needle and probe or identification of the needle tip are now available. In this scoping review, advantages and limitations of the following categories of those solutions are presented: needle guides; alterations to needle or needle tip; three- and four-dimensional ultrasound; magnetism, electromagnetic or GPS systems; optical tracking; augmented (virtual) reality; robotic assistance; and automated (computerised) needle detection...
May 22, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28510308/satisfaction-is-not-substantially-affected-by-quality-of-recovery-different-constructs-or-are-we-lost-in-statistics
#8
EDITORIAL
C F Royse, S Clarke
No abstract text is available yet for this article.
May 16, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28510285/influence-of-quality-of-recovery-on-patient-satisfaction-with-anaesthesia-and-surgery-a-prospective-observational-cohort-study
#9
V Berning, M Laupheimer, M Nübling, T Heidegger
Patient satisfaction and quality of recovery are important measures of quality. Whether, and to what extent, patient satisfaction is influenced by quality of recovery, however, is not clear. The aim of this study was to evaluate the additional influence of quality of recovery on total patient satisfaction with anaesthesia and surgery. In this prospective cohort study, we used a validated quality of recovery questionnaire and a multi-item patient satisfaction questionnaire. Patients completed the quality of recovery questionnaire pre-operatively and 24 h postoperatively...
May 16, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28493510/comparison-of-reversal-with-neostigmine-of-low-dose-rocuronium-vs-reversal-with-sugammadex-of-high-dose-rocuronium-for-a-short-procedure
#10
E S Choi, A Y Oh, B W Koo, J W Hwang, J W Han, K S Seo, S H Ahn, W J Jeong
Some short procedures require deep neuromuscular blockade, which needs to be reversed at the end of the procedure. Forty-four patients undergoing elective laryngeal micro-surgery were randomly allocated into two groups: rocuronium 0.45 mg.kg(-1) with neostigmine (50 μg.kg(-1) with glycopyrrolate 10 μg.kg(-1) ) reversal (moderate block group) vs. rocuronium 0.90 mg.kg(-1) with sugammadex (4 mg.kg(-1) ) reversal (deep block group). The primary outcome was the intubating conditions during laryngoscopy secondary outcomes included recovery of neuromuscular block; conditions for tracheal intubation; satisfaction score as determined by the surgeon; onset of neuromuscular block; and postoperative sore throat...
May 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28463474/the-height-of-the-cricothyroid-membrane-on-computed-tomography-scans-in-trauma-patients
#11
T Nutbeam, R Clarke, T Luff, D Enki, D Gay
Emergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following a 'can't intubate, can't oxygenate' scenario. It is rarely performed and has a significant failure rate. There is variation in the reported size of the cricothyroid membrane, especially across population groups. Procedural failure may result from attempting to pass a device with too large an external diameter through the cricothyroid membrane. We aimed to determine the maximum height of the cricothyroid membrane in a UK trauma population...
May 2, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28449280/a-randomised-controlled-trial-of-placebo-droperidol-or-ondansetron-to-prevent-nausea-and-vomiting-after-tonsillectomy-in-children-receiving-dexamethasone
#12
P Flubacher, N Fournier, J Cherpillod, F Waridel, M Nydegger, E Albrecht
We tested whether prophylactic droperidol and ondansetron, in combination with a moderate dose of dexamethasone, were equally effective in reducing nausea and vomiting after tonsillectomy in children and that both were superior to saline with dexamethasone. We randomly allocated 300 children to intravenous saline, droperidol 10 μg.kg(-1) or ondansetron 150 μg.kg(-1) , after induction of anaesthesia and the administration of intravenous dexamethasone 250 μg.kg(-1) . The rates (95%CI) of nausea or vomiting within 24 postoperative hours were: 42/91 after saline, 46% (36%-57%); 43/87 after droperidol, 49% (39%-60%); reduced to 18/84 by ondansetron, 21% (13%-32%), p < 0...
April 27, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28444779/a-randomised-controlled-trial-of-propofol-vs-thiopentone-and-desflurane-for-fatigue-after-laparoscopic-cholecystectomy
#13
T Nostdahl, O M Fredheim, T Bernklev, T S Doksrod, R M Mohus, J Raeder
Fatigue may delay functional recovery after day surgery and may be more common after propofol anaesthesia. We randomly allocated 123 participants scheduled for ambulatory laparoscopic cholecystectomy to induction and maintenance of general anaesthesia with propofol or thiopentone and desflurane. Postoperative fatigue was unaffected by the allocated anaesthetic. The combined mean (SD) Identity-Consequences Fatigue Scale of 34.3 (15.1) before surgery increased in the first postoperative week: to 60.4 (21.1) on day 1, p < 0...
