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Anaesthesia

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https://www.readbyqxmd.com/read/28703290/the-association-between-peri-operative-acute-risk-change-arc-and-long-term-survival-after-cardiac-surgery
#1
T G Coulson, M Bailey, C M Reid, L Tran, D V Mullany, J A Smith, D Pilcher
Acute risk change has been described as the difference in calculated mortality risk between the pre-operative and postoperative periods of cardiac surgery. We aimed to assess whether this was associated with long-term survival after cardiac surgery. We retrospectively analysed 22,570 cardiac surgical patients, with minimum and maximum follow-up of 1.0 and 6.7 years. Acute risk change was calculated as the arithmetic difference between pre- and postoperative mortality risk. 'Rising risk' represented an increase in risk from pre- to postoperative phase...
July 13, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28696015/strength-of-commonly-used-spinal-needles-the-ability-to-deform-and-resist-deformation
#2
A Pillai, R S Monteiro, S W Choi, S M Yentis, D Bogod
We investigated the strength of commonly used spinal needles in relation to the amount of deformation, and registered forces during standardised testing. We investigated differences between manufacturers for the same length and gauge of Luer and non-Luer needles, and examined the effect of the internal stylet in terms of needle strength. A specialised rig was designed to perform the testing in both the horizontal and axial plane, reflecting common industrial tests and clinical use. Needles from four commonly used manufacturers were used (Vygon, Becton Dickinson, B Braun, and Pajunk)...
July 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28695993/sugammadex-when-should-we-be-giving-it
#3
EDITORIAL
C R Bailey
No abstract text is available yet for this article.
July 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28695980/arterial-to-end-tidal-carbon-dioxide-difference-in-children-undergoing-mechanical-ventilation-of-the-lungs-during-general-anaesthesia
#4
C Onodi, P K Bühler, J Thomas, A Schmitz, M Weiss
Capnography (ETCO2 ) is routinely used as a non-invasive estimate of arterial carbon dioxide (PaCO2 ) levels in order to modify ventilatory settings, whereby it is assumed that there is a positive gap between PaCO2 and ETCO2 of approximately 0.5 kPa. However, negative values (ETCO2 > PaCO2 ) can be observed. We retrospectively analysed arterial to end-tidal carbon dioxide differences in 799 children undergoing general anaesthesia with mechanical ventilation of the lungs in order to elucidate predictors for a negative gap...
July 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28695979/withdrawal-of-treatment-after-devastating-brain-injury-post-cardiac-arrest-pathways-lead-in-best-practice
#5
EDITORIAL
A R Manara, D K Menon
No abstract text is available yet for this article.
July 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28695978/ultrasonographic-gastric-volume-before-unplanned-surgery
#6
G Dupont, J Gavory, P Lambert, N Tsekouras, N Barbe, E Presles, L Bouvet, S Molliex
We aimed to measure gastric antral cross-sectional area with ultrasound and estimate the gastric volume of 300 patients before unplanned surgery, fasted for at least six hours. Measurements were successfully recorded in 263 semi-recumbent patients. The median (IQR [range]) area was 333 (241-472 [28-1803]) mm(2) and the mean (SD) estimated volume was 45.8 (34.0) ml. The area exceeded 410 mm(2) in 92/263 (35%) measurements. Body mass index and morphine administration were associated with larger gastric areas on multivariable linear regression analysis, with beta coefficient (95%CI) 0...
July 11, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28681546/a-national-survey-of-the-effects-of-fatigue-on-trainees-in-anaesthesia-in-the-uk
#7
L McClelland, J Holland, J-P Lomas, N Redfern, E Plunkett
Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Working Time Directive into UK law, and in August 2009 it was applied to junior doctors, reducing the maximum hours worked from an average of 56 per week to 48. Despite this, there is evidence that problems with inadequate rest and fatigue persist...
July 5, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28681420/for-nature-cannot-be-fooled-why-we-need-to-talk-about-fatigue
#8
EDITORIAL
M Farquhar
No abstract text is available yet for this article.
July 5, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28677832/medical-identification-or-alert-jewellery-an-opportunity-to-save-lives-or-an-unreliable-hindrance
#9
REVIEW
S Rahman, D Walker, P Sultan
Medical identification jewellery can convey vital information to emergency responders, but mistakes and ambiguity may lead to misdiagnosis and morbidity. We performed a review of relevant articles retrieved from Pubmed(®) , Embase(®) and Scopus(®) and Google UK Inc. to investigate the commercial availability and issuance of these products. From 84 identified studies, we shortlisted 74 for review. The Google search retrieved 1,090,000 results within 0.57 s (January 2017). We explored 32 websites selling medical alert jewellery in the first five pages of these results...
July 5, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28613004/a-survey-of-uk-peri-operative-medicine-pre-operative-care
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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