European journal of anaesthesiology
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Transfusion in the exsanguinating Jehovah's Witness patient--the attitude of intensive-care doctors.
The attitude of a Jehovah's Witness patient refusing a blood transfusion during an exsanguinating episode can raise important ethical problems. Various ethical principles, including the patient's autonomy, the sanctity of life and the dignity of the medical profession can be confronted. A total of 242 doctors, members of the European Society of Intensive Care Medicine, answered a questionnaire indicating that 63% would transfuse in those circumstances. ⋯ Only 45% considered the blood transfusion as appropriate, of whom 25% were unable to define the best option. Doctors from France and Italy more commonly transfuse while those from The Netherlands, the United Kingdom and Scandinavia more commonly withhold transfusion. These data stress the need for a definition of the appropriate medical attitudes towards the patient refusing blood transfusion.
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Randomized Controlled Trial Clinical Trial
Is the diagnosis of significant residual neuromuscular blockade improved by using double-burst nerve stimulation?
Although DBS is more sensitive than TOFC, manual assessment of DBS fade can only detect residual paralysis at TOF ratio < 0.7.
pearl -
Randomized Controlled Trial Clinical Trial
Awakening and recovery of simple cognitive and psychomotor functions 2 h after anaesthesia for day-case surgery--total intravenous anaesthesia with propofol-alfentanil versus thiopentone-alfentanil.
Fifty-seven patients undergoing minor out-patient gynaecological procedures were allocated to one of two total intravenous anaesthesia regimes: propofol and alfentanil or thiopentone and alfentanil. Diazepam was given orally as premedication. ⋯ The time to opening of eyes and orientation was equal in both groups, as was the recovery of the tested cognitive and psychomotor functions after 2 h, when the score in both groups had returned to baseline. We conclude that the use of propofol instead of thiopentone for shorter surgical procedures gives no advantage as regards length of stay in hospital.
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Comparative Study Clinical Trial Controlled Clinical Trial
Spontaneous EMG activity for detection of arousal during general anaesthesia--comparison between recordings from frontal and neck musculature.
Monitoring of the spontaneous electromyographic activity of the frontal muscles (FEMG) is used for detection of impending arousal during general anaesthesia. Since the irritation caused by an endotracheal tube in situ might enhance the sensitivity of neck muscles in detecting arousal, EMG recordings from sternocleidomastoid muscles (NEMG) were compared to FEMG recordings under five different clinical conditions with 10 patients in each group. ⋯ The results thus support our initial hypothesis and favour the use of neck muscles for monitoring. This, however, does not allow simultaneous recording of EEG through the same electrodes.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intrapleural bupivacaine analgesia after thoraco-abdominal incision for oesophagectomy.
Intrapleural bupivacaine administration is said to produce good analgesia for the pain induced by a subcostal incision. However, reports of its efficacy after thoracotomy are conflicting. The goal of this study was to compare the analgesia produced by intrapleural administration of bupivacaine after oesophagectomy using a thoraco-abdominal incision with that obtained from intrapleural saline. ⋯ Plasma bupivacaine concentrations on Day 1 after the first intrapleural bupivacaine injection were less than 350 ng ml-1; on Day 4 after the last injection they were less than 1300 ng ml-1. In conclusion, intrapleural administration of bupivacaine produces effective analgesia after oesophagectomy performed with a thoracoabdominal incision. The technique is easy to perform and is safe.