April 26, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28439886/lifebox-pulse-oximeter-implementation-in-malawi-evaluation-of-educational-outcomes-and-impact-on-oxygen-desaturation-episodes-during-anaesthesia
#14
V Albert, S Mndolo, E M Harrison, E O'Sullivan, I H Wilson, I A Walker
Pulse oximetry is an essential monitor for safe anaesthesia but is often not available in low-income countries. The aim of this study was to determine whether the introduction of pulse oximetry with training was feasible and could reduce the incidence of oxygen desaturation during anaesthesia in a low-income country. Pulse oximeters were donated, with training, to 83 non-physician anaesthetists in Malawi. Knowledge was tested immediately before and after training and at follow-up. Providers were asked to record the lowest peripheral oxygen saturation (SpO2 ) for the first 100 cases anaesthetised after training...
April 24, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28439874/the-effective-introduction-of-lifebox-pulse-oximetry-to-malawi
#15
EDITORIAL
D A Scott, R McDougall
No abstract text is available yet for this article.
April 24, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28418067/a-case-series-of-vital-signs-controlled-patient-assisted-intravenous-analgesia-vpia-using-remifentanil-for-labour-and-delivery
#16
W L Leong, B L Sng, Q Zhang, N L R Han, R Sultana, A T H Sia
Intravenous remifentanil patient-controlled analgesia can be used during labour as an alternative to epidural analgesia. Adverse effects of opioids, including hypoxia and bradycardia, may lead to maternal morbidity and mortality. We devised an interactive feedback system based on a clinical proportional algorithm, to continuously monitor for adverse effects to enhance safety and better titrate analgesia. This vital signs-controlled, patient-assisted intravenous analgesia with remifentanil used a prototype delivery system linked to a pulse oximeter that evaluated maternal oxygen saturation and heart rate continuously...
April 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28419420/reliability-of-pressure-waveform-analysis-to-determine-correct-epidural-needle-placement-in-labouring-women
#17
I Al-Aamri, S H Derzi, A Moore, M F Elgueta, M Moustafa, T Schricker, D Q Tran
Pressure waveform analysis provides a reliable confirmatory adjunct to the loss-of-resistance technique to identify the epidural space during thoracic epidural anaesthesia, but its role remains controversial in lumbar epidural analgesia during labour. We performed an observational study in 100 labouring women of the sensitivity and specificity of waveform analysis to determine the correct location of the epidural needle. After obtaining loss-of-resistance, the anaesthetist injected 5 ml saline through the epidural needle (accounting for the volume already used in the loss-of-resistance)...
April 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28419411/pressure-waveforms-to-assess-epidural-placement-is-there-a-role-on-delivery-suite
#18
EDITORIAL
R A McKendry, N A Muchatuta
No abstract text is available yet for this article.
April 17, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28407211/long-term-alterations-in-monocyte-function-after-elective-cardiac-surgery
#19
M Zawadka, J Wahome, H Oszkiel, W Y Szeto, B Cobb, K Laudanski
Optimal immunological homoeostasis determines the long-term recovery of patients in the postoperative period. The functional adaptability of monocytes plays a pivotal role in adjusting the host's response to an insult, immunostasis and long-term health, and may help to determine successful recovery. We undertook a longitudinal analysis of the functional adaptability of monocytes in 20 patients undergoing heart surgery with cardiopulmonary bypass, as a model of severe stress. Using each patient's pre-cardiopulmonary bypass data as a baseline, we investigated the characteristics of peripheral blood monocytes' functional plasticity in-vitro before elective bypass, and three months afterwards...
April 13, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28401537/effect-of-prophylactic-placement-of-internal-iliac-artery-balloon-catheters-on-outcomes-of-women-with-placenta-accreta-an-impact-study
#20
S Feng, Z Liao, H Huang
We performed an impact study on the introduction of routine placement of internal iliac artery balloon catheters for the management of haemorrhage during caesarean section in women with placenta accreta. We identified 11 women, with prenatally diagnosed placenta accreta/increta/percreta before this change in practice, who acted as controls, and 30 women who had iliac artery balloons placed. The balloons were inflated in 27 cases. The median (IQR [range]) intra-operative blood loss was 1100 (800-2600 [500-6000]) ml in controls, compared with 1000 (600-2513 [400-15000]) ml in women with iliac artery balloons (p = 0...
April 12, 2017: Anaesthesia
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