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Anaesthesia

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https://www.readbyqxmd.com/read/28613004/a-survey-of-uk-peri-operative-medicine-pre-operative-care
#1
A-M Bougeard, A Brent, M Swart, C Snowden
The majority of UK hospitals now have a Local Lead for Peri-operative Medicine (n = 115). They were asked to take part in an online survey to identify provision and practice of pre-operative assessment and optimisation in the UK. We received 86 completed questionnaires (response rate 75%). Our results demonstrate strengths in provision of shared decision-making clinics. Fifty-seven (65%, 95%CI 55.8-75.4%) had clinics for high-risk surgical patients. However, 80 (93%, 70.2-87.2%) expressed a desire for support and training in shared decision-making...
June 14, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28603907/a-randomised-controlled-trial-evaluating-a-low-cost-3d-printed-bronchoscopy-simulator
#2
T H Pedersen, J Gysin, A Wegmann, M Osswald, S R Ott, L Theiler, R Greif
Low-fidelity, simulation-based psychomotor skills training is a valuable first step in the educational approach to mastering complex procedural skills. We developed a cost-effective bronchial tree simulator based on a human thorax computed tomography scan using rapid-prototyping (3D-print) technology. This randomised, single-blind study evaluated how realistic our 3D-printed simulator would mimic human anatomy compared with commercially available bronchial tree simulators (Laerdal(®) Airway Management Trainer with Bronchial Tree and AirSim Advance Bronchi, Stavanger, Norway)...
June 12, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28603897/in-search-of-consensus-on-ethics-in-airway-research
#3
EDITORIAL
T M Cook, L V Duggan, M S Kristensen
No abstract text is available yet for this article.
June 12, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28603868/pre-operative-brachial-plexus-block-compared-with-an-identical-block-performed-at-the-end-of-surgery-a-prospective-double-blind-randomised-clinical-trial
#4
A Holmberg, A R Sauter, Ø Klaastad, T Draegni, J C Raeder
We evaluated whether pre-emptive analgesia with a pre-operative ultrasound-guided infraclavicular brachial plexus block resulted in better postoperative analgesia than an identical block performed postoperatively. Fifty-two patients undergoing fixation of a fractured radius were included. All patients received general anaesthesia with remifentanil and propofol. Patients were randomly allocated into two groups: a pre-operative block or a postoperative block with 0.5 ml.kg(-1) ropivacaine 0.75%. After surgery, all patients received regular paracetamol plus opioids for breakthrough pain...
June 12, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28585391/understanding-mortality-rates-after-hip-fracture-repair-using-asa-physical-status-in-the-national-hip-fracture-database
#5
A Johansen, C Tsang, C Boulton, R Wakeman, I Moppett
Hip fracture is the most common reason for older patients to need emergency anaesthesia and surgery. Up to one-third of patients die in the year after hip fracture, but this view of outcome may encourage therapeutic nihilism in peri-operative decisions and discussions. We used a multicentre national dataset to examine relative and absolute mortality rates for patients presenting with hip fracture, stratified by ASA physical status. We analysed ASA physical status, dates of surgery, death and hospital discharge for 59,369 out of 64,864 patients in the 2015 National Hip Fracture Database; 3914 (6...
June 6, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28585304/an-analysis-of-the-delivery-of-anaesthetic-training-sessions-in-the-united-kingdom
#6
A Green, K C Tatham, S M Yentis, J Wilson, M Cox
We analysed data from the electronic rota system CLWRota, covering 2,689,962 anaesthetic sessions between 01/01/2014 and 31/12/2015, in 91 UK Trusts, in order to investigate trainees' supervision. There were 8209 trainee attachments analysed, during which 618,695 sessions were undertaken by trainees. The number of supervised sessions per week that trainees worked varied considerably (median (IQR [range]) 2.6 (1.6-3.6 [0-10]) for all grades combined), with senior trainees more likely than junior trainees to be supervised for fewer than the three sessions per week mandated by the Royal College of Anaesthetists...
June 6, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28580657/widening-the-search-for-suspect-data-is-the-flood-of-retractions-about-to-become-a-tsunami
#7
EDITORIAL
J A Loadsman, T J McCulloch
No abstract text is available yet for this article.
June 4, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28580651/data-fabrication-and-other-reasons-for-non-random-sampling-in-5087-randomised-controlled-trials-in-anaesthetic-and-general-medical-journals
#8
J B Carlisle
Randomised, controlled trials have been retracted after publication because of data fabrication and inadequate ethical approval. Fabricated data have included baseline variables, for instance, age, height or weight. Statistical tests can determine the probability of the distribution of means, given their standard deviation and the number of participants in each group. Randomised, controlled trials have been retracted after the data distributions have been calculated as improbable. Most retracted trials have been written by anaesthetists and published by specialist anaesthetic journals...
June 4, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28555748/patient-controlled-analgesia-effective-and-cost-effective-management-of-acute-pain-within-the-emergency-department
#9
EDITORIAL
B Doleman, J P Williams
No abstract text is available yet for this article.
May 27, 2017: Anaesthesia
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